Agencies | Governor
Virginia Regulatory Town Hall
Agency
Department of Health Professions
 
Board
Board of Physical Therapy
 
chapter
Regulations Governing the Practice of Physical Therapy [18 VAC 112 ‑ 20]
Action Practice of dry needling
Stage Proposed
Comment Period Ends 7/26/2019
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7/25/19  10:16 pm
Commenter: Nathan Pierce PT, DPT

A needle is simply a tool. I support Physical Therapists and Dry Needling
 

 

At first glance, It may be convenient and almost logical to equate trigger point dry needling to acupuncture due to the tool being used; the needle.  However, when you look deeper, you will quickly realize that this is not the case.  A tool does not define a practitioner.  Their training and knowledge base will define who they are as a practitioner.  This is precisely why Physical Therapists do not claim, whatsoever, that they are performing acupuncture simply because they are inserting a fine monofilament needle into the patient's body.  

Similarly, an Orthopedic Surgeon is not classified as a Neurosurgeon simply because of the instrument he or she uses to make the first incision.  He or she is classified by their successful completion of their vast training, knowledge-base and board certification.  They are both highly skilled and specialized in their own unique method of surgical intervention.  The tool that they use to make the first pass in that patient's skin is simply to allow them access to that patient's body, which will ultimately allow them to perform their necessary duties as surgeons.  

This is the same for acupuncture and dry needling.  The similarity starts and ends with the tool; the needle.  The needle simply allows us access to that patient's soft tissue so that we can deliver a more precise, targeted delivery of a neurophysiological reset to that tissue.  This could be to improve range of motion, decrease pain, decrease neurological facilitation and hypertonicity (resting tension) of that muscle with an overall goal to improve their function.  A physical therapist will use their very strong knowledge of anatomy, neurophysiology, cellular physiological responses and knowledge of relevant research/evidence-based practice/clinical prediction rules, etc as their guiding principles, which may lead them to the decision to implement dry needling in their patients treatment plan.  These are well research-based standards of Western Medicine principles that any Health Care practitioner can appreciate and understand.  At no time do we use Eastern Medicine or Traditional Chinese Medicine to help guide our thinking, thought process, diagnosis, or treatment.  

Another example would be Physical Therapists performing wound care; specifically sharp debridement of a non-healing wound.  In addition to dry needling, I have first hand experience in performing wound care as a physical therapist.  
Wound debridement can be performed by using autolytic, enzymatic OR SHARP debridement.  Sharp debridement of a wound is performed by using a scalpel or scissors.  Just because we use a scalpel and/or scissors to eliminate nonviable tissue or to stimulate the wound bed,  we are NOT classified as surgeons.  In fact, this invasive procedure has been in our scope of practice since 1917 during World War 1!

I can tell you that I have had countless patients stop taking prescription drugs for migraine headaches and tension headaches after receiving trigger point dry needling.  Many of these patients had tried everything, including botox and acupuncture.  

Am I saying dry needling is superior to acupuncture or botox?  Of course not.  What I am saying is that they are very different.

I can also tell you that I have had many patients swear by acupuncture to alleviate seasonal allergies and has allowed them to get off of over-the-counter and prescription allergy medication.  

Am I saying acupuncture is superior to dry needling?  Of course not.  What I am saying is that they are very different.  In fact, I encourage patients to try acupuncture!  Why?  Because neither acupuncture nor dry needling (or any other medical practice) are a "catch all, cure all, silver bullet."  

Lastly, I want to address the "lack of training," argument I have seen countless times on this forum.  I can only speak for the field of Physical Therapy.  Physical Therapists undergo intense, rigorous training in gross anatomy, which includes extensive cadaveric dissection.  For this reason alone, this more than qualifies us to be able to perform procedures like wound care and dry needling.  Our thorough understanding of three dimensional anatomy and the intricacies of vessels, nerves, organs and their locations is second to none.  It is this knowledge that makes us very well suited to preserve public health and safety when performing dry needling.  But even so, we are still required to undergo extensive and thorough post-graduate training prior to performing dry needing in our clinical practice.  I think this is a good thing.  We already have the anatomical knowledge; the post-graduate coursework/training is simply to teach needle manipulation skills.  Therefore, the argument that Physical Therapists are performing dry needling after only "weekend courses" is highly inaccurate and very misleading.  Physical Therapists have a minimum of a Master's Degree Graduate education while most now have their Doctorate.  

I think it is very important to distinguish the two (acupuncture and dry needling).  Each field should be advocating for their own profession so that the patient is well-informed regarding their treatment options.  Because in the end, wouldn't you want your loved ones to have access to and the freedom to choose the treatment which fulfills their wants and needs? 

For the detailed reasons cited about, I strongly support physical therapists performing dry needling

 

 

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