FACT SHEET DRY NEEDLING

A Public Health Issue in Massachusetts

On June 28, 2012, the Board of Registration of Allied Health Professionals, the MA regulatory board for physical therapy, entered a motion stating that dry needling is within the physical therapy scope of practice. Due to pressure from the Acupuncture and Oriental Medicine Society of MA, this motion was tabled on July 26, 2012, pending further discussion with the Committee on Acupuncture, the MA regulatory board for acupuncture.
BACKGROUND In April, 2011, the Board of Registration of Allied Health Professionals first began to consider whether dry needling for intramuscular therapy is within the scope of practice of physical therapists in Mass-achusetts. At that time, the Acupuncture and Oriental Medicine Society of Massachusetts (AOMSM) collected and presented position papers from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) the American Association of Acupuncture and Oriental Medicine (AAAOM), the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM), and the New England School of Acupuncture (NESA) supporting the position that dry needling is acupuncture. On June 22, 2011 the Board of Registration in Medicine, Committee on Acupuncture (COA) submitted its opinion that dry needling is acupuncture and that acupuncture can only be practiced in Massachusetts by licensed acupuncturists and licensed physicians. WHAT IS ACUPUNCTURE? Acupuncture is the subcutaneous insertion of solid filiform needles into either meridian points or non-meridian tender points, called ashi points, to create a therapeutic effect. WHAT IS DRY NEEDLING? The American Physical Therapy Association defines dry needling for intramuscular therapy as an invasive technique used by physical therapists (where allowed by state law) to treat myofascial pain that uses a dry needle without medication or injection, which is inserted into areas of the muscle known as trigger points. A trigger point describes a taut band of skeletal muscle located within a larger muscle group. Trigger points can be tender to the touch and can refer pain to distant parts of the body. DRY NEEDLING IS AC UPUNCTURE Both the AAAOM and the CCAOM have examined the practice of dry needling and found it to be consistent with and synonymous with the practice of acupuncture. The World Health Organization (WHO) defines trigger points as a subset of acupuncture points. Dry needling for intramuscular therapy is a retitling and repackaging of a historically documented subset of acupuncture known as ashi point needling. In a national survey, 82% of acupuncturists use trigger/ashi points for treating musculoskeletal pain. The #1 reason patients seek out acupuncture treatment is musculoskeletal pain. DRY NEEDLING NO COMPETENCY STANDARDS Acupuncturists are required to complete 2500 hours of education in acupuncture theory, methodology and supervised clinical training at an accredited school, pass the national certification examinations for acupuncture and complete an assessment-based clean needle technique certificate.These are rigorous, nationally recognized standards. Acupuncturists in Massachusetts are licensed under the Board of Registration in Medicine Committee on Acupuncture. Subcutaneous needling is not part of existing professional competencies for physical therapists. There is no required curriculum for teaching dry needling and no validly determined minimum requirements for safe practice. Physical therapists do not have to complete any assessment for the safe and competent practice of dry needling. The public health implication of this is that there is no way to assure that physical therapists using dry needling for intramuscular therapy are providing the public with a safe and effective therapeutic treatment. Furthermore, to have a new rule on dry needling that lacks any professional standards would directly contradict the licensing requirements that already exist in Massachusetts regulating the practice of acupuncture. It is not in the public interest to have two professions doing the same thing, one profession with years of training and clearly established national standards for competency, the other with minimal training and no national standards. DRY NEEDLING CIRCUMVENTING ESTABLISHED RULES Using the term dry needling is clearly an effort to redefine identical medical procedures and thereby circumvent or obscure established rules and regulations regarding practice. Within the section of Massachusetts General Law that defines the practice of acupuncture (Part I, Title XVI, Chapter 112, Section 162) only licensed acupuncturists and physicians are allowed to do subcutaneous needling, although physical therapists may perform transcutaneous procedures: Nothing contained herein shall prevent physical therapists from practicing transcutaneous (emphasis added) nerve stimulation, the stimulation of muscle contractions for the purpose of diagnosis or rehabilitation, or other techniques in the context of standard Western Medical Procedure and neither defined as nor held out to be acupuncture. Nothing contained herein shall prevent licensed physicians from practicing acupuncture. Currently in Massachusetts, a physical therapist who wants to do acupuncture must also be licensed as an acupuncturist. It is in the public interest to keep it this way it guarantees that the citizens of Massachusetts receive safe, effective, high quality health care.

www.aomsm.org