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Eli Petrovich
Mrs. Meeker
AP Literature
20 October 2016
Dry Needling
Dry needling is a form of neuromusculoskeletal therapy that utilizes a needle to stimulate
connective and muscular tissue deep to the skin. It has been used since the 1940s; when
injections into sensitive parts in muscle were first proposed. Modern Dry Needling is an
intervention tool developed approximately 40 years ago that led to sudden nationwide interest
about ten years ago. It is a popular method of therapy due to its extremely low (.04%) risk of
after-effects in comparison to over-the-counter medication (.137%). (Jones, 2015) Dry needling,
within the scope of Physical Therapist practice, to treat neuromusculoskeletal pain is one of the
largest issues facing the Physical Therapy field. Today, controversy surrounds the topic, and in
some states only licensed acupuncturists may practice dry needling; restricting physical
therapists duties. If a physical therapist can meet and uphold acupuncturist standards for dry
needling, then they should be able to perform that task.
Those who believe dry needling is not within the scope of practice argue that physical
therapists do not possess the necessary education and training to allow them to practice dry
needling. The National Center for Acupuncture Safety, for example, sent letters to the Federation
of State Boards of Physical Therapy, American Physical Therapy Association, Food and Drug
Administration, Boards of Physical Therapy, boards of Chiropractic, and boards of naturopathy
questioning the legality of dry needling. NCAS also challenged board rulings that accepted dry
needling into the physical therapy scope of practice. The Federation of State Boards of Physical

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Therapy replied to NCAS with the following statement: "NCAS argued that state boards'
determination that TPDN (Trigger Point Dry Needling) is within the Physical Therapy scope of
practice are inconsistent with the requirements for acupuncture needles under the FDC Act, 21
U.S.C. 301 et seq., and U.S. FDA implementing regulations. A legal analysis performed by
FSBPT found that the allegation in the NCAS letter was without merit. APTA's independent legal
analysis also said it was without merit. States, not FDA, determine who is a qualified practitioner
to use acupuncture needles." (Adrian, 2016) The Federation of State Boards of Physical Therapy
then stated that Doctor of Physical Therapy programs provides almost 90% of the education
requirements needed to practice dry needling. Due to the possession of this knowledge, physical
therapists whose states require additional education, usually only need fifty-four hours of
advanced, post-graduate training for dry needling. These 55 hours of post-licensure training are
solely related to knowledge of needle technique. In states it was otherwise not allowed, many
physical therapists have already completed the process of passing the requisite education and
training that allows them to practice dry needling. (Adrian, 2016)
Physical therapists are specifically authorized to practice dry needling in 25 states.
However, all states have limitations or requirements to perform it. 42 states have either given no
opinion or determined Functional Dry Needling (FDN/TDN) to be within the Scope of Practice
for Physical Therapists. Doctors are working with their state Physical Therapy boards to rule for
Dry Needling in the remaining eight states California, Florida, Hawaii, Illinois, New York,
Pennsylvania, South Dakota, and Washington. A primary reason for the physical therapy scope of
practice to lack dry needling in California is to ensure job security for acupuncturists.
Acupuncturists train for months and sometimes years to perfect their profession, and have
communicated their concerns to the California Physical Therapy Board. The Florida physical

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therapy practice act explicitly states that any act of penetrating the skin is dry needling and is
therefore not within the scope of physical therapy. Hawaii is another one of the few states that
are currently ruling against physical therapists performing dry needling; for the same reason as
Florida. (Jonas, 2016) In Illinois, there were concerns about a lack of standards for physical
therapists when dry needling is involved. The Illinois Department of Financial and Professional
Regulation originally said that Dry Needling was included in the physical therapy scope of
practice, but later this was reversed by a department lawyer. The reasoning behind this was that
all Physical Therapy procedures listed in the state legislature are noninvasive. (Rockar, 2014) In
2007 it was ruled that a temporary ban on dry needling by physical therapists will take place in
New York. Many Physical Therapists and Physical Therapist affiliated companies have attempted
to communicate with the New York State Physical Therapy Board without success. (Kinetacore,
2016) Pennsylvania's State Physical Therapy Board declared, in 2011, that dry needling is not
within the scope of practice for Physical Therapists. In 2014 the board discussed the topic again
and reached the same conclusion. (Blackburn, 2011) Unlike its northern relative, South Dakota
does not currently allow Physical Therapists to perform dry needling. However, the South
Dakota state physical therapy board is developing an advisory plan to explore it further as an
option.(Jonas, 2016) The Washington Eastern Medicine Association delivered a cease and desist
letter to Kinetacore to stop a continuing education course. "South Sound Acupuncture
Association filed a lawsuit against a CE instructor and Physical Therapists who attended the CE
course arguing that participants who are not licensed to practice acupuncture or medicine pose a
significant threat to public health. The lawsuit alleged that the CE company was illegally
practicing acupuncture in Washington." The King County Superior Court determined that
Physical Therapists were not allowed to practice dry needling in the state.(Adrian, 2014)

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The West region of the United States is made up of thirteen states, ten of which recognize
Dry Needling as within the practice of physical therapy. Alaska allows Dry Needling, but
licensed physical therapists are required to complete a day of additional education approved by
the APTA to perform it. (Kinetacore, 2016) Arizona is currently establishing rules and standards
that clarify what education and training are required for physical therapists to practice dry
needling in the state. Arizona Senate Bill 1154 added dry needling to the scope of practice for
physical therapists; "On or before July 1, 2015, the board of physical therapy shall establish by
rules professional standards of care and training and education qualifications for the performance
of dry needling for therapeutic purposes. A physical therapist who was performing dry needling
as a therapeutic modality before January 1, 2014, may continue to perform dry needling until the
board adopts standards of care and training and education qualifications pursuant to this section
and then is required to meet the standards and qualifications adopted by the board." In the state
of Colorado, Dry Needling is included in the Physical Therapy scope of practice. (Brewer, 2015)
Colorado has recognized Dry Needling as a practice for Physical Therapists since 2005.
However, recently Colorado has been producing more standards and guidelines for physical
therapists to include more education and training. It is required in Rule 211 that, "A Physical
Therapist must have the knowledge, skills, ability, and documented competency to perform an
act that is within the Physical Therapist's scope of practice. Except as part of a course of study
on dry needling pursuant to paragraph D.2 of this Rule, a Physical Therapist shall not perform
dry needling unless competent to do so." The Colorado Physical Therapy Association also states
that for a practitioner to be accepted into a Dry Needling program, they must have two full years
practicing as a Physical Therapist. (Hickenlooper, 2014) Montana announced in 2011 that Dry
Needling would, without further educational requirements, be included into Physical Therapist's

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practices. New Mexico has issued statements confirming that Dry Needling is included under
the Physical Therapy Practice. Nevada ruled for Dry Needling in the scope of physical therapy in
2012. (Kinetacore, 2016) Oregon has advised physical therapists in the state not to perform dry
needling since 2009. The state board believes that Dry Needling is likely within the scope of
practice, but advises against it until requirements are put into place. (Jonas, 2016) Utah recently
recognized dry needling specifically into its practice act. Utah's state legislature requires 2+
licensed years and additional training for physical therapists to practice dry needling. Wyoming
determined in 2009 that dry needling is within guidelines and scope of practice for those physical
therapists with licenses. (Kinetacore, 2016)
Ten of the twelve states in the Midwest region allow physical therapists to perform dry
needling on patients. Iowa's physical therapy board determined that physical therapists may only
practice dry needling if they demonstrate ability in the performance of the procedure and have
taken classes in dry needling. The Iowa Physical and Occupational Therapy Board stated that it
"does not appear to be prohibited."(Jonas, 2016) In 2013, Indiana expressed support for their
physical therapists to use dry needling. In 2015 the Kansas Board of Healing Arts announced that
they had not reached a decision and therefore have no opinion to the Kansas Physical Therapy
Association. "Following the return of a "no opinion" by the healing arts board on June 13, 2015,
it appears that qualified physical therapists in Kansas may perform dry needling as part of
physical therapy services. The board carefully stated its opinion in an open public meeting and
specifically left it to the legislature to change the law if it desires. As with all services we provide
to our patients/clients, we must first become competent before we begin to practice them. KPTA
quickly established and communicated best practice standards for recommended education and
training for its members. KPTA's role in establishing standards necessary to protect the public

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has been validated through legal consultation."(Kinetacore, 2016) Michigan, Minnesota, and
Missouri are all states that have offered no opinion on whether to accept dry needling into the
scope of physical therapy. Nebraska has not released much information on the topic, but the
Nebraska Attorney General stated that Dry Needling in his opinion is well within the scope of
practice for Physical Therapists. North Dakota allows Physical Therapists to perform
Intramuscular Manual Therapy (Dry Needling) in their state as of 2014. For nine years Dry
Needling has been practiced by licensed Physical Therapists in Ohio. Wisconsin released the
following statement," The Board considers trigger point dry needling as within the scope of
practice of physical therapy provided that the licensed physical therapist is properly educated and
trained."(Jonas, 2016)
The Southern region of the United States has the highest acceptance of dry needling. Out
of the sixteen states in the region only one state, Florida, doesnt allow physical therapists to
perform dry needling. In Arkansas, it was determined that dry needling was a necessary tool
within the scope for physical therapists to practice in the state. However, for physical therapists
in Arkansas to gain their license to practice dry needling, they have to complete two CEUs
(Continuing Education Unit) in every biennium (2 year period). 1 CEU is ten contact hours of an
accredited course or program. (Kinetacore, 2016) With the passing of House Bill 359, Delaware
added dry needling to the Physical Therapy practice act. This law mentions that additional
training as determined by the Physical Therapy Board may be required. "Nothing in this chapter
shall be construed to limit the practice of physical therapy by Physical Therapists as is currently
being practiced or determined by the Board so long as such practice does not include surgery and
the medical diagnosis of disease. Advanced services may require advanced training, as
determined by the Board's rules and regulations, to assure the licensee meets the accepted

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standard of care." The language used in this passage allows Delaware to have some flexibility at
the board level and consider issues regarding future issues. (Adrian , 2014) In the state of
Georgia the TDN (trigger point dry needling) technique is currently approved. In 2012 the
Georgia physical therapy board set a minimum requirement of 50 hours of face-to-face training
in 6 months to receive admittance to perform dry needling. An exception to this is if a physician
has been practicing for two or more years they are given a year and nine months to fulfill this
requirement. (Jonas, 2016) Currently, Kentucky accepts dry needling for physical therapists to
practice. Louisiana requires 50 hours of instruction for physical therapists to practice dry
needling. Maryland has had a lot of positive feedback in letters from patients and constituents
who were healed through Dry Needling. On the downside, acupuncturists still insist that physical
therapists should not be allowed to utilize dry needling.(Adrian, 2014) In 2012 Mississippi's
Physical Therapy Board announced its decision to require 50 hours of education for a Physical
Therapist to perform dry needling.(Kinetacore, 2016) North Carolina and South Carolina both
approved Dry Needling for Physical Therapists. However, North Carolina instituted education
requirements of 54 contact hours. "the Board believes physical therapists can continue to
perform dry needling so long as they possess the requisite education and training required by
NCGS 90-270.24(4), but there are no regulations to set the specific requirements for engaging in
dry needling." (Jonas, 2016) Oklahoma only approves fundamental dry needling to Physical
Therapists. They must pass a level 1 functional dry needling course. Governor Haslem of
Tennessee officially issued a legislation formally stating that dry needling is included under
physical therapy. Texas has not revealed much information, but it approves dry needling to be
performed by licensed physical therapists. Virginia supports dry needling by physical therapists
as long as they have 54 hours of extended education. However, a recent letter from the Virginia

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Physical Therapy Board states that 54 hours of education is not a requirement, but a
recommendation. In West Virginia licensed physical therapists that have completed the required
27 hours of continued education, may perform dry needling. (Kinetacore, 2016) In Washington
DC dry needling is within the scope of physical therapy. However, dry needling is only allowed
if it is practiced under rules enforced under section 6716 of the Municipal Regulations for
Physical Therapy. Also, Section 6715.2 says that physical therapists may practice dry needling
only if section 6716 isn't ignored. (Jonas, 2016)
The smallest region, the northeast, only has nine states; seven of which allow dry
needling. Massachusetts doesnt offer much information on the legality of dry needling.
However, Doctor Moulison, a physical therapist with Orthowell Physical Therapy in
Massachusetts said the following in response to a question about certification; Yes, I am
certified and have been performing dry needling for the past two years. In order to perform
trigger point dry needling in the state of Massachusetts, training is required. I am certified
through the American Dry Needling Institute. I have a strong knowledge of anatomy and 2 years
of experience successfully performing this technique. One can infer from this that although
there is no official status of dry needling in Massachusetts, physical therapists in the state take
certification classes in order to relax concerned patients. (Moulison, 2016) New Hampshire
released the following statement on trigger dry needling; Please be advised that dry needling is
considered in the scope of practice for physical therapy. However, the Governing Board would
like to stress that one should never practice procedures beyond their personal competency, and
specific training is strongly recommended. (Soucy, 2002) New Jersey requires twenty-five
continued education hours in order to be dry needle certified. Maine's physical therapy board
voted unanimously to allow physical therapists to treat patients with dry needling. Rhode Island

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ruled for Dry Needling in 2012. Vermont has not issued a formal status on dry needling, so
physical therapists in the state may freely perform it until legislation limiting it is signed into
law. (Kinetacore, 2016)
Trigger Dry Needling is sometimes said to be a placebo, and some studies have produced
results showing that punctures have caused structural damage to muscles. There is a scarcity of
evidence that Trigger Dry Needling is useful. Some physical therapists believe solely in Dry
Needling and may use it against primary physician's wishes. This was mentioned in a physical
therapy article saying, "many pleas by physicians to NOT use TDN on their patients and yet the
PT's go on anyhow since they have an anchoring bias to TDN and an ignorance to referral
sources demands." Many Physical Therapists go to a weekend course in dry needling to get a leg
up on the competition, raising concern that they may be unqualified to perform it. (Benz, 2014)
Another cause for concern is that damage has been recorded in some tests after performing dry
needling on patients experiencing musculoskeletal pain. One test provided the following
statements; "After 15 repeated punctures in the LAL muscle, we analyzed structural changes at
several time points. Muscular injuries were quite separated, and we could only observe a single
muscle injury by field at low magnification." and "connective tissue was injured." However,
over time this microscopic tissue damage was reported to have been fixed after muscular
regeneration. Through these results, one can also see how a conclusion can be reached that
intramuscular damage occurs, but this damage is microscopic and usually lasts a few days.
Nerve Damage has also been reported from performing dry needling on skeletal muscles.
"Performing DN in skeletal muscles could injure the intramuscular nerves. In our samples, we
did not see more than one injury in the same intramuscular nerve branch." This nerve damage is
temporary, and after three days neuromuscular activity was back to normal. (Domingo, Mayoral,

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Monterde, Santafe, 2013) These results have shown that contrary to popular belief, dry needling
does produce intramuscular nerve damage. The tissue damage caused by Dry Needling does not
interfere with muscle recovery and does not appear to cause permanent damage. The Nerve
damage is also temporary, as it returns to normal after three days. These experiments would have
to be tested hundreds of time for it to be accepted as a legitimate study.
It is a fact that some physical therapists blindly go to dry needling before trying other
options. CAPT Richard Schumway DPT (USCG Ret.) a physical therapist in Tucson, Arizona
uses it quite often, and his colleagues did not use it nearly as much. However, Dr. Schumway did
not solely believe in dry needling because he found that stretching is the major answer to most
muscular problems. "People sometimes request dry needling without recommendation, and a
placebo effect then takes place where their mind persuades the body that it is fine, and then
injury recurs. A lazy physical therapist can abuse dry needling; it is a practice lasting around 20
minutes that requires little effort."(Schumway, 2016)
There has been considerable public support seen for dry needling, helping to strengthen
the argument to allow the practice nationwide. Surveys shown on the Arizona physical therapy
board website found that a majority of people are satisfied with dry needling as a mode of
healing. "Research supports that dry needling improves pain control, reduces muscle tension,
normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an
accelerated return to active rehabilitation." (Hill, 2016) This quotation and ones like it could be
used to calm anyone who was previously worried about its effects and whether or not they
should use it. "Both active and passive ROM of shoulder internal rotation, and the pressure pain
threshold of MTrPs on the treated side were significantly increased." (Hsieh, Kao, Kuan, Chen,
Chen, Hong, 2007) This excerpt, from a widely viewed study, explains the use of dry-needling

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and its accuracy in the results it produces. It informs readers that this is a safe procedure when
performed by a trained professional, and has minor consequences. "Five years ago I primarily
was sitting in a wheelchair. Today I'm regularly walking 3 miles. The difference dry needling has
made in my life hasn't simply been physical, but also social and psychological. I feel more
hopeful and less depressed. I can do so much more that I could do before. The effects have been
cumulative." (Ries, 2015) This is a prime example of someone who has been helped through dry
needling there are many similar stories online.
With policy adjustments allowing the practice of dry needling to be implicated in all
physical therapy practices, many humans would benefit by receiving better recovery from
muscle pain. In many studies that have done this, it has been observed that although it is
minimal, temporary neuromuscular damage, the benefit of muscle recovery outweighs the cost.
This practice should be more widely used but not used as a first choice. If physical therapists
were able to practice dry needling with education requirements, then it would also be a
compromise and satisfy those who question the eligibility of them. The common goal between
either argument is to protect the well-being of the patients being treated. Physical therapists want
to help more people recover by utilizing a safe practice and want those people to return to their
regular daily activities with the same abilities as before the injury. Those who are against
physical therapists using dry needling are doing it to reduce the risk of neuromuscular
complications and because they want to make sure those performing dry needling are educated in
practice through educational requirements.

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Works Cited Page

Adrian, Leslie. "Dry Needling And Physical Therapy Pdf - Ebookbrowse." FSBPT. N.p., Fall 2014.
Web. 21 Aug. 2016.
Ares Domingo, Orlando Mayoral, Sonia Monterde, and Manel M. Santaf. "Neuromuscular Damage
and Repair after Dry Needling in Mice." Evidence-Based Complementary and Alternative
Medicine 2013 (2013): 1-10. Web. 21 Aug. 2016.
Benz, Larry. "Trigger Point Dry Needling (TDN) Is Not #Physicaltherapy."Evidence in Motion. N.p.,
16 Mar. 2014. Web. 21 Aug. 2016.
Blackburn, Thomas A. Letter. 9 Sept. 2011. Kinetacore. N.p., 2011. Web. 21 Aug. 2016.
Brewer, Jan. "Board Action on Dry Needling; SB 1154; Rules | Arizona ..." PT Board. N.p., 1 July

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2015. Web. 21 Aug. 2016.

Hickenlooper, John W. "State Physical Therapy Board." Kinetacore. N.p., 21 Mar. 2014. Web. 21
Aug. 2016.
Hill, S. "Alliance Physical Therapy in Chattanooga :Our Services ..." Alliance Physical Therapy.
N.p., 2016. Web. 21 Aug. 2016.
Jonas. "NEW DEVELOPMENTS AND RULINGS ABOUT DRY NEEDLING BY U.S. STATE
BOARDS." Myopainseminars. N.p., 2016. Web. 21 Aug. 2016.
Jones, Emilie, Leslie Adrian, Joseph Caramagno, Justin Purl, and Lorin Mueller. "Sunrise Review Physical Therapist Scope of Practice ..." DOH. N.p., 06 Jan. 2014. Web. 21 Aug. 2016.
Moulison, Katie. "Trigger Point Dry Needling - OrthoWellPT." Trigger Point Dry Needling. N.p.,
2016. Web. 21 Aug. 2016.
Ries, Eric. "Dry Needling: Getting to the Point - APTA." PT in Motion. N.p., May 2015. Web. 21
Aug. 2016.
Rockar, Paul. Letter to Jay Stewart. 7 May 2014.
Http://myopainseminars.com/wp-content/uploads/2015/03/illinois_reply_2014.pdf. N.p., n.d.
Web. 21 Aug. 2016.
Schumway, Richard. "Physical Therapy." Personal interview. 15 July 2016.
Soucy, Veronique C. "State of New Hampshire Office of Allied Health Professionals." Letter. 1 Mar.
2002. Kinetacore. N.p., n.d. Web. 21 Aug. 2016.
Yueh-Ling Hsieh, Mu-Jung Kao, Ta-Shen Kuan, Shu-Min Chen, Jo-Tong Chen, and Chang-Zern
Hong. "Dry Needling to a Key Myofascial Trigger Point May Reduce the Irritability of
Satellite MTrPs." American Journal of Physical Medicine & Rehabilitation 86.5 (2007): 397403. Web. 21 Aug. 2016.

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