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Physical Therapists Want to Give Their Patients the Dry Needle — Again

Legislation would allow PTs to expand their practice to include pain-relief technique currently limited chiefly to acupuncturists

dry needling

Physical therapists have relaunched a campaign to add "dry needling" to their list of services, just five months after New Jersey officials ruled the increasingly popular pain-relief technique was not within their professional scope of practice and should be left to acupuncturists.

On Thursday a Senate committee is scheduled to consider legislation that would expand the list of licensed physical therapy treatments to allow these professionals to legally offer the practice, a technique that is similar to acupuncture and involves using small needles to pierce the skin and stimulate "trigger points" in muscles.

Acupuncture, based on ancient Chinese principles, involves using these needles in many of the same regions of the body to activate nerve impulses to reduce pain or address other conditions, including complex issues like depression, addiction, and obesity. (Both procedures involve needles that are hollow-tipped but "dry," in that they do not contain any injections.)

Some physical therapists had been offering the treatment for nearly a decade, as part of an effort to offer drug-free relief to more patients. The practice was limited to a few hundred of the than 10,000 licensed PT's in the Garden State, according to professionals, but had a big impact on individuals receiving the treatments.

Public-safety concerns

But acupuncturists and other providers raised public-safety concerns with state regulators — alleging that dry needling is essentially unlicensed acupuncture — and last year New Jersey officials ordered physical therapists to end the practice by September. The decision was based on a legal opinion from then-Attorney General Christopher Porrino, who said the law did not permit physical therapists to pierce the skin.

Former Gov. Chris Christie also signed legislation that updated that scope of practice law in July, expanding the work physical therapists can do to include the diagnoses and treatment of balance disorders, wound care, and assisting patients with general health and wellness goals. But the measure he approved did not address dry needling.

The status quo could shift if the state adopts the new legislation, introduced in early January by Sen. Nellie Pou (D-Passaic) and Sen. Richard Codey (D-Essex), which would explicitly permit dry needling among physical therapists with two years general experience and documented training in the practice. Pou chairs the Commerce committee, which is scheduled to hear the bill Thursday; she declined to comment on the proposal late Tuesday.

As drafted, the measure (S-431) seeks to differentiate between dry needling and acupuncture, requires patients to provide written consent, and requires providers to clearly post a sign that must read, among other things: "Dry Needling Technique Should Not Be Confused with an Acupuncture Treatment Performed by a Licensed Acupuncturist."

Backdoor route

Acupuncturists — who number around 1,000 in New Jersey — are concerned about what they see as a backdoor route to expanding a practice they believe overlaps greatly with their own profession, but without requiring the same training requirements.

Jason Sargis, an acupuncturist who is president of the New Jersey Association of Acupuncture and Oriental Medicine, stressed that state licensing requirements currently permit only three professions to perform both internal and external therapies: acupuncturists, medical doctors, and dentists. Invasive procedures are not part of the scope of practice for physical therapists, he said.

"To allow a physical therapist to practice internal therapies is a huge jump that cannot be justified by their education," Sargis said. "Physical therapists are not medically qualified to practice internal modalities; allowing them to do so is a public health concern and an unjustifiable jump in scope."

Sargis noted that acupuncturists must receive at least 2,500 hours of professional training, on top of their undergraduate and graduate education; while physical therapists also undergo the same basic education, the legislation calls for a minimum of 54 hours of dry-needling training in order to qualify.

Physical therapists, on the other hand, insist that the current restrictions only harm patients, especially now, as more people are eager for opioid-free pain relief. They stress that dry needling is distinct from acupuncture and not something exclusive to physical therapists, but a technique that any trained professional can learn.

"Access (to care) is definitely a concern" for patients, noted Paul Vidal, a PT who is president of the American Physical Therapy Association of New Jersey. "This is a modality or treatment tool we can effectively use to deal with pain," he added. "We're moving forward with a legislative solution to make sure that physical therapists who are qualified can perform dry needling."

This is not the first time physical therapists have sought to expand their practice to include dry needling via legislation. While the measure Christie signed in July did not address the technique, it was based on bills from previous legislative sessions that did include language to permit PTs to engage in the practice.

But those versions of the bill failed to advance, in part because of significant opposition from acupuncturists and other medical providers who are concerned about the encroachment of physical therapists on their own fields of practice. Once the controversial clause was removed, the measure passed both houses last year and made its way to Christie's desk.

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