Legal Opinion Could Curb ‘Dry Needling’ Practice by Physical Therapists

Lilo H. Stainton | April 12, 2017 | Health Care
Attorney general decides physical therapy does not include treatments that break the skin; acupuncturists applaud opinion

dry needling
A nearly decade-long debate over who can provide “dry needling” treatments may have reached a new plateau with a legal opinion that held the technique is not within the scope of practice for physical therapists in New Jersey, some of whom have been providing the service for years.

State Attorney General Christopher Porrino issued an opinion in February following requests dating back to 2012 from licensed acupuncturists who complained that physical therapists are endangering patients by performing a type of acupuncture they are not trained to provide.

But advocates for Garden State physical therapists said that while similar, the two procedures are not the same, and denying them the right to provide a treatment they’ve offered to patients since 2009 only adds to their pain and suffering. “That’s the biggest thing,” said Dr. Paul Vidal, a physical therapist and president of the American Physical Therapy Association of New Jersey, “We have patients who are being helped and their access to this treatment approach is in jeopardy.”

Discontinuing dry needling

The New Jersey State Board of Physical Therapy Examiners, which licenses practitioners, acknowledged the AG’s opinion — but disagrees with his findings. Board leaders said it would advise all its members to stop taking new dry-needling clients and phase out their existing practices in this treatment by December. There are some 11,000 licensed physical therapists in the state, several hundred of whom now offer the treatment, Vidal said.

The difference between the two procedures depends on who you ask, but all agree dry needling involves using acupuncture-type needles (that are “dry,” or not used for injecting substances) to pierce the skin and stimulate muscle ‘trigger points’ to reduce pain. Acupuncture, based on ancient Chinese principles, uses these needles to stimulate or harness nerve impulses to reduce pain or address a wide range of other conditions.

dr. paul vidal
 “Acupuncture is a profession with a distinct body of knowledge and training, much like the profession of physical therapy,” Vidal, the physical therapist, explained. “We don’t own dry needling, we are one of the many professionals that use it.”

Muscles, not traditional medicine

While physical therapists said dry needling is focused on muscles, not traditional medicine, acupuncturists said it is basically a form of acupuncture, since 95 percent of the muscle “trigger points” overlap with sites that play key roles in their own practice. “Dry needling is the unlicensed practice of acupuncture,” said Jason Sargis, an acupuncturist who is president of the New Jersey Association of Acupuncture and Oriental Medicine. “Everyone keeps telling them no, but they keep hearing yes.”

Dry needling appears to be a growing trend, and New Jersey acupuncturists became concerned in 2009 after the physical therapy licensing board decided nothing in state statute prevented their practitioners from offering the treatment here. Efforts to resolve the issue between licensing boards and professional organizations failed to materialize.

The issue was reignited in 2012, when the state acupuncture association noticed a Colorado company was sponsoring dry-needling training courses for physical therapists in the Garden State. The association asked the Division of Consumer Affairs, which oversees licensing boards, to get involved. Other professional groups, including the powerful Medical Society of New Jersey, echoed the acupuncturists’ concerns and urged the division to rein in the physical therapists.

In the meantime, physical therapists also sought to get their scope of work expanded through legislative change. Proposals have been introduced during the past two legislative sessions, but language that spelled out their right to do dry needling was eventually removed in an effort to reduce opposition from other medical providers. The latest version (A-1839/S-1315) has passed an Assembly committee, but has yet to see any action in the Senate.

Acupuncture advocates kept up the pressure until Consumer Affairs requested a legal opinion from Porrino, which was issued February 9. In his explanation, he noted that the statute defines physical therapy as a practice that involves manual manipulation of limbs, massage, hydrotherapy, electro-therapy, and the use of physical or mechanical modalities to expand movement and reduce pain. There is no mention of dry needling directly and none of the other techniques involve piercing the skin.

Porrino also wrote that the physical therapy licensing board did not have the authority to expand the scope of practice “so significantly” to include dry needling. “Accordingly, you are advised that under the current statute, physical therapists are not authorized to engage in dry needling or intramuscular stimulation,” he said, echoing the legal opinions offered by a number of other states.

“It’s very black and white — there’s no gray there,” Sargis said. “Yet they still push forth.”

However, when the licensing board met in late February, a dozen people — therapists, patients, and others — spoke out in favor of letting physical therapists continue to offer dry needling. They raised concerns about the impact on patients, who they said may be forced to travel out of state for this treatment, and said that, given the need for nonaddictive pain treatment, it is not the right time to restrict the practice.

But Sargis, the acupuncturist, said this approach endangers consumers and encourages physical therapists to perform treatments outside the scope of their practice. And while there are just over 1,000 licensed acupuncturists in New Jersey, he said these providers have the capacity to absorb additional patients, if needed. “This is not a turf battle,” Sargis said. “They are putting consumers and licensees at risk.”