Advocacy

Washington Courts Ban Physical Therapists from Practicing “Dry Needling”

I received an email earlier today from the South Sound Acupuncture Association and have been granted approval for reposting it here.  What are your thoughts?  – Joe B

MEDIA RELEASE-FOR IMMEDIATE RELEASE
October 15, 2014
Contact: Suzy Griffin
(360) 399-6408
ssaa.communications@gmail.com

Washington Court Injunction Bans Physical Therapists
From Practicing Acupuncture “Dry Needling”:

Colorado-based training company, Kinetacore, is also enjoined from using needles in dry needling training workshops

Seattle, WA – King County Superior Court Judge Laura Inveen issued a permanent injunction against physical therapists on Friday finding that they lacked the legal authority to practice “dry needling”, a term used by physical therapists who want to insert acupuncture needles into human tissue without the extensive hours of hands-on supervised training required for Licensed Acupuncturists, now called East Asian Medicine Practitioners (EAMP).

The court’s ruling came in a lawsuit brought by the South Sound Acupuncture Association (“SSAA”) against Kinetacore, which holds “dry needling” workshops around the country. Additional defendants included more than 20 physical therapists who had attended a Kinetacore workshop in October of 2013. The court found that under Washington law, the physical therapy scope of practice does not authorize the insertion of any type of needle, including acupuncture needles, for the purpose of “dry needling”, and their practice of “dry needling” constitutes the unlicensed practice of medicine. The workshop was held at Salmon Bay Physical Therapy’s office in Seattle. Salmon Bay, along with the other defendants, were legally enjoined from continuing to practice dry needling.

Under the ruling, Washington State physical therapists who are outside the group specified in the Injunction, are subject to future legal action for the unauthorized practice of medicine if they perform “dry needling” and do not have a second license that allows the insertion of needles into human tissue. Two groups representing Washington acupuncturists praised the court ruling as an important public health victory and are alerting the public to be aware of any physical therapists that continue to practice “dry needling” after the judge’s ruling.

“This is a major victory for public safety. There’s a reason Washington law requires 500 hours of supervised clinical training before people are allowed to practice acupuncture” says Dan Dingle, a board member of SSAA, an Olympia-based organization that promotes education and patient safety. “When physical therapists take weekend workshops of only 27 hours and then start needling as deep as 4 inches into their patients, it’s only a matter of time before someone is seriously injured in Washington, as they have been elsewhere.“

The Washington East Asian Medicine Association (WEAMA), the state professional organization, applauds the decision. “The Legislature clearly never intended that physical therapists practice acupuncture and they are certainly not qualified to safely do so after just a weekend workshop,” says WEAMA President, Curt Eschels.

In the coming weeks, the SSAA will be seeking information from the Washington State Department of Health regarding the enforcement of the court’s ruling.

Here is a copy of the court’s ruling:
http://ssaa.wildapricot.org/Resources/Documents/2014_10_10%20Order%20for%20Partial%20Summary%20Judgment.pdf
Here is a copy of this press release as a pdf:
https://gallery.mailchimp.com/329b9e7fce1fe1e541a89b8b5/files/Press_Release_10_15_14_02.pdf

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  1. Interesting to see the comment on only “27 hours” regarding physical therapists, how are Doctors of Physical Therapy who go through extensive training through schooling and additional continuing education not qualified to perform dry needling?

    • I am the owner of Salmon Bay PT. This is a scare tactic and you’ll notice that the article was sent to Forward Thinking by the acupuncturists. The verdict in this case affects Salmon Bay PT and Kinetacore ONLY. Until other PTs are sued, and lose, they are allowed to needle. Please continue your practice.

      • If you want to practice acupuncture, then go to school and study acupuncture. Your schools aren’t allowed to teach you methods that are not in your scope of practice, but they do anyway. Acupuncture, no matter what name you give it, is not in your scope of practice. Go through the sunrise review process if you want it to be like every other profession in this state. PT boards can’t just decide you can do it.

      • Please don’t you guys obviously don’t know what you’re doing which is why so many of these dry needle patients end up with pneumothorax and other chronic conditions. What’s so hard about sticking to your own practice, does it make you sound cool to say you use needles? If you really care about providing the best treatment to your patients you should at least invest time and care in the technique you are using. I’m sure no one in Acupuncture would attempt to masquerade as a physical therapist in a sense that ppl hear that title and expect a certain style of tx.

    • Dry needling is using an empty hyperdermic needle. Dry needling with an acupuncture needle is acupuncture. Where in PT training has there been breaking of the skin? Statistically dry needling performed by a PT has caused more pneumothorax and injury than acupuncturists. State license requirements are set
      By the state and clearly due to the number of hours acupuncturists are required to complete indicates the adequate training. Dry needling is acupuncture. Acupuncture is 3000 years old. PT’s looking to do it under another name are continuing the ‘doctor’ complex.

      • Peter, onus of proof.
        Show us these statistics please.

        The only reason why acupuncturists are trying to stop PT’s from practicing a musculoskeletal modality, not an energetic systemic one like acupuncture, is because IMS works better for pain than acupuncture for specific muscle related conditions.

    • Because, in the basic DPT curricula, Dry Needling is not a subject that is currently being taught (thank God). So, while DPTs might have extensive schooling in Physical Therapy, they have had no training in dry needling. Ergo they would need an additional 500 hours of DN training. Perhaps slightly less as their basic knowledge of anatomy and physiology and neurology is covered. But they would still need clinical mentorship hours.. Orthopedic Manipulative Physical Therapists do at least 150 hours of clinical supervised mentorship hours before being allowed to do a graduation exam to become a Fellow of AAOMPT.

      • It is in Australia, a country that is known for it’s high level of PT research and standards. They don’t even have to take post graduate courses to practice IMS/DN there. Thank God for forward thinking physiotherapy education in Australia. No fear based nonsense.

        I’d love for Peter or whomever it was up above to show us statistics on how many people are injured with IMS vs Acupuncture.

        Let’s see it.

    • Because Acupuncture is not the same as biomedicine different modality. MD’s specialize in a whole different system and put forward much effort towards many Biochemical aspects. None of them are Chinese Medicine. Acupuncture is not just sticking needles in someone. the needle is not for show, it is just a means to an end………

    • I have been able to avoid multiple surgeries with dry needling/IMS treatments. This therapy is literally my magic pill – but without pills. It will be a truly sad day if the state makes it so I don’t have access something as important to my health as this. Why do the accupuncturists even care. If they are all about making people healthy they should applaud such an effective treatment rather than try and shut it down. Believe me – what they do is not even similar to what dry needling is. It’s like comparing a GP to a Pediatrican. Both are doctors and use the same tools but their breath of specialty are so far apart they are recognized by governments and insurance agencies as 2 very different and separate entities. And they don’t compete for business which it seems is a motivating factor for the accupuncturists. I know from experience acupuncture cannot do what dry needling does. It serves a very important purpose but it is NOT dry needling bay any stretch of the practice. Very sad they want to take this away from me.

  2. Physical therapists go through rigorous education and have extensive knowledge of the integumentary system, nervous system, and musculoskeletal system, including acupressure and trigger points commonly associated with acupuncture. It just sounds like the acupuncturists did not want to lose their jobs and hired a good lawyer. It’s all pseudoscience anyway. Most of the research shows acupuncture no more effective than placebo. They can keep their needles. Let the real professionals do their jobs and do the healing.

    • If we acupuncturists practice pseudoscience, then leave our pseudoscience techniques alone. Don’t practice with them as it isn’t in your scope of practice to do so no matter how much money you want to make from your clients. Leave that treatment code to the people who are trained to do it. You have plenty of other ways to make a living. Why not do something crazy and refer? We might then do the same.

      • Hey Vaughn, eight jurisdictions have decided it is not within the PT scope of practice. None of the other 43 have done the same. I know, it’s an inconvenient truth isn’t it?

      • You guys don’t dry needle, or use pistoning techniques to release trigger points. Never have. Your art of sticking a needling into an Ai shi our ouchy point was only ever to appease patients in pain because the meridian nonsense is no more particularly effective, as the literature shows, at treating pain than faith based healing.

      • Donald, he was talking about acupuncture not IMS. It’s ironic that the 3000 year old meridian method has much less scientific validation than IMS, isn’t it?

    • So why use it if its a pseudo science, do you want to provide your patients with psuedo healthcare? Any Practitioner worth the beans is going to take care in how he approaches his patients tx’s and invest the due time. If you think its so cool go to school. We see Chiropracters, Psychologists, MD’s and Licensed Acupuncturists going to school for their Masters in TCM…Not to mention all the training and knowledge accumulated over possibly 5000 years that they will continue to seek out post grad school. Acupuncturist lobby and do studies to get a fair shake just as any other medicine has had to..Reform your practice, do more research and figure out a way that will effectively allow needling in your practice

  3. Trigger point dry needling is totally different from traditional Chinese Acupuncture…the meridians are not used and completely ignored. Working on trigger points is nothing like sticking a needle into a point to affect the kidneys or the digestive system, they’re totally different things. To say that an acupuncturist knows the body and it’s neuromuscular skeletal system better than a physical therapist is completely ridiculous! The judge clearly knows nothing and this has again come down to good lawyers…sad that people will still suffer when dry needling has helped so many people in other countries!!!

    • I have to disagree. My friend left physical therapy yesterday and is in the ER today with a collapsed lung, from “dry needling”

      • AC,
        I hope you encourage your friend to file a formal complaint to the PT Board in Washington. I’m not suggesting that the therapist who treated your friend was negligent in any way, but accidents happen when you start sticking needles in people, and this wouldn’t be the first time someone punctured a lung with a dry needle. If we’re going to fight against the spread of this potentially harmful and poorly supported intervention, then we need documented cases like this to wage the battle. As the kinds of incidents pile up, professional liability insurers will have no choice but to start raising the premiums of PTs.

        I don’t want my licensure dues used to pay lawyers to defend anyone’s right to perform this treatment, and I don’t want my insurance premiums to rise.

      • AC, I’m in Canada, trained in both IMS and AFCI based acupuncture. In our practical exam for an AFCI course a student gave one of the instructors she was doing her technique on a pneumothorax. Is Acupuncture to blame?

    • No it’s not Paul, what you are doing is ashi acupuncture. Punturing only the sore spots regardless of the channel. Puncturing the skin with a filiform needle is acupuncture, period.

      • No. doing ashi points could be putting a needle anywhere that is painful, be it subcutaneous tissue (which most ashi points are) or other structures. Dry needling is trigger point, muscle “knot” based and far more effective at alleviating pain than Ashi acupuncture. Read the literature.

  4. The ruling according to the PPSIG of washington says ” While the trial court’s ruling does not carry the precedence of an appellate court decision, and was issued just against the specific named defendants, it certainly serves as a caution to other physical therapists in Washington who may be practicing – or thinking about practicing – dry needling that they could find themselves on the receiving end of another lawsuit by the acupuncture association that sued Salmon Bay PT and Kinetacore. ”
    Unfortunately the eastern asian medicine association singled out only one group that weekend, and have overlooked the fact that we are all here to find the best way to assist our patients on the path to wellness. I hope the Washington PT association takes this up to solidify it in our practice act. As it has previously been said, we are not practising acupuncture.

  5. In Delaware, our state legislature has just passed one of the most advanced PT practice acts which includes dry needling. I would recommend Washington’s PT association consider this to clarify scope of practice and avoid potential litigation. The court is subject to interpret the current laws as the relate to specific cases, not make law.

  6. Did the APTA provide legal counsel for Kineticore? I certainly hope so. I want my membership dues going towards fighting these battles. We should not be losing this type of suit.

    • This is Andi, the owner of Salmon Bay. Our lawyer is the same lawyer as WA state chapter. No, legally the APTA is not able to help us financially. Elaine Armantrout has set up a fund for WA PTs to help us. Any contributions would be greatly appreciated. Thanks for paying attention to this. We took one for the team and we need to encourage our board to make a clear statement in our favor.

      • Your posting is over 1 year old. I’m not in WA state, or the USA, but tell us where the donations should go and I’m in!

  7. Sorry, Kyle, I hardly ever give anyone a “thumbs down” on blog comments, but yours qualified. This is precisely what I don’t want my licensure dues going towards: lawyers writing up briefs and arguing in court (at $200/hour) for my right to dispense a placebo. Anna’s post above is spot on. These battles are expensive, and when there’s such thin evidence in support of an intervention (despite JOSPT’s willingness to publish arguably disingenuous clinical trials and reviews) that indeed has shown no more benefits from needling than a sham intervention, then it’s time to tell APTA and our state chapters to keep their hands out of our wallets. We’ve got enough to worry about with shrinking reimbursement than to also have to countenance increases in licensure dues and mal-practice insurance premiums due to the inevitable accidents that will occur (have occurred) from needling.

    If PTs want to stick needles in people, then join this “East Asian Medicine” group in Washington and do it on your own time and with your own money, not my licensure dues.

    • I recommend you to read research by Jay Shah and research central sensitization prior to qualifying dry needling as Psuedoscience

      • Joe,
        What makes you think I haven’t read Jay Shah’s work and the research on central sensitization? Why don’t we get out of the theory for a moment and look at the actual outcomes research on needling? It tells the story. The recently published review in JOSPT by Kietrys et al made a claim of “grade A” evidence for dry needling despite the fact that the trials they cited showed that the effect sizes from needling were scarcely better than sham needling. The scholars at BodyInMind.org wrote a letter to the editor indicating this serious flaw in the interpretation and conclusions from the Kietrys et al review, but for some mysterious reason, the letter was refused for publication on the grounds that it was, wait for it…too long.

        A subsequent trial was published in JOSPT a few months later, which got a lot of press and prompted the editors at JOSPT to write an adjacent “Patient’s Perspectives” piece essentially advocating that patients consider dry needling for neck pain. The trial in question by Merjato-Vazquez et al devoted very little time to making a argument (a short paragraph on page 253) for the existence of trigger points, and the argument they present is full of holes and even overt inaccuracies. For instance, from the Gerwin et al (1997) reliability study they cite kappas ranging between 0.84-0.88 on the four criteria for the diagnosis of an active trigger point in the upper trapezius muscle. This didn’t sound right to me, so I went back and reviewed the Gerwin study, and I was not able to locate values anywhere near what was reported by Merjato-Vazquez et al. Also, the operational definitions of the criteria used by Gerwin et al do not match those used by Merjato Vazquez et al. They then make the leap to the more recent reliability study by Myburgh et al, who did not include the local twitch response criterion, which according to Jan Dommerholt is a requisite finding to confirm the existence of an active trigger point. But even in this study the kappas for the experienced examiners averaged 0.63, which is considerably lower than the range that Merjato-Vazquez had mis-cited from Gerwin et al.

        Merjato-Vazqez et al mention in passing the Lucas et al review from 2009, (which incidentally found that the Gerwin et al study was of low quality), but they neglect to mention a key flaw in trigger point diagnosis identified by Lucas et al, which is particularly relevant to needling. These researchers found that pinpointing the location of trigger points had not been established. They found a range of variability in identifying location of a specific trigger point between 3.3cm and 6.6cm. With such a wide location range, it begs the question of whether the needle insertion is actually located in the identified trigger point or even needs to be to produce an effect. Neither Myburgh et al nor Gerwin et al address the specificity of location of the “taut band” in their studies, just that one exists somewhere in the muscle. Obviously, the large surface area of skin over the upper trapezius suggests that there are myriad potential locations for needle insertion. Shouldn’t any reliability analysis address the need to show that diagnostic accuracy includes specifying a discrete location within certain acceptable boundaries? Perhaps a centimeter or less?

        Something’s not right at JOSPT with respect to their exuberance over publishing positive trials on needling. I’m concerned, as you should be, that the editors at JOSPT are putting treatment advocacy and maybe impact factor concerns ahead of rigorous peer review and trial publication standards.

  8. I wanted to share this quote by KeithPT on Facebook because I think he nails it:
    “A bigger question – for me – is why the state sanctions/licenses pseudo-scientific acupuncture?

    From an acupuncturist in the report: “This is a major victory for public safety. There’s a reason Washington law requires 500 hours of supervised clinical training before people are allowed to practice acupuncture”

    Apparently 500 hours of education is enough to become licensed in robbing people of their money in Washington?”

  9. To Joseph Brence, I am an Acupuncturist and Board Certified Sports Chiropractor of 35yrs in Australia. I have been one of the therapists of choice based on clinical evidence results for the Australian Olympic track & field team,swimming teams and various Rugby League teams. I am a past member of the Board of Governors for the main Acupuncture College in Brisbane and spent some time working in the hospitals in Beijing….Reading what you
    just said indicates to me you are poorly informed and along with you PT friend poorly researched.
    500 clinical hours is just clinical hours you twit, not the whole course. As for pseudo-scientific , do you really want to go there? If your looking for that, just look at the practice of medicine which is empirical and rarely scientific…..
    As for dry needling by either PT’s or Chiropractors……wrong and dangerous. I have voiced these concerns in Australia for quite awhile and now the chickens are coming home to roost.

    • What is a “twit”. I’ve never heard this term used in professional discussion or debate.

      You suggest modern acupuncture is a science-based practice? Am I correct?

      Why is dry needling dangerous when performed by Physical Therapists?

      • This is not a profeesional discussion at all, but a bunch of men crying because they can’t use their big toy? Again why the hell would you want to practice a Pseudo Science in your legally certified healthcare business. There are endless healing modalities to choose from to treat a patient? This whole thread should be eye opening to many. It is just sad because this is the kind of world we live in

    • Timothy,
      Is your argument that because medicine relies on empiricism and is “rarely scientific” (which I don’t agree with), that it’s ok for acupuncturists to rely on pseudo-science? That’s a very weak “tu quoque” argument. And then you admit that you’re “one of the therapists of choice based on clinical evidence results”- that’s an empirical argument! You added the “ad hominem” attack on for good measure, it seems. For these reasons, its hard for me to take you seriously.

      And what is this 500 clinical hours requirement based on? Are there any studies comparing the effectiveness or incidence of adverse events in novice needlers versus those with a certain number of hours of clinical experience or instruction? Or was the 500 hour requirement just pulled out of thin air? How much does 500 hours of clinical education in acupuncture cost? I expect more than 100 or 250 hours. Why not just require 250 or 300 hours or even 100 hours?

      I don’t know if I’m the “PT friend” you’re talking about, but I’m very familiar with needling research of both the acupuncture and dry needling variety, and the evidence is clear that the effects of real needling are only slightly better than sham needling. Among the high quality trials and systematic reviews this has been shown over and over again. This slight difference can be attributed to counter-irritation analgesia, which is also referred to as “diffuse noxious inhibitory control (DNIC)” from descending pathways originating in the CNS. These effects are short term. The obvious risks of harm from needling should be sufficient to make any ethical practitioner think twice about using it. However, the less obvious risks come with promulgating a meme in the culture that if you have pain you need some “expert” to fix it for you, which requires surrendering one’s internal locus of control. Low self-efficacy has been shown to be a strong predictor of long term disability following musculoskeletal injuries.

      Ok, you can start calling me names now.

    • It’s such a shame that Acupuncturists are fighting what they believe to be, their OWN profession. I mean, think about it. They’re claiming IMS as Acupuncture, even while it’s vastly different in theory, philosophy and practice, and then saying it shouldn’t be practiced. The real reason why they don’t want another profession to use needles, in a completely different scope, is because the other practice is vastly superior for pain relief and they know it. Out of fear of becoming irrelevant, they’re trying to stop an innovation. It’s sad. Rather than embrace it and maybe moving out of woo philosophy and allowing PT to really bring some validation to needling, they’re fighting against validation to stay at what is really a dogmatic religious practice with less evidence than John or Timothy Dunn say exists for IMS.

  10. For those that needle I’d like to ask a few questions that I’ve often asked regarding cervical manipulation however rarely get a straight forward answer. What clinical decision making is involved that leads one to needling? What do you suppose the decrease in pain (if present) is attributed to? Also, similar to cervical manipulation, is the evidence strong enough in support of dry needling for the benefit to outweigh the risk? (We should be asking this question regarding all interventions).

  11. What’s the difference between the PT’s in the US than the PT’s in China? The PT’s in China know their boundary and do not practice or attempt to practice “dry needling.”
    Perhaps any healthcare professionals can practice “physical therapy” after some weekend seminars, as long as they can come up with a new name for it.
    Hooray! Ignorance is a bliss!!

    • Dry Needling was put on the map as IMS in Vancouver Canada. Travell and Simons popularized myofascial pain and dysfunction and showed how to treat it with needling 40+ years ago.

      Tell us when TCM ever talked about myofascial pain and dysfunction or neuropathic pain as means to how acupuncture worked?

      Never.

      Acupuncturists who say they can do the same thing as IMS are the ones who are misleading the public. They are not performing IMS because they are not trained in it, much the same as PT’s using IMS are not diagnosing patients based on tongue, pulse and trying to affect energy flow along meridian lines somehow related to organs, and therefore not practicing Acupuncture.

  12. I seem to be getting a steady diet of “thumbs down” responses to my posts here, but no one has yet addressed the substance of my argument, nor have they attempted to answer Anna’s question about fighting for the right to dispense a placebo intervention and Mark’s question about the mechanism of how this intervention produces analgesia and if it’s worth the risks that it poses.

    “Joe”, who doesn’t feel comfortable using his full name online, has assumed that I’m unaware of the needling research, which is inaccurate, and Timothy has called Joe Brence a “twit”.

    Is this the best proponents of needling can do? I hope for the PTs among you that you can do better than simply click on an icon showing whether you agree or disagree with the commment. Is anyone willing to make an actual argument in favor of this procedure? What’s your premise?

  13. Dry needling has helped me in so many different ways. After suffering with frozen shoulder, dry needling restored my range of motion and movement…not to mention it dramatically reduced my pain. Traditional medicine would have preferred me to undergo an operation, and to take highly addictive pain medication. Dry needling allowed me to forego surgery and addictive pain meds. Dry needling changed everything for me. I have tried acupuncture, but it wasn’t able to get down to the root of my problem. I agree that training and clinical hours for dry needling should be and is in place prior to practicing treatment, but there is no reason to stop the practice. Acupuncture and dry needling are 2 different things…and shouldn’t be compared. Dry needling literally changed my outlook…pain relief and unobstructed movement were achieved solely because of my dry needling sessions.

    • I am glad to hear you had a positive experience, Leslie. You appear to attribute the improvements in your shoulder to an intervention vs. guidance of a practitioner. Is this correct?

      Since you have received both acupuncture and dry needling, can you reflect on the major differences between the two?

    • I am also glad you have had a positive experience and your shoulder problem seems to have resolved. But this n=1 is absolutely no proof of the effectveness of DN. For one; the management of your frozen shoulder seems unusual: surgery is hardly ever used in treating a frozen shoulder. Secondly, a frozen shoulder is a self-limiting condition which usually resolves in 9-12 months following three well defined stages. Proper management through each of these stages is useful in minimizing resudual complaints. So it is questionable if and how much of your restoration of motion can be attributed to DN. I am sure any PT in his right mind would have you exercise (minimal in the freezing stage and increasingly more during the thawing fase of the frozenshoulder management) and this would be essential in resti\oring function and ROM.
      The effectiveness of DN can only be shown through robust double blind randomized controlled trials with both placebo and other conservative management strategy treatment arms.

    • Leslie, everywhere you state dry needling please change it to acupuncture. Acupuncture points inserted outside of meridians are referred to as Ashi points in Chinese medicine which is the treatment you received.

  14. I concur with Erik. Leslie’s recovery from “frozen shoulder”- assuming that was an accurate diagnosis- cannot be attributed to dry needling. In fact, if she actually did have adhesive capsulitis, I’m wondering what rationale the therapist used to employ this intervention? It’s just as likely that her recovery was attributable to natural history of the condition. Her belief in the treatment may have facilitated a reduction in pain due to the non-specific effects of expectation: “This therapist is going to get to the real source of my problem.” Inserting needles into “trigger points” would logically reinforce this belief.

    I don’t doubt that tender spots in the upper quarter region are commonly associated with the persistent pain typically associated with this condition, but the evidence to date indicates that the ability to reliably identify these as “trigger points” is poor. There’s a very well-written critique of the myofascial pain/trigger point construct by John Quintner and Milton Cohen here: http://www.pain-education.com/referred-pain.html?

    I highly recommend that anyone who treats “trigger points” read this and then re-consider their position on what exactly these things are.

  15. The court’s ruling came in a lawsuit brought by the South Sound Acupuncture Association (“SSAA”) against Kinetacore, which holds “dry needling” workshops around the country. Additional defendants included more than 20 physical therapists who had attended a Kinetacore workshop in October of 2013. The court found that under Washington law, the physical therapy scope of practice does not authorize the insertion of any type of needle, including acupuncture needles, for the purpose of “dry needling”, and their practice of “dry needling” constitutes the unlicensed practice of medicine. The workshop was held at Salmon Bay Physical Therapy’s office in Seattle. Salmon Bay, along with the other defendants, were legally enjoined from continuing to practice dry needling.

    500 hours of education in needling still doesn’t give you a license to practice medicine, so doesn’t this ruling effectively prohibit acupuncturistsa from needling as well?

  16. Good point, Garrett. I appears that this judge has decided that having the term “medicine” in the name of your organization means that you actually practice medicine. Talk about a twit.

    I don’t think this ruling will stand, but it’s going to cost Washington PTs some significant legal fees to fight it. And so it goes… the PT profession continues to see reimbursement shrink and salaries flatten as we pay lawyers to fight the latest turf wars. When will PTs wake up and see that much of what we do and why we do it is built on sand?

    This is the way it’s been for the entire 20 years I’ve been a PT, and the more these kinds of silly battles with other professions appear, the less confident I am that things will change anytime soon.

    • Agreed. Let’s work on getting people better in as cost-effective a manner as we can and then use that to advocate for our profession and the patients we serve rather than battling with other people that deep down are trying to do the same thing.

    • So what do you do as a PT John? I’m assuming you don’t use any technique build on sand so I’m genuinely curious as to what you do do as a PT?

  17. “Dingle said that although health care professions are painting this as a turf war started by acupuncturists, the NCASI has no problem with them performing acupuncture as long as they are properly trained and follow safety and educational standards.

    “Acupuncturists have a minimum of 1,245 hours of education plus an additional 660 hours of hands-on supervised clinical training, whereas many dry needlers have taken only a weekend workshop,” said Dingle. “Currently, the unsuspecting public is grossly unaware of the paltry amount of training most dry needlers have.””

    • Yes, do you know even how many functions these points have, how to harmonize your tx and what pts to needle in combination. Most Acupuncturists will continue to study Acupuncture well after they graduate school.

  18. Needling, is a tattooing technique. It is not an acupuncture technique, and it is not a physical therapy technique. Tattooing is vastly different than acupuncture. Please refer to the writings of Desmond (Des) Fernandes. Dr. Fernandes noticed that the facelift patients he sent to tattoo artists for scar camouflage to color in their white scars, had their scars greatly reduced and often the skin’s natural pigment began to return after the treatment. This is the genesis of needling and I would go to no one else than a tattoo artist for this procedure.

  19. I continue to get an occasional feed showing that this thread is still kicking about a year after it started, so I was prompted to provide a relevant update on dry needling in my neck of the woods. Between December 2013 and April 2015, the Louisiana State Board of PT has spent about $16,000 on protecting dry needling as within PT scope of practice. About $12k of that was for legal fees, and the rest went to communications/flyers for licensees to provide updates on the issue. For now, the battle with the La State Board of Medical Examiners has died down, but it’s just a matter of time before it heats up again. If you’re interested to find out how much of your PT licensure dues are going towards protecting your right to jab patients with needles, you can submit a public records request to the licensing authority in your state. It cost me about $10 in copying fees to have the entire record (most of which were invoices from the attorney representing the PT Board) mailed to me.

    It would be interesting to find out how much is being spent on this scope of practice issue nationally. Meanwhile, evidence continues to mount that real dry needling is no more effective than a sham procedure. Don’t we have better things to spend our licensure dues on than an intervention that is essentially just an elaborate placebo (http://ptthinktank.com/2015/08/03/what-are-the-issues-with-therapeutic-or-trigger-point-dry-needling-9-considerations-to-ponder/)?

  20. It’s irrational decision. We all know it’s very difficult for physiotherapist to cause any injury more than regular acupuncturist. Decision is based on misunderstanding acupuncture.

    Dr Pardeshi MD DGO. Nashik India

  21. This decision has been taken in absence of patients needs. I need dry needling for my condition and now can’t get it anymore. I wish patients interest were put in front of financial interests of acupuncturists.

    • Dear Barbara, IF there is evidence of effectiveness, it is at least so that Dry Needling is a short term modality that will only be used for a limited number of sessions and should ALWAYS be used in conjunction with other physical therapy modalities, of which exercises specifically tailored to your “condition” will be one of the main ingredients. It is definitely NOT meant as a continuum of treatments to which you now seemingly have become dependent on.

  22. First of all i don’t think so they know the difference between DRY NEEDLING AND ACUPUNCTURE…….. Still they are commenting on that……. God….. How you can ask a PHYSICAL THERAPIST to learn Acupuncture to practice DRY NEEDLING with knowing the basics also?????

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