Scope Of Practice (For PT’s)

DRY NEEDLING IN PHYSICAL THERAPY

Scope of Practice 

U.S. State Dry Needling Scope of Practice Decisions

Resource:Federation of State Boards

The American Physical Therapy Association states that Dry Needling is within the scope of practice for a Physical Therapist. Several other health professions cite that dry needling is within their specific scope of practice as well. There are however, specific U.S. state rules, regulations and guidelines that do not permit the practice of dry needling. It is your responsibility to know, understand and practice within the specific rules, regulations and guidelines of your state, jurisdiction and professional license.

Master Dry Needling Seminars or TMR Seminars is solely an educational resource to provide the knowledge and technical skills necessary to deliver safe and effective dry needling treatment. Master Dry Needling Seminars or TMR Seminars does not make policy, claims, or interpretation on professional licensure or scope of practice. Master Dry Needling Seminars encourages all participants to contact their licensing board for official positions and rulings related to the practice of dry needling.

 

Alabama – Allowed

October 23 2007: Board Minutes: Acupuncture & Dry Needling does fall within the scope of practice for physical therapy.

 
Alaska – Allowed
April 24 2012: Letter regarding performance of dry needling. Paraphrase:The board will not address specific treatment approaches by licensure. However; expect the professionalism of the clinician to determine if they are qualified to provide the type of treatment in question or whether referral is more appropriate. The PT will be held accountable for demonstrating this competence if there is ever a complaint.

Arizona – Allowed
We meet all the requirements as per PT Board Guidelines. On April 25th, 2014 the Arizona physical therapy statute was amended to include dry needling within the physical therapy scope of practice. For PT Board Guidelines, click here

Arkansas – Allowed
The Arkansas Board of Physical Therapists has determined that Dry Needling is within the Scope Of Practice for physical therapists.

California – Not Allowed

Colorado – Allowed

Colorado Physical Therapy Licensure Rules and Regulations

4 CCR 732-1 RULE 11 – REQUIREMENTS FOR PHYSICAL THERAPISTS TO PERFORM DRY NEEDLING

  1. Dry needling is a physical intervention that uses a filiform needle to stimulate trigger points, diagnose and treat neuromuscular pain and functional movement deficits; is based upon Western medical concepts; requires an examination and diagnosis, and treats specific anatomic entities selected according to physical signs. Dry needling does not include the stimulation of auricular or distal points.
    B. Dry needling as defined pursuant to this rule is within the scope of practice of physical therapy.
    C. A physical therapist must have the knowledge, skill, ability, and documented competency to perform an act that is within the physical therapist’s scope of practice.
    D. To be deemed competent to perform dry needling, a Physical Therapist must:
    1.  have practiced for at least two years as a licensed Physical Therapist; and
    2. have successfully completed a dry needling course of study that consists of a minimum of 46 hours of in-person (i.e. not online) dry needling training.
    E. A provider of a dry needling course of study must meet the educational and clinical prerequisites as defined in this rule, paragraph D above and demonstrate a minimum of two years of dry needling practice techniques. The provider is not required to be a physical therapist.
    F. A physical therapist performing dry needling in his/her practice must have written informed consent for each patient where this technique is used. The patient must sign and receive a copy of the informed consent form. The consent form must, at a minimum, clearly state the following information:
    1. Risks and benefits of dry needling
    2. Physical therapist’s level of education and training in dry needling
    3. The physical therapist will not stimulate any distal or auricular points during dry needling.
    G. When dry needling is performed this must be clearly documented in the procedure notes and must indicate how the patient tolerated the technique as well as the outcome after the procedure.
    H. Dry needling shall not be delegated and must be directly performed by a qualified, licensed physical therapist.
    I. Dry needling must be performed in a manner consistent with generally accepted standards of practice, including clean needle techniques, and standards of the center for communicable diseases.
    J. The physical therapist must be able to supply written documentation, upon request by the Director, which substantiates appropriate training as required by this rule. Failure to provide written documentation is a violation of this rule, and is prima facie evidence that the physical therapist is not competent and not permitted to perform dry needling.

Connecticut – Not specified. Status Unclear

 Delaware – Allowed

July 1st. 2014: Delaware passed a bill that redefines and expands the ‘practice of physical therapy’ and ‘athletic training’ to include the use of dry needling treatment.

District of Columbia – Allowed

District of Columbia Municipal Regulations Title 17, Chapter 67, Physical Therapy

6715 SCOPE OF PRACTICE A physical therapist may also perform intramuscular manual therapy, which is also known as dry needling, if performed in conformance with the requirements of section 6716.

6716 REQUIREMENTS FOR PHYSICAL THERAPISTS TO PERFORM INTRAMUSCULAR MANUAL THERAPY

6716.1 Intramuscular manual therapy may be performed by a licensed physical therapist who meets the requirements of this section.

6716.2 Intramuscular manual therapy shall be performed directly by the licensed physical therapist and shall not be delegated.

6716.3 Intramuscular manual therapy shall be performed in a manner that is consistent with generally accepted standards of practice, including clean needle techniques, and other applicable standards of the Centers for Disease Control and Prevention.

6716.4 Intramuscular manual therapy is an advanced procedure that requires specialized training. A physical therapist shall not perform intramuscular manual therapy in the District of Columbia unless he or she has documented proof of completing:

(a) A board-approved professional training program on intramuscular manual therapy. The training program shall require each trainee to demonstrate cognitive and psychomotor knowledge and skills. The training program shall be attended in person by the physical therapist, shall not be attended online or through any other means of distance learning, and shall not be a self-study program

(b) A professional training program on intramuscular manual therapy accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE). The training program shall require each trainee to demonstrate cognitive and psychomotor knowledge and skills. The training program shall be attended in person by the physical therapist, shall not be attended online or through any other means of distance learning, and shall not be a self-study program; or

(c) Graduate or higher-level coursework in a CAPTE-approved educational program that included intramuscular manual therapy in the curriculum.

6716.5 A physical therapist shall only perform intramuscular manual therapy following an examination and diagnosis, and for the purpose of treating specific anatomic entities selected according to physical signs.

6716.6 A physical therapist who performs intramuscular manual therapy shall obtain written informed consent from each patient who will receive intramuscular manual therapy before the physical therapist performs intramuscular manual therapy on the patient.

6716.7 The informed consent form shall include, at a minimum, the following:

(a) The patient’s signature;

(b) The risks and benefits of intramuscular manual therapy;

(c) The physical therapist’s level of education and training in intramuscular manual therapy; and

(d) A clearly and conspicuously written statement that the patient is not receiving acupuncture.

6716.8 A physical therapist who performs intramuscular manual therapy shall maintain a separate procedure note in the patient’s chart for each intramuscular manual therapy. The note shall indicate how the patient tolerated the intervention as well as the outcome after the intramuscular manual therapy.

6716.9 A physical therapist who performs intramuscular manual therapy shall be required to produce documentation of meeting the requirements of this section immediately upon request by the board or an agent of the board.

6716.10 Failure by a physical therapist to provide written documentation of meeting the training requirements of this section shall be deemed prima facie evidence that the physical therapist is not competent and not permitted to perform intramuscular manual therapy.

 Florida – Not Allowed

Florida physical therapy practice act contains language which specifically excludes penetrating the skin in the performance of acupuncture: ‘Practice of physical therapy’ means the performance of physical therapy assessments and the treatment of any disability; injury; disease; or other health condition of human beings; or the prevention of such disability; injury; disease; or other condition of health and rehabilitation as related thereto by the use of the physical; chemical; and other properties of air; electricity; exercise; massage; the performance of acupuncture only upon compliance with the criteria set forth by the Board of Medicine; when no penetration of the skin occurs; The board has not yet taken up the issue of whether or not dry needling is acupuncture. For now; this statute prohibits dry needling in Florida.

Georgia – Allowed

2011 Dry needling added to GA PT practice act; only state to have in statute. Currently drafting rules for the statute.

Hawaii – Not Allowed

Physical therapists; by statute; are not allowed to puncture the skin of a patient for any purpose

 Idaho – Now allows PT to take dry needling course

Here is the link to the new guidelines – Click Here

Illinois – Allowed

On July 3, 2017, a new bill authorizing dry needling by physical therapists in Illinois was sent to the Governor for his signature. The bill passed unanimously out of the House and Senate with bipartisan sponsorship and support. In summary, the new bill requires – 

  • Prerequisite of 50 hours of general education that are traditionally part of entry level education for physical therapists
  • Completion of 30 hours of self-study related to dry needling (acceptable self-study includes pre-course reading requirements such as textbooks and literature)
  • Completion of 54 hours of face to face dry needling education that can be divided into modules; however, all 54 hours must be completed within 12 months
  • Completion of 200 patient treatment session under supervision that can be in coordination with face to face education modules

 

Indiana – Allowed
August 2012: Board meeting minutes – Claimed by some resources to have approved dry needling for PTs; minutes state that “Indiana does not take a position on needling. The current statute is open and does not specifically state whether or not it is appropriate.” Not prohibited; but not endorsed either. As an update to prior opinion in 2012 The IN APTA as of July 2013 has not declared a particular stance on dry needling but rather follows the National APTA White Paper on Dry Needling as within the scope of practice for PTs

Iowa – Allowed
On January 14, 2016, the Iowa Board of Physical & Occupational Therapy issued a Ruling on the Petition for Declaratory Order and concluded that dry needling is within the scope of physical therapy practice as defined in Iowa Code section 148A.1(1)(b). 
On January 10, 2018, the Iowa Court of Appeals issued a decision upholding the declaratory order of the Iowa Board of Physical and Occupational Therapy that dry needling is within the scope of physical therapy. The Board issued its order in response to a petition filed in August of 2015 by the Iowa Association of Oriental Medicine and Acupuncture.  The APTA and the Iowa Chapter petitioned to intervene and submitted a joint brief to the Board. The Board’s order, issued in January of 2016, declared that dry needling was a “rehabilitative procedure” within the definition of physical therapy in the practice act.  The Acupuncture Association sought judicial review in the District Court. The Iowa Chapter intervened on the side of the Board. In October, 2016, the District Court  affirmed the Board’s declaratory order.
The Acupuncture Association next filed an appeal, which the Iowa Supreme Court transferred to the Iowa Court of Appeals. The Iowa Chapter intervened in support of the Board and submitted a brief.  The Court of Appeals held a hearing on December 12, 2017, at which the APTA’s General Counsel, Jack Bennett, argued on behalf of the Chapter. The opinion of the Court of Appeals noted that the standard of judicial review was highly deferential to the Board.  The Court concluded:“The Board is generally allowed to apply its expertise in the area of physical therapy to determine what matters are within the scope of the practice. In granting deference to the Board’s expertise in the area of physical therapy, we conclude its determination that the practice of dry needling falls within the definition of physical therapy was not irrational, illogical, or wholly unjustifiable.”The decision by the Court of Appeals is not necessarily the end of the case, because the Acupuncture Association has seven days in which to ask the Court of Appeals for a rehearing, and it has twenty days in which to apply to the Iowa Supreme Court for further review of the case. The decision of the Court of Appeals is available here.

Kansas – Allowed
On May 13, 2016, Kansas Governor Sam Brownback signed legislation affecting the use of dry needling by physical therapists. The legislation clarifies that dry needling is within the scope of practice of physical therapy in Kansas. The new dry needling provisions in the physical therapy practice act will take effect July 1, 2016. Kansas is now working on developing rules and regulations for dry needling. On April 14, 2017, the Kansas Board of Healing Arts approved the Dry Needling Regulations for Physical Therapists in the state of Kansas.

Kentucky- Allowed
KRS 327.070(2)

The board is of the opinion dry needling is within the scope of the practice of physical therapy as defined in Kentucky law by the General Assembly at KRS 327.010(1). Dry needling is a treatment used to improve neuromuscular function. As such it falls within the definition of physical therapy as defined under KRS 327:010 (1): Physical therapy – means the use of selected knowledge and skills; invasive or noninvasive procedures with emphasis on the skeletal system; neuromuscular; and cardiopulmonary function; as it relates to physical therapy. There is nothing in KRS Chapter 327 to prohibit a licensed physical therapist from performing dry needling so long as the physical therapist is competent in performing this intervention.

While dry needling is within the scope of practice of physical therapy, a physical therapist must practice only those procedures that the physical therapist is competent to perform. The board can discipline a physical therapist for “engaging or permitting the performance of substandard patient care by himself or by persons working under their supervision due to a deliberate or negligent act or failure to act, regardless of whether actual injury to the patient is established.”

Louisiana -Allowed

Subchapter B. General Provisions
§123. Definitions A. As used in this Title, the following terms and phrases, defined in the practice act, La. R.S.37:2401–2424, shall have the meanings specified here. Dry Needling—a physical intervention which utilizes filiform needles to stimulate trigger points in a patient’s body for the treatment of neuromuscular pain and functional movement deficits. Dry Needling is based upon Western medical concepts and does not rely upon the meridians utilized in acupuncture and other Eastern practices. A physical therapy evaluation will indicate the location, intensity and persistence of neuromuscular pain or functional deficiencies in a physical therapy patient and the propriety for utilization of dry needling as a treatment intervention. Dry needling does not include the stimulation of auricular points.

  • 311. Treatment with Dry Needling
  1. The purpose of this rule is to establish standards of practice, as authorized by La. R.S. 37:2405 A.(8), for the utilization of dry needling techniques, as defined in §123, in treating patients.
  2. Dry needling is a physical therapy treatment which requires specialized physical therapy education and training for the utilization of such techniques. Before undertaking dry needling education and training, a PT shall have no less than two years experience working as a licensed PT. Prior to utilizing dry needling techniques in patient treatment, a PT shall provide documentation to the executive director that he has successfully completed a board–approved course of study consisting of no fewer than 50 hours of face–to–face instruction in intramuscular dry needling treatment and safety. Online and other distance learning courses will not satisfy this requirement. Practicing dry needling without compliance with this requirement constitutes unprofessional conduct and subjects a licensee to appropriate discipline by the board.
  3. In order to obtain board approval for courses of instruction in dry needling, sponsors must document that instructors utilized have had no less than two years experience utilizing such techniques. Instructors need not be physical therapists, but should be licensed or certified as a healthcare provider in the state of their residence.
  4. A written informed consent form shall be presented to a patient for whom dry needling is being considered, telling the patient of the potential risks and benefits of dry needling. A copy of a completed form shall be preserved in the patient treatment record and another copy given to the patient.
  5. Dry needling treatment shall be performed in a manner consistent with generally accepted standards of practice, including sterile needle procedures and the standards of the U.S. Centers for Disease Control and Prevention. Treatment notes shall document how the patient tolerated the technique and the outcome of treatments.

Minimum Criteria for Licensees in pursuit of Dry Needling Certification:

  1. Prerequisites – Before undertaking dry needling education and training, a Physical Therapist shall have no less than two years of experience working as a licensed Physical Therapist.
  2. Education Requirements – Complete a minimum of 50 hours of face-to-face instruction in intramuscular dry needling treatment and safety, provided by a board-approved course of study.

Licensee Procedures with the LPTB:

  1. Upon completion of each board-approved Dry Needling course, licensee notifies the LPTB of completion by sending a copy of the certificate of completion via mail, email, or fax. Notification must be sent upon completion of each course.
  2. Licensee will receive “Dry Needling Episodes for Educational Purposes Acknowledgement” form, which must be signed by licensee and the original must be sent back to the LPTB office. This course provides the licensee with information about dry needling episodes that must be completed for educational purposes, if the course requires a certain number of episodes to be completed before taking additional coursework.
  3. Upon completion of 50 hours of board-approved Dry Needling Level coursework, licensee will receive “Letter to Dry Needling Certified Licensees” along with “Dry Needling Acknowledgement” form, which will be signed by Licensee and the original must be sent back to the LPTB office. The board office must have a signed Dry Needling Acknowledgement for every licensee practicing dry needling in Louisiana.

Maine – Allowed

June 17, 2016: The Board voted in full agreement that “dry needling” is a recognized technique associated with the practice of physical therapy and is an appropriate technique when used during the course of a physical therapy treatment.

 Maryland- Allowed

The Maryland board of Physical Therapy Examiners ruled that dry needling is in the scope of practice of a Physical Therapist as long as they meet the minimum education and training requirements.  A full description of the requirements is listed here.

Massachusetts – Unknown.

Michigan- Unclear : The Michigan Physical Therapy board has not ruled for or against physical therapists performing dry needling.

MINNESOTA – Unclear : The Minnesota Physical Therapy licensure board is silent on dry needling.  The board is prohibited from making position statements.

Mississippi (APTA statement here) – Allowed

A.To be deemed competent to perform intramuscular manual therapy a physical therapist must meet the following requirements:

  1. Documented successful completion of a intramuscular manual therapy course of study; online study is not considered appropriate training. a. A minimum of 50 hours of face-to-face IMS/dry needling course study; online study is not considered appropriate training. b. Three years of practice as a licensed physical therapist prior to using the intramuscular manual therapy technique.
    2. The physical therapist must have board approved credentials for providing intramuscular manipulation which are on file with the board office prior to using the treatment technique.
  2. The provider of the required educational course does not need to be a physical therapist. A intramuscular manual therapy course of study must meet the educational and clinical prerequisites as defined in this rule,

C(1)(a)&(b) and demonstrate a minimum of two years of intramuscular manual therapy practice techniques.

  1. A physical therapist performing intramuscular manual therapy in his/her practice must have written informed consent for each patient where this technique is used. The patient must sign and receive a copy of the informed consent form. The consent form must, at a minimum, clearly state the following information:
  2. Risks and benefits of intramuscular manual therapy.
    2. Physical therapist’s level of education and training in intramuscular manual therapy
    3. The physical therapist will not stimulate any distal or auricular points during intramuscular manual therapy.
  3. When intramuscular manual therapy is performed, this ust be clearly documented in the procedure notes and must indicate how the patient tolerated the technique as well as the outcome after the procedure.
  4. Intramuscular manual therapy shall not be delegated and must be directly performed by a qualified, licensed physical therapist.
    G. Intramuscular manual therapy must be performed in a manner consistent with generally accepted standards of practice, including but not limited to, aseptic techniques and standards of the center for communicable diseases.

Missouri – Unknown

Montana – Allowed

24.177.413    DRY NEEDLING

(1) Dry needling is a skilled technique performed by a physical therapist using a mechanical device, filiform needles, to penetrate the skin and/or underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability.

(2) Dry needling requires a physical therapy examination and diagnosis.

(3) Licensed physical therapists who perform dry needling must be able to demonstrate they have completed training in dry needling that must meet the American Physical Therapy Association (APTA) GUIDELINES: STANDARDS OF QUALITY FOR CONTINUING EDUCATION OFFERINGS BOD G11-03-22-69 and/or the Federation of State Boards of Physical Therapists (FSBPT) STANDARDS FOR CONTINUING COMPETENCE ACTIVITIES.

(a) Dry needling courses must include, but not be limited to, training in indications, contraindications, potential risks, proper hygiene, proper use and disposal of needles, and appropriate selection of clients.

(b) Initial training in dry needling must include hands-on training, written, and practical examination as required by this rule.

(4) A licensed physical therapist must perform dry needling in a manner consistent with generally accepted standards of practice, including relevant standards of the Center for Disease Control and Prevention, and Occupational Safety and Health Administration blood borne pathogen standards as per 29 CFR 1910.1030 et.seq.

(5) Dry needling shall only be performed by a licensed physical therapist and may not be delegated.

(6) The physical therapist performing dry needling must be able to provide written documentation, upon request by the board, which substantiates appropriate training as required by this rule. Failure to provide written documentation may result in disciplinary action.

 Nebraska – Allowed

On July 8, 2016, the Attorney General of Nebraska, Mr. Douglas Peterson, issued a ruling that “If dry needling is defined using the descriptions provided to this office by the Board of Physical Therapy and the APTA, it is our opinion that a reasonable legal argument can be made that dry needling is a “mechanical modality” or a “physical agent or modality” and, therefore, falls within the statutory definition of physical therapy.”  In addition, it was opinioned that dry needling was not within the scope of practice for OTs and Athletic Trainers. A copy of the legal opinion is available here.

A physical therapist who wished to perform tissue penetration for the purpose of dry needling must meet the following requirements:

  1. Complete pre-service or in-service training. The pre-service or in-service training must include:
  2. Pertinent anatomy and physiology;
  3. Choice and operation of supplies and equipment;
  4. Knowledge of technique including indications and contraindications;
  5. Proper technique of tissue penetration;
  6. Sterile methods, including understanding of hazards and complications; and
  7. Post intervention care; and
  8. Documentation of application of technique in an educational environment.
  9. The training program shall require training to demonstrate cognitive and psychomotor skills. Also, the training program must be attended in person by the physical therapist.
  10. Maintain documentation of successful completion of training.

Nevada – Allowed : Dry needling is within the scope of practice of physical therapists as ruled by NV Board of PT on March 20 2012. As of April 19 2012; the PT board legal counsel is writing up the new board Policy on dry needling and once signed by Chairman Kathy Sidener; dry needling will be permissible by PTs in NV.

New Hampshire – Allowed : October 19 2011: Physical Therapy Board Minutes: PTs can do dry needling if they have been trained to do so.

New Jersey – Not Allowed : On February 9, 2017, the Attorney General of New Jersey issued a statement that physical therapists are not authorized to engage in the practice of dry needling.

New Mexico – Allowed : March 2000: In a letter dated March 21 2000; the PT board determined that the PT Act does not prohibit dry needling and that Section 61-12D-3: Paragraph I: Number 2 – describing the practice of physical therapy supports that decision.

New York : Not Allowed

North Carolina – Allowed : On January 15th, 2015 the Rules Review Commission meeting restated the board’s opinion that dry needling is within the scope of practice of physical therapy. The Board also believes physical therapists can continue to perform dry needling so long as they possess the requisite education and training required by N.C.G.S. § 90-270.24(4), but there are no regulations to set the specific requirements for engaging in dry needling. Read the RRC’s statement

On August 2, 2017, Louis A. Bledsoe, III, Special Superior Court Judge for Complex Business Cases of the North Carolina General Court of Justice, Superior Court Division, ruled that physical therapists may perform dry needling.  A copy of the legal opinion is available here.  The Court’s ruling affirms a decision by the North Carolina Board of Physical Therapy Examiners that reached the following conclusions:

  • “The scope of physical therapy under North Carolina law includes dry needling.”
  • “Dry needling is distinct from acupuncture.”
  • The Acupuncture Board “fails to recognize that health professions are allowed to have overlapping scope of practice.”
  • “North Carolina public policy favors patient choice in health care.”

NORTH DAKOTA – Allowed : Board meeting May 13 2013: The board voted to state that ‘Dry Needling’ is within the scope of practice for PT in North Dakota.

Ohio – Allowed : It is the position of the Physical Therapy Section that nothing in the Ohio Physical Therapy Practice Act prohibits a physical therapist from performing dry needling techniques. As with any specialized procedure, the physical therapist must have training and demonstrate competency in the modality. The manner in which the training is obtained and competency demonstrated are not addressed in the Practice Act. The PT Board recommends you contact the OPTA for approved coursework in dry needling at www.ohiopt.org .

Oklahoma : Unknown.

Oregon – Unclear : Oregon Physical Therapist Licensing Board 2.18.14 Board Updated Statement Relevant to Physical Therapists using the Intervention of Dry Needling.On January 23, 2014 the Court of Appeals Appellate Commissioners held the opinion that dry needling is not within the scope of practice of chiropractic medicine and the recently adopted rule (OAR 811-015-0036) exceeded the scope of the Chiropractic Board’s statutory authority and is invalid.At its February 18, 2014 Special Meeting the Oregon Physical Therapist Licensing Board discussed the Appellate Courts findings and has determined the Appellate Courts opinion is not applicable to the practice of physical therapy.The primary accountability of the Oregon Physical Therapist Licensing Board is public protection, rather than promotion of the profession. The Board has established professional standards of practice which help assure that physical therapists and physical therapist assistants are properly educated, hold valid/current licenses, practice within their scope of practice and continue to receive ongoing continuing competency training.The Oregon Physical Therapist Licensing Board still holds to its original opinion that dry needling of trigger points is likely within the physical therapist scope of practice (excluding PTAs). Further, the Board acknowledges that dry needling of trigger points is an advanced intervention requiring post graduate training and education. In the interest of public safety, until a measure of evidence based training and education can be determined, the Board strongly advises its licensee to not perform dry needling of trigger points. The Board, in partnership with the Oregon Physical Therapy Association, will continue to monitor National trends and legislation regarding this issue.

Pennsylvania – Not Allowed : Physical therapy board was advised by legal counsel that dry needling is not within the scope of practice of a physical therapist.

Rhode Island – Allowed : Feb 14 2012 PT board minutes: Board members revisited the matter of dry needling for intramuscular therapy. A board member questioned if it pertained to other professions; including Acupuncturist. The board administrator related guidance from attorney Tom Corrigan stating the use of a needle by one profession does not preclude a different profession from having a different use for a needle. Board members comment dry needling is within their scope of practice provided the licensed professional is comfortable trained and has appropriate background knowledge. For licensed physical therapists that are not qualified there are educational seminars they may sign up for and gain the required background and training.

South Carolina – Allowed : In an email written in October 2004 in response to a licensed practitioners question regarding scope of practice and dry needling; the Chairperson affirmed that dry needling appears to fall within the SOP of a licensed PT in SC if they are fully trained in its use and comply with all legal and ethical requirements for professional practice in physical therapy.

South Dakota – Not Allowed : The South Dakota Board of Medical and Osteopathic Examiners considers procedures involving the breaking or altering of human tissue for diagnostic; palliative or therapeutic medical purposes to be the practice of medicine. The board determines that dry needling is significantly different from ‘electromyography (EMG)’ which the board previously opined was an activity within the scope of practice for a physical therapist. Decision: The South Dakota Board of Medical and Osteopathic Examiners determined that the procedure known as ‘dry needling’ does not fall within the physical therapist scope of practice as defined in SDCL ch. 36-10. This opinion issued by the Board of Medical and Osteopathic Examiners is advisory in nature. It does not constitute an administrative rule or regulation and is intended solely to serve as a guideline for persons registered; licensed; or otherwise regulated by the Board of Medical and Osteopathic Examiners.

Tennessee – Allowed : On March 16, 2015, the House of Tennessee passed House Bill 25, which cleared the way for physical therapists in TN to start using dry needling again in clinical practice.  The bill also clarifies that the Physical Therapy board will be required to establish minimum competency requirements for a physical therapist to practice dry needling. The bill also redefined “dry needling” to clarify that the practice is for the management, instead of evaluation and management of neuromusculoskeletal conditions, pain, and movement impairments.  On March 23, 2015, the Senate of Tennessee passed the legislation.  On April 9, 2015, Governor Bill Haslam signed the bill into law effective July 1, 2015

New Rule: 1150-01-.22 Dry Needling

(1) In order to perform dry needling, a physical therapist must obtain all of the educational instruction described in paragraphs (2)(a) and (2)(b) herein. All such educational instruction must be obtained in person and may not be obtained online or through video conferencing.

(2) Mandatory Training – Before performing dry needling, a practitioner must complete educational requirements in each of the following areas:

(a) Fifty (50) hours of instruction, to include instruction in each of the four areas listed herein, which are generally satisfied during the normal course of study in physical therapy school:

  1. Musculoskeletal and Neuromuscular systems;
  2. Anatomical basis of pain mechanisms, chronic pain, and referred pain;
  3. Trigger Points;
  4. Universal Precautions; and

(b) Twenty-four (24) hours of dry needling specific instruction.

  1. The twenty-four (24) hours must include instruction in each of the following six (6) areas:

(i) Dry needling technique;

(ii) Dry needling indications and contraindications;

(iii) Documentation of dry needling;

(iv) Management of adverse effects;

(v) Practical psychomotor competency; and

(vi) Occupational Safety and Health Administration’s Bloodborne Pathogen Protocol.

  1. Each instructional course shall specify what anatomical regions are included in the instruction and describe whether the course offers introductory or advanced instruction in dry needling.
  2. Each course must be pre-approved by the Board or its consultant. For a course to be pre­approved, the provider must provide to the Board administrator the name of the course provider, a synopsis and description of the course, and a copy or description of any course materials used.

(3) A newly-licensed physical therapist shall not practice dry needling for at least one (1) year from the date of initial licensure, unless the practitioner can demonstrate compliance with paragraph (2) through his or her pre-licensure educational coursework.

(4) Any physical therapist who obtained the requisite twenty-four (24) hours of instruction as described in paragraph (2)(b) in another state or country must provide the same documentation to the Board, as described in paragraph (2)(b), that is required of a course provider. The Board or its consultant must approve the practitioner’s dry needling coursework before the therapist can practice dry needling in this state.

(5) Dry needling may only be performed by a licensed physical therapist and may not be delegated to a physical therapist assistant or support personnel.

(6) A physical therapist practicing dry needling must supply written documentation, upon request by the Board, that substantiates appropriate training as required by this rule. (7) All physical therapy patients receiving dry needling for the first time shall be provided written documentation from the patient’s physical therapist that includes a definition and description of the practice of dry needling, a description of the education and training taken by the physical therapist which qualifies the therapist to practice dry needling, and a description of any potential side effects of dry needling, and the patient must give written informed consent after acknowledging the risks before dry needling may begin.

Texas – Allowed : Based on the broad definitions of physical therapy established by the Legislature and the Board, the Board has concluded that “dry needling is within the scope of practice of a Texas physical therapist.  TX allows PT to take DN Courses  and currently they do not have any specific credential hours-requirements, but they said that it is the responsibility of the Licensee to make sure that he/she is competent enough to incorporate DN in their practice and use it safely. They can use the credentials and practice it. But they should be competent enough and have the complete knowledge and safety rules of it.

For TX Licensed PTA : The Texas PT Practice Act/rules do not prohibit a PTA from performing dry needling. The supervising PT holds the primary responsible for all physical therapy care rendered under his/her supervision, and is responsible for assuring that a PTA has the competencies required to perform any treatment or modality, including dry needling. Consideration should be given to the PTA’s level of skill/training and experience/advanced competency, the practice setting in which the procedure is performed, the type of monitoring that might be needed, and the acuity and complexity of the patient’s condition. It would be a violation of the PT Practice Act/Rules for a PT to delegate a technique or procedure to a PTA who is not competent to perform it, and it would be a violation of the PT Practice Act/Rules for a PTA to perform or attempt to perform techniques or procedures for which they are not competent. It is recommended that you review the rules and regulations of payer sources, i.e. Medicare/Medicaid or private insurance, to determine if dry needling is reimbursable if performed by a PTA as they can differ from the licensure rules/regs.

For TX Licensed OTs : According to §362.1(32)(C)(xiii) of the OT Rules, occupational therapy interventions and procedures that promote or enhance safety and performance in activities of daily living (ADL), instrumental activities of daily living (IADL), education, work, play, leisure, and social participation include the application of physical agent modalities, and use of a range of specific therapeutic procedures (such as wound care management; techniques to enhance sensory, perceptual, and cognitive processing; manual therapy techniques) to enhance performance skills. The Texas Board of Occupational Therapy Examiners does not dictate the specific modalities, techniques, or procedures that may be incorporated into the occupational therapy plan of care.  However, at all times, it is the responsibility of the occupational therapy practitioners (OTs and OTAs) to demonstrate competency in all modalities, techniques, and procedures used for treatment. The occupational therapy practitioners must know how to perform and demonstrate proficiency in, as noted, any modalities, techniques, or procedures performed; however, please note that the Board does not specify certifications they must hold for specific modalities, etc.  The occupational therapy practitioners are responsible for all of the modalities, techniques, or procedures that are used and the use of such must comply with the OT Rules and OT Practice Act.  To access the full OT Rules and OT Practice Act, please follow the link  http://www.ptot.texas.gov/page/ot-acts-and-rules

Utah – Allowed : On April 1: Utah Governor Gary R. Herbert signed into law HB 367. The legislation amends the Utah physical therapy statute to specifically add dry needling to the physical therapist scope of practice. Read the full scope of practice amendments. Requirements

Vermont – Allowed : On June 22, 2015, the Office of Regulation replied pointing out that “under the existing law, the Vermont Office of Professional Regulation believes that physical therapists reasonably may practice TDN if appropriately trained and experienced, and if the therapy is reasonably indicated for the relief of an impairment of physical movement.”

Virginia – Allowed : July 18 2012: Opinion of the West Virginia Board of Physical Therapy Regarding Dry Needling Therapy: In summary; the Board is of the opinion that dry needling is within the scope of the practice of ‘physical therapy’ as defined by West Virginia Code.

Board of Physical Therapy : Guidance on Dry Needling in the Practice of Physical Therapy

Upon recommendation from the Task Force on Dry Needling, the Board voted that dry needling is within the scope of practice of physical therapy but should only be practiced under the following conditions:

  • Dry needling is not an entry level skill but an advanced procedure that requires additional training.
  • A physical therapist using dry needling must complete at least 54 hours of post professional training including providing evidence of meeting expected competencies that include demonstration of cognitive and psychomotor knowledge and skills.
  • The licensed physical therapist bears the burden of proof of sufficient education and training to ensure competence with the treatment or intervention.
  • Dry needling is an invasive procedure and requires referral and direction, in accordance with § 54.1-3482 of the Code of Virginia.  Referral should be in writing and specific for dry needling; if the initial referral is received orally, it must be followed up with a written referral.
  • If dry needling is performed, a separate procedure note for each treatment is required, and notes must indicate how the patient tolerated the technique as well as the outcome after the procedure.
  • A patient consent form should be utilized and should clearly state that the patient is not receiving acupuncture.  The consent form should include the risks and benefits of the technique, and the patient should receive a copy of the consent form.  The consent form should contain the following explanation:

Dry needling is a technique used in physical therapy practice to treat trigger points in muscles.  You should understand that this dry needling technique should not be confused with a complete acupuncture treatment performed by a licensed acupuncturist. A complete acupuncture treatment might yield a holistic benefit not available through a limited dry needling treatment

Guidance Document 112-9

Board of Physical Therapy Guidance on Dry Needling in the Practice of Physical Therapy

Upon recommendation from the Task Force on Dry Needling, the board voted that dry needling is within the scope of practice of physical therapy but should only be practiced under the following conditions:

Dry needling is not an entry level skill but an advanced procedure that requires additional training.

A physical therapist using dry needling must complete at least 54 hours of post professional training including providing evidence of meeting expected competencies that include demonstration of cognitive and psychomotor knowledge and skills.

The licensed physical therapist bears the burden of proof of sufficient education and training to ensure competence with the treatment or intervention.

Dry needling is an invasive procedure and requires referral and direction, in accordance with § 54.1-3482 of the Code of Virginia. Referral should be in writing and specific for dry needling; if the initial referral is received orally, it must be followed up with a written referral.

If dry needling is performed, a separate procedure note for each treatment is required, and notes must indicate how the patient tolerated the technique as well as the outcome after the procedure.

A patient consent form should be utilized and should clearly state that the patient is not receiving acupuncture. The consent form should include the risks and benefits of the technique, and the patient should receive a copy of the consent form. The consent form should contain the following explanation:

Dry needling is a technique used in physical therapy practice to treat trigger points in muscles. You should understand that this dry needling technique should not be confused with a complete acupuncture treatment performed by a licensed acupuncturist. A complete acupuncture treatment might yield a holistic benefit not available through a limited dry needling treatment.

Washington – Not Allowed : The statute that defines the practice of physical therapy allows a variety of interventions, but we conclude that the best reading of the statute excludes dry needling from the practice of physical therapy. Our conclusion is based solely on the law as currently written; it is not our role to weigh the policy benefits and drawbacks of authorizing physical therapists to engage in dry needling. The legislature, of course, could also expand the scope of physical therapy by amending the relevant statutes. Here is a link to the full AG’s opinion.  On April 15, 2016, the Attorney General of Washington State concluded that “The definition of the practice of physical therapy indicates that the legislature did not intend to include dry needling within the scope of practice. We have been informed of many reasons for including dry needling in the practice of physical therapy and arguments to the contrary, but our role is not to resolve such public policy disputes. We conclude only that RCW 18.74, as currently written and implemented, does not encompass dry needling in the practice of physical therapy.”

West Virginia – Allowed : July 18 2012: Opinion of the West Virginia Board of Physical Therapy Regarding Dry Needling Therapy: In summary; the Board is of the opinion that dry needling is within the scope of the practice of ‘physical therapy’ as defined by West Virginia Code.

Wisconsin – Allowed : July 2009 Board Minutes: Discussion of Dry Needling – Statute 448.50 (6) allows for ‘therapeutic intervention’ within the scope of physical therapy. Larry Nosse discussed the use of dry needling as a therapeutic technique. This process uses sterile techniques; the surface skin is cleaned; it does not draw blood and the physical therapists are trained in blood-body precautions. Mark Shropshire noted that the American Academy of Orthopedic and Manual Physical Therapists has made a position statement that dry needling is within the scope of practice of physical therapy. California; Nevada; Tennessee; and Florida do not allow this technique within the scope of practice within physical therapy because these states have language noting that PTs cannot puncture the skin. MOTION: Otto Cordero moved; seconded by Jane Stroede that 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. Motion carried unanimously.

Wyoming – Allowed : In a letter dated Aug 18 2009: the Wyoming Board of Physical Therapy affirmed that nothing in the current practice act would preclude PTs performing dry needling with proper credentials.