Dry Needling

[GeneChing]

I've only heard a little about this. Anyone know more?

'Dry needling' for pain therapy is under scrutiny
Kim Painter, Special for USA TODAY 10:39 a.m. EDT July 17, 2016


(Photo: The Ohio State University Wexner Medical Center)
Alex Pierce, 25, took up distance running with great enthusiasm a couple of years ago. Then she developed knee pain so severe that she could not climb stairs.

So Pierce, a doctoral student in food science, went to see physical therapist Matt Briggs at The Ohio State Wexner Medical Center in Columbus. He performed deep massages, suggested changes in her running form and taught her how to exercise her thigh and gluteal muscles to better protect her knees. She believes all of that helped.

But Pierce, like a growing number of patients, had another treatment she is convinced helped even more. It’s called "dry needling," and it involves the insertion of thin, non-medicated solid needles into muscles or connective tissues. Proponents say it can reduce pain and improve movement. Pierce has had the procedure more than half a dozen times and believes it is one reason she will be able to run her fourth marathon in November.

“This has kind of changed my life,” she says.


Dry needling involves the insertion of non-medicated solid needles at certain points in the body. (Photo: The Ohio State University Wexner Medical Center)
Testimonials like that are a big reason dry needling has caught on with some physical therapists, athletes and other patients, Briggs says. But testimonials are not scientific proof.

And there, Briggs says, is where dry needling is lacking. While some studies have shown promise, he says, “the quality of the evidence is not strong.” That’s why Briggs and his colleagues are starting a study looking at dry needling in “runner’s knee,” the condition that has plagued Pierce. Their goal, and the goal of other researchers now looking at dry needling, is to produce results rigorous enough to show whether it really works.

For now, here’s what consumers should know:


Alex Pierce, 25, is running again after her knee pain was treated with dry needling. (Photo: The Ohio State University Wexner Medical Center)

Is this acupuncture?

Physical therapists say it is not, “though superficially, it may look the same,” says Justin Elliott, vice president of government affairs for the American Physical Therapy Association. For one thing, he says, dry needling as performed by a physical therapist is not rooted in ancient Chinese medicine — there’s no talk about redirecting the body’s energy flow by placing needles at certain points in the body. Instead, needles are placed directly in problem areas.

Elliott says dry needling also is practiced by some chiropractors, naturopathic physicians and nurses, which puts it outside the realm of any one specialty.

Acupuncturists beg to differ. “What is being called dry needling is clearly a form of acupuncture” and should be done only by professionals extensively trained in that discipline, says Thomas Burgoon, a West Chester, Pa., physician who is president of the American Academy of Medical Acupuncture. He says many acupuncturists do exactly what the physical therapists describe, with the same kind of needles.

Burgoon’s group has persuaded some states to bar physical therapists from the practice.

How might it work?

One theory is that the needles cause tight muscles to twitch, then relax. The needles may also increase blood flow or set off nerve responses that alter pain perception, Briggs says.

Another possibility: It’s a placebo effect, an improvement triggered by the expectation that a treatment will work rather than by the treatment itself. To look for that possibility, the Ohio State study will compare patients who get the real needle treatment to those poked with sham needles that don’t pierce the skin.

Mark Crislip, an infectious-disease doctor in Portland, Ore., who recently wrote about dry needling for Science-Based Medicine — a website critical of alternative medicine — says the version practiced by physical therapists doesn’t “come with the mystical baggage that accompanies acupuncture.” But he says it may well be a “theatrical placebo.”

What do published studies say?

“It’s a mixed bag,” Elliott says. In a 2011 review, the physical therapy association rated the evidence for dry needling a 3 out of 5, based on the best studies. A formal analysis of 35 trails on acupuncture and dry needling for chronic lower back pain was published by the Cochrane research group in 2005. It found they “may be useful” additions to standard treatment. But it said higher quality studies were needed.

What are the risks?

Needling can produce minor bleeding and some soreness, but in trained hands, and with the use of sterile needles and gloves, “it’s a very safe procedure,” Briggs says.

In rare cases, deep needling can lead to a punctured lung or injuries to nerves and blood vessels, and acupuncturists fear non-specialists will be more likely to make such mistakes, Burgoon says.

Will insurers pay for this?

Many will not. Charges for patients can range from $10 to $75 per session, says Edo Zylstra, CEO of KinetaCore, a company that offers intensive three-day weekend courses in dry needling to physical therapists.

Do all physical therapists offer this?

No. The physical therapy association tells members in seven states to steer clear because of recent court or regulatory decisions or language in existing licensing laws. They are: California, Florida, Hawaii, Idaho, New York, South Dakota and Washington.

And most of the nation’s 200,000 licensed physical therapists are not trained in the technique. About 6,000 have taken courses in dry needling in the past few years, Zylstra says.

[GeneChing]

A lawsuit. I was thinking this might be headed this way...

Acupuncturists sue Colorado’s physical therapy board over the very definition of their craft
Board policy allowing less-trained therapists to practice “dry needling” is unsafe, says Acupuncture Association of Colorado in suit


Seth McConnell, The Denver Post
An acupuncture needle in a clients ear at Hasse Family Chiropractic in Lakewood, Colorado on May 18, 2016.
By DAVID MIGOYA | dmigoya@denverpost.com | The Denver Post
PUBLISHED: April 5, 2017 at 5:28 pm | UPDATED: April 7, 2017 at 1:16 pm

A needling controversy between Colorado’s acupuncturists and physical therapists over the former’s exclusive claim to the Chinese technique could ultimately be decided by a judge.

The Acupuncture Association of Colorado has sued the state’s Physical Therapy Board for refusing to rescind a rule that allows the lesser-trained therapists to practice “dry needling,” a technique acupuncturists say is merely a euphemism for what they have done for centuries.

They claim the procedure is dangerous in the hands of an untrained practitioner and point to a number of Coloradans – including Olympic skier Torin Yater-Wallace – injured as a result, mostly from collapsed lungs.

“They needed to call it something, and you can’t say it’s acupuncture without having to undertake all the requirements of training,” said Stuart Wilcox, the Denver attorney representing AAC. “A lot of the controversy by the acupuncturists isn’t that they’re losing business; it’s that they’re fundamentally concerned that insufficiently trained practitioners are hurting patients.”

The American Medical Association last year noted that “dry needling is indistinguishable from acupuncture” and the U.S. Food and Drug Administration says the needles – called filiform needles – are to be made available only to qualified practitioners of acupuncture.

A spokesperson for the Colorado Division of Regulatory Agencies, which houses the board, said it could not comment because it’s an ongoing legal matter.

“PTs provide essential health care and, concerning dry needling, have demonstrated exceptional safety: No PT in Colorado has lost their license or been sanctioned due to improper use of dry needling in patient care,” said Cameron MacDonald, president of the Colorado chapter of the American Physical Therapy Association, in an emailed statement. “PTs are well-trained, receiving more than 3,400 hours of education as post-graduates after a four-year entry level degree.”

Claiming their petitions to the board to repeal the rule were little more than brushed aside, the AAC and the Colorado Safe Acupuncture Association filed suit in Denver District Court last month to force the issue.

Three states – California, Washington and Oregon – have removed similar provisions after court battles, and several others are expected to do the same.

In the suit, the groups say they pushed to have Rule 211 — adopted five years ago — abolished because it allows physical therapists to practice dry-needling with only 46 hours of training for the very same procedures acupuncturists must attend 1,905 hours of classes to be licensed — more than 40 times the amount.

There are more than 6,000 registered physical therapists in Colorado. There are about 1440 licensed acupuncturists here, according to DORA.

The acupuncture groups say the rule is illegal because it gives therapists the authority to practice an invasive procedure that, by law, they are not allowed to do, with needles that are, by definition, controlled by federal law.

The board is made up of five physical therapists and two members of the public, all appointed by the governor. The legislature reestablished the board in 2012 after a 25-year absence when the authority had been under the director of the state Division of Regulatory Agencies.

Shortly afterward, the board passed Rule 211 allowing physical therapists to practice dry needling, which is described in the rule as “based upon Western medical concepts.” It had been allowed previously, but the rule formalized it.

“Dry needling involves the insertion of needles into the same ‘trigger points’ that have been recognized in acupuncture as reactive acupuncture points, also known as ‘ashi points’ for over 2,000 years,” the lawsuit says. “Physical therapists often argue that they are not engaged in the practice of acupuncture, asserting that dry needling is based on Western medical ‘philosophies’ or concepts. There is no dispute, however, that insertion of FDA-regulated acupuncture needles as deep as five inches into patients qualifies as acupuncture.”

Skier Yater-Wallace suffered a collapsed lung after a physical therapist punctured it during a procedure with an acupuncture needle.

The suit notes two other Olympic athletes – American mixed martial artist Mitch Clarke and Canadian judoist Kim Ribble-Orr – who suffered severe injuries during dry-needling procedures.

The lawsuit lays out how AAC members petitioned the board in January to repeal the rule, in part because physical therapists in Colorado are, by law, only allowed to practice noninvasive procedures and treatments.

The board met in executive session “to obtain legal advice” on the petition, minutes of the meeting show. Then, without explanation, the board in open session declined to rule on it.

“Fear of needles is one of the greatest challenges to acupuncturists seeking new patients,” the lawsuit says. “Regardless of the alternate name ‘dry needling,’ unsafe practice of acupuncture damages the reputation of all acupuncturists in Colorado …”

MacDonald said the scope of the procedure is determined by who’s handling the needle.

“Dry needling, when performed by a PT, is physical therapy, when performed by a chiropractor is chiropractic care, and when performed by an acupuncturist is acupuncture,” MacDonald said in the statement.

Editor’s note: This story has been updated to include a statement from the American Physical Therapy Association and to reflect the accurate number of licensed acupuncturists in the state. An incorrect number initially had been provided by DORA.

[herb ox]

Highly controversial - and the main problem seems to be that the training required for "dry needling certification" is minimal - in the neigborhood of 20-200 hours. Contrast that to TCM education and subsequent licensing requirements in most states - avg 3200 hours. The majority of adverse events involving needling have been from PT's and athletic trainers doing this so-called dry needling.

From the tone of my post, I'm sure you can infer where I stand on the subject

herb ox

[herb ox]

It's really all about invasive vs non invasive procedures...

LEGAL OPINION COULD CURB ‘DRY NEEDLING’ PRACTICE BY PHYSICAL THERAPISTS

LILO H. STAINTON | APRIL 12, 2017
Attorney general decides physical therapy does not include treatments that break the skin; acupuncturists applaud opinion

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.


“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.”

[GeneChing]

They're even poaching Veterinary acupuncture.

Equine Dry Needling – A practical guide for the competent therapist


"Equine Dry Needling" by Cornelia Klarholz and Andrea Schachinger

Cornelia Klarholz and Andrea Schachinger transfer their experience of dry needling to horses and explain how in their new book "Equine Dry Needling".

Humans have used the method of dry needling for many decades. It is helpful as a therapy for muscular trigger points and has helped many people with their myofascial pain syndrome. Andrea Schachinger and Cornelia Klarholz thought that this method could also be useful for treating horses and have transferred their knowledge of this method accordingly. In this book, experienced as well as new dry needling therapists can learn more about how equine dry needling works. Questions about the histology and pathophysiology of myofascial pain and the formation of trigger points and movement disorders are answered in a professional and clear way.

Other topics that are covered in "Equine Dry Needling" by Cornelia Klarholz and Andrea Schachinger include the basic rules of Equine Dry Needling, the Schachinger Equine Dry Needling Method’s mode of action, the differential diagnosis and the indicators, and the exact treatment of each muscle including insertion technique. After reading this well designed reference book, no question about equine dry needling should remain open.

"Equine Dry Needling" by Cornelia Klarholz and Andrea Schachinger is now available from tredition or can alternatively be ordered by using ISBN 978-3-7323-9045-8. The main aim of the tredition publishing house is to provide young and unknown authors with the chance to publish their own books, and to offer cooperations to publishers and book sellers. Tredition publishes books across all media types, distribute them in the book industry, and also actively market books since October 2012.

Additional information about this book can be found here: www.tredition.de

Media Contact
Company Name: Tredition GmbH
Contact Person: Nadine Otto
Email: presse@tredition.de
Phone: 040414277800
Address:Grindelallee 188
City: Hamburg
Country: Germany
Website: https://tredition.co.uk/

[mickey]

Greetings,

I agree that there should be a distinction between invasive and non-invasive practices and that invasive practices like dry needling falls under the umbrella of acupuncture.

I am scratching my head over why the PTs did not pursue acupressure to begin with; or, moxibustion. Or is it just about money?

mickey

[GeneChing]

PHYSICAL THERAPISTS WIN LATEST BATTLE IN TURF WAR WITH ACUPUNCTURISTS
LILO H. STAINTON | OCTOBER 16, 2018
Although acupuncturists are vehemently opposed, a measure allowing certain PTs to use “dry needling” to help relieve pain has advanced in the state Assembly


Credit: Air Force Medical Service

Patients, several large healthcare systems, and even the New York Giants joined physical therapists yesterday in support of a measure to allow certain trained physical therapists licensed in New Jersey to perform dry needling, a drug-free technique used to reduce pain.

But acupuncturists and some doctors continued to oppose the legislation, which they said would weaken the state’s regulatory standards — rules that currently allow only licensed acupuncturists to perform this kind of work — and could endanger patients.

The Assembly Regulatory Professions Committee sided with the physical therapists, however, voting yesterday to advance the bill to expand the use of dry needling, although several members stressed it was not a slight on the work of acupuncturists. The bill establishes training and other requirements for these PTs and would define the technique as something separate from acupuncture.

“As a patient of both entities, this is really not a step on anybody’s toes,” said Assemblywoman Angelica M. Jimenez (D-Hudson), a lead sponsor of the bill who chaired the hearing, which involved more than an hour of passionate testimony from advocates on both sides of the issue, and letters of support from the Giants and two of the state’s largest health systems, RWJBarnabas Health and Atlantic Health. The Medical Society of New Jersey was one of several physicians groups that opposed the bill.

Acupuncturists say PTs not properly trained for it

Monday’s hearing was the latest round in a longstanding turf battle over who can use the technique, which involves the insertion of dry, or “empty” hollow-tipped needles into key muscle points. Acupuncturists, who use these tools and a technique based on ancient Chinese principles, to treat pain, behavioral health issues and other conditions, insist physical therapists are not properly trained to pierce the skin with these needles.

“Dry needling is just another name for acupuncture. It’s been relabeled,” said Jason Sargis, president of the New Jersey Association of Acupuncture and Oriental Medicine, noting that by using a different term, PTs are in fact providing treatments outside the scope of their practice. With the legislation, the state is “actually lowering the standards, and that’s going to present a risk to the public,” he added.

But physical therapists insist there is a difference in how the needles are used and they stress that, with proper education, they should also be able to provide this popular therapy — especially given the growing need for nonaddictive pain treatment. For close to a decade they have been pushing state officials to change the regulations and allow them to use dry needling, after receiving certain training.

“We look at acupuncture as a profession and dry needling as a technique,” said Daniel Klim, who heads the American Physical Therapy Association of New Jersey. “The association supports this (expansion bill) because it is an additional tool in the physical therapy toolkit,” he said.

Patients say they’ve suffered

In fact, several hundred of the roughly 11,000 PTs in New Jersey offered dry needling for years, some dating back to 2008. But this ended in September 2017, after the state Attorney General found that the technique was outside the scope of practice for physical therapists here. The state’s more than 1,000 licensed acupuncturists could still offer the procedure, but some PT patients told the committee they have been suffering without treatment ever since.

“I teared up. I could not believe someone would take away this miracle,” recalled Patti Heffner, a nurse who benefited from dry needling in her battle against chronic pain, when she learned of the AG’s ruling. “I cannot stress enough how much this technique matters. It works.”

(Acupuncturists suggested to the committee this period of unregulated dry needling by physical therapists could have been dangerous to patients, although PTs note there were no complaints filed with state officials. “It was the Wild West, for lack of a better term,” said Paul Bent, the lobbyist for the acupuncture association.)

In July 2018, former Gov. Chris Christie signed legislation that updated the scope of practice for PTs, allowing them to diagnose and treat balance disorders, perform wound care — a technique that involves removing dead skin with a scalpel — and assisting patients with general health and wellness goals. But, despite advocacy from the profession, the changes did not include dry needling.

Fifty-four hours of training

The legislation (A-392) — introduced in January by Assembly members Jimenez, committee chair Thomas P. Giblin (D-Essex), Tim Eustace (D-Bergen) and former Assembly speaker and member Vincent Prieto (D-Bergen), who stepped down last year — seeks to reinstate the practice among willing PTs, under certain conditions.

The bill would require PTs to complete a 54-hour continuing education course on dry needling, that they are certified in cardio-pulmonary resuscitation, have two years’ experience in the field and hold an active, unrestricted license in New Jersey. Under current licensing regulations, acupuncturists must complete at least 2,500 hours of professional training, on top of course work.

The measure also provides a definition of the practice — something now lacking in state law — and makes clear that dry needling is distinct from acupuncture. It would require patients to sign a consent form acknowledging they have been informed of the risks and that they understand they are receiving dry needling, not acupuncture. It also calls for PTs to document their training and treatments carefully, or risk losing their permission to practice the technique.

“It’s a great technique. The dry needling is just a tool that blows the doors off any other (muscular-skeletal pain) technique that’s out there,” Steve Curtis, a licensed PT for three decades who also became an acupuncturist 18 years ago, told the Assembly panel. “Why deny it to anyone? I don’t know why there has to be such a turf war.”

A companion version of the measure, led by Sens. Nellie Pou (D-Passaic) and Richard J. Codey (D-Essex), cleared the Senate Commerce Committee in February and awaits action by the Senate Budget Committee.

Another one of my Kung Fu brothers is an acupuncturist and his eye-roll whenever I bring up dry needling