Dry needling and acupuncture

Jefferson Breland

(4/2024) I have been asked about dry needling a number of times recently. It is a controversial subject in the acupuncture community. Rather than simply share my opinions with you, I thought, let me learn more about this practice performed by chiropractors and physical therapists and share it with you.

As the Emmitsburg News-Journal serves a readership in both Maryland and Pennsylvania, I will present the current training and practice guidelines for both dry needling and acupuncture in both states.

My goal today is to provide information to help you make informed choices. To achieve this goal, I will cite sources from healthcare organizations, state health agencies, as well as professional associations. I will reserve my opinion until the end of the article.

First off, what is dry needling?

According to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) (the national professional certification organization),

"'Dry needling' is acupuncture. Acupuncture is the insertion of thin solid needles into anatomical locations to treat disease, injury, pain, or dysfunction, and to promote health and wellness. 'Dry needling' is a recently coined name for an acupuncture technique that involves the insertion of acupuncture needles directly into muscles and 'trigger points' for the relief of musculoskeletal pain."

From the Cleveland Clinic website- my.clevelandclinic.org/health/treatments/16542-dry-needling: "Dry needling isn’t the same as acupuncture. Both procedures involve penetrating your skin with needles. They use the same type of needles, but that’s where the similarities end.

Different providers with different training perform dry needling. Acupuncture is performed by licensed acupuncturists and based in Eastern medicine, while dry needling is based in Western medicine and evaluation of pain patterns, postures, faulty movement patterns and orthopaedic testing.

Acupuncture treats musculoskeletal pain but also treats other systems of your body. Dry needling treats muscle tissue with the goal of reducing pain, inactivating trigger points and improving movement. Typically, it’s used as part of a broader physical therapy approach that includes other physical therapy treatments."

In the state of Maryland, the requirements for physical therapists and chiropractors are similar since chiropractors must have physical therapy privileges to perform dry needling so I have only listed the requirements for physical therapists:

Minimum Education and Training Necessary to Perform Dry Needling.

"A. In order to perform dry needling, a physical therapist shall have at least 80 total hours of instruction, which includes:

(1) A total of at least 40 hours of instruction in the following dry needling-specific course content areas: (a) Theory and application of dry needling; (b) Dry needling technique, including spine and extremities; (c) Dry needling indications and contraindications; (d) Infection control, the Occupational Safety and Health Administration’s Bloodborne Pathogen Protocol, and safe handling of needles; (e) Emergency preparedness and response procedures related to complications associated with dry needling; and (f) Appropriate documentation of dry needling.

(2) At least 40 hours of practical, hands-on instruction in the application and technique of dry needling, under the supervision of a licensed health care practitioner competent in dry needling procedures who has: (a) Completed the requisite course work under §A(1) of this regulation; and (b) Practiced dry needling for at least 5 years….

(3) A physical therapist shall have practiced physical therapy for at least 2 years before performing dry needling in the State…. (edited for brevity)"

"Standards of Practice in Performing Dry Needling.

A physical therapist shall: (1) Fully explain dry needling to the patient in advance of treatment; and (2) Obtain written informed consent specific to dry needling that shall be included in the patient’s medical record…. (edited for brevity)

Dry needling is not within the scope of practice of limited physical therapy and shall only be performed by a licensed physical therapist." www.health.maryland.gov/regs/Pages/10-38-12-Dry-Needling-(.aspx

According to my research, the education and hands-on training for dry needling vary from state to state which is to say there are no national standards. Maryland requires the most training of any of the jurisdictions where dry needling is allowed.

According to the website of the American Physical Therapy Association as of June 2023: "Law permits physical therapists to perform dry needling in 39 states and District of Columbia. Law prohibits physical therapists to perform dry needling in 4 states: California, Hawaii, New York, and Oregon. The law is silent on physical therapists performing dry needling in 7 states: Connecticut, Massachusetts, Michigan, Minnesota, Missouri, Oklahoma, and Pennsylvania."

If you live in Pennsylvania: "The State Board of Physical Therapy would like to remind you that 'Dry Needling' is not currently within the scope of physical therapist practice… it is not legal to perform this procedure as a physical therapist in the Commonwealth of Pennsylvania."

According to the Maryland Acupuncture Practice the minimum requirements to obtain an acupuncture license are: "§ 1A-302. (Sections 1-2 removed for brevity): Demonstrate competence in performing acupuncture by meeting one of the following standards for education or training:

(i) Graduation from a course of training of at least 1,800 hours in acupuncture, including 300 clinical hours, that is: 1. Approved by the Maryland Higher Education Commission;

2. Accredited by the Accreditation Commission for Acupuncture and Oriental Medicine; or, 3. Found by the Board to be equivalent to a course approved by the Accreditation Commission for Acupuncture and Oriental Medicine; or

(ii) Achievement of a: 1. Diplomate in acupuncture from the National Certification Commission for Acupuncture andOriental Medicine; or 2. Passing score on an examination that is determined by the Board to be equivalent to the examination given by the NCCAOM; (Edited for brevity)"

For the purposes of acupuncture licensing requirements in Pennsylvania I will cite the minimum requirements from the NCCAOM certification which is mandatory for licensure in the state:

• Complete a minimum of three years or 1,905 hours of postgraduate education, including a minimum of 660 hours of supervised clinical training.
• Graduate with a Master’s degree or Professional Doctorate degree in Acupuncture or Oriental Medicine that is accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). ACAOM is the only accreditation agency recognized for this purpose by the United States Department of Education.
• Successfully pass three psychometrically validated NCCAOM National Board Examinations: Foundations of Oriental Medicine, Acupuncture with Point Location, Biomedicine
• Document completion of an NCCAOM approved course and assessment in Clean Needle Technique."

From the American Medical Association: "Our AMA recognizes dry needling as an invasive procedure and maintains that dry needling should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed medical physicians and licensed acupuncturists."

"The American Academy of Physical Medicine and Rehabilitation recognizes dry needling as an invasive procedure using acupuncture needles that has associated medical risks. Therefore, the AAPMR maintains that this procedure should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed acupuncturists or licensed medical physicians."

In my opinion, it is important to be one’s own advocate. As with any healthcare provider it is very important to make sure they have sufficient training to do what they say they can do. You have the right to ask to see their credentials.

You also have the right to make "Informed Consent." You should know what you are agreeing to. Generally speaking, you have the right to decline any treatment offered to you. There are exceptions. This article from the National Institute of Health is helpful- www.apta.org/patient-care/interventions/dry-needling/laws-by-state.

For me, the primary difference between dry needling and acupuncture is two fold. Firstly, there is a whopping difference in the amount of training (dry needling- 80 hours vs. acupuncture- 1800 hours).

Secondly, dry needling only treats the physical symptom unlike acupuncture which is designed to treat the whole of you: body, mind, and spirit including the "root cause" of your symptoms. Acupuncture is not just the needles. It is also a philosophy of living which supports not just health, but quality of life. A qualified acupuncturist will help you reconnect to your natural healing ability and live life more fully.

If you would like to know more about how I help people please call me at 410-336-5876 or visit my website www.jeffersonbrelandacupuncture.org. Be well.

Jefferson Breland is a board-certified acupuncturists licensed in Pennsylvania and Maryland with offices in Gettysburg and Towson, respectively.
He can be reached at 410-336-5876.