Why Is Dry Needling Illegal? U.S. Laws Explained

Dry needling, a technique often used by physical therapists to treat muscle pain, involves inserting a “dry” needle, one without medication or injection, into areas of the muscle known as trigger points. The practice is a subject of contention, primarily due to concerns about professional scope of practice, required qualifications, and patient safety.

Understanding Dry Needling

Dry needling is sometimes confused with acupuncture, an ancient Chinese medicine practice. However, they are distinct techniques. Dry needling is based on Western anatomical and neurophysiological principles, whereas acupuncture is based on traditional Chinese medicine’s concept of energy pathways in the body.

Scope of Practice Issues

The core of the legal debate around dry needling revolves around whether it falls within the scope of practice for certain healthcare professionals:

• Physical Therapists: Some argue that physical therapists are not sufficiently trained in this invasive technique during their standard education and that additional, specific training should be required.
• Acupuncturists: Acupuncturists claim that dry needling is virtually indistinguishable from acupuncture and should be performed only by practitioners with extensive training in this area, such as licensed acupuncturists.
• Medical and Osteopathic Doctors: These practitioners generally have the legal authority to perform dry needling as part of their broader scope of practice, assuming they have received appropriate training in the technique.

State Regulations and Legal Challenges

The legality of dry needling varies by state, with some states having explicit laws or board regulations permitting the practice by certain professionals, while others have banned it or not addressed it in statute or regulation.

States Where Dry Needling is Explicitly Allowed

• Arizona: Dry needling is permitted for physical therapists with specific training.
• Colorado: Requires physical therapists to undergo training and certification to practice dry needling.
• Idaho: Allows physical therapists to perform dry needling following adequate training.
• Illinois: Permits dry needling by physical therapists who have completed specified training.
• Maryland: Physical therapists can perform dry needling with required education and certification.
• New Mexico: Was one of the first states to explicitly include dry needling in physical therapists’ scope of practice, contingent on training.
• Oregon: Allows dry needling by physical therapists, subject to completing educational requirements.
• South Carolina: Permits dry needling for physical therapists who meet training prerequisites.
• Tennessee: Dry needling is within the scope of practice for trained physical therapists.
• Virginia: Allows physical therapists to perform dry needling after obtaining specific training.
• Washington: Permits dry needling by physical therapists who have completed required education.

States with Restrictions or Ambiguities

• California: Dry needling is not clearly defined within physical therapists’ scope of practice, leading to legal ambiguities.
• Florida: Recent legal interpretations have allowed for dry needling by physical therapists, but specific guidelines and training requirements are stringent.
• New York: Dry needling is not explicitly recognized within the scope of physical therapy practice, leading to uncertainties.
• Alabama and New York: Have seen debates and legal challenges regarding whether dry needling falls within the scope of practice for physical therapists.

States Where Dry Needling is Not Clearly Addressed

• Many states do not have explicit laws or regulations addressing dry needling by physical therapists, leading to a regulatory gray area. In these states, physical therapists and their professional boards often seek clarification and guidance on incorporating dry needling into practice safely and legally.

Training and Competence

Training requirements for practitioners who wish to perform dry needling vary widely:

• Physical Therapy Boards: Some state physical therapy boards require specific training or certification programs for physical therapists to perform dry needling.
• Lack of Standardization: Unlike acupuncture, there is no national standard for dry needling training, leading to inconsistencies in practitioner competence and safety protocols.

Safety Concerns

Safety is a primary concern driving the regulation of dry needling:

• Risk of Injury: Improperly performed dry needling can lead to serious injuries, including punctured lungs (pneumothorax), excessive bleeding, or infections.
• Regulatory Oversight: The varying levels of regulatory oversight on training and practice standards contribute to differing perceptions of the safety of dry needling.

The legality of dry needling in the United States is complex and varies by state, depending on scope of practice laws, professional board regulations, and specific training requirements. The debate often centers around patient safety, practitioner training, and the distinction between dry needling and acupuncture. Practitioners must navigate these legal waters carefully and ensure they are operating within the bounds of their state’s laws.

References

• American Physical Therapy Association’s perspective on dry needling: https://www.apta.org/your-practice/outcomes-measurement/evidence-based-practice-resources/practice-guidelines/dry-needling
• Federation of State Boards of Physical Therapy resource on dry needling: https://www.fsbpt.org/Free-Resources/Regulatory-Resources/Practice-Issues/Dry-Needling