What Is Dry Needling?

Dry needling is a type of acupuncture that is rapidly gaining popularity. It involves the precise insertion of acupuncture needles into tiny tight wads of muscle called "trigger points". Trigger points are found within taut bands of muscle and are often located in areas far from the location of the pain that causes a patient to seek treatment. 

This leads to immediate reduction of local and referred pain, improved range of motion, decreased irritability of trigger points both in the are that was needled and elsewhere, normalized the pH within the muscle, and restored blood circulation.

There are about a dozen dry needling training programs, available to physical therapists, but I still have concerns about the lack of standardized credential and the absence of independent oversight of dry needling training for physical therapists. These factors make it very difficult for the prospective patient to assess the credentials of physical therapists offering dry needling. The physician group American Association of Medical Acupuncturists (AAMA) shares my concern and stated in a recent position paper that only licensed acupuncturists or medical doctors should perform dry needing:

The AAMA strongly believes that, for the health and safety of the public, this procedure should be performed only by practitioners with extensive training and familiarity with routine use of needles in their practice and who are duly licensed to perform these procedures, such as licensed medical physicians or licensed acupuncturists. In our experience and medical opinion, it is inadvisable legally to expand the scope of physical therapists to include dry needling as a part of their practice.

Many states, including Alaska, do not offer clear guidance about how many hours of training in needling physical therapists much have in order to use the technique; with some states leaving it up to the individual physical therapist (or his/her employer) to determine whether they feel "competent" with the technique. In the absence of a standardized dry needling credential or clearly defined training requirements for physical therapists, the onus is left on patients to ask careful questions of their physical therapist if dry needling is suggested. Some questions to consider asking include:

  • Where did you receive your dry needling training?
  • How many hours of training in the use of needles have you had?
  • How many of these hours were hands-on versus classroom hours?
  • Was supervised clinical practice part of your training in dry needling?
  • Does your malpractice insurance policy explicitly cover dry needling?

What Is Acupuncture? 

An acupuncturist must complete an accredited graduate-level degree program in Acupuncture or Traditional Chinese Medicine, pass three rigorous national certification examinations administered by the National Certification Commission on Acupuncture and Oriental Medicine (NCCAOM), pass written and practical portions of the Clean Needle Technique examination administered by the Council on Colleges of Acupuncture and Oriental Medicine, submit proof of malpractice insurance, and be approved for licensure by the Alaska State Board of Medical Examiners.

Graduate-level degree programs in Acupuncture or Traditional Chinese Medicine entail 2800-3400 hours of specialized instruction and extensive supervised clinical practice (3-4 years of full-time study). A practitioner who has passed the NCCAOM acupuncture examination is entitled to add Dipl. Ac. (Diplomate of Acupuncture) after their name and a practitioner who has passed the NCCAOM herbal examination is entitled to add Dipl. CH (Diplomate of Chinese Herbology) after their name. The highest level of board certification is the Dipl. OM (Diplomate of Oriental Medicine) — practitioners with this designation have passed written and practical examinations on acupuncture, Chinese herbal medicine, and Western biomedicine.

Although some other healthcare professionals (such as medical doctors, doctors of osteopathy, and chiropractors) have the legal ability to practice acupuncture, it is important to recognize the vast discrepancy between the acupuncture training required of Licensed Acupuncturists versus other health professionals. In most states, medical doctors and doctors of osteopathy are allowed to practice acupuncture without any training whatsoever in Traditional Chinese Medicine, while chiropractors are required to complete only 100 hours of training (usually completed over the course of several weekends). 

Unfortunately, the limited training of other healthcare professionals in acupuncture often leads to a “cookbook” approach to treatment. Although this approach may bring about some benefits, acupuncture and Chinese herbal medicine only reaches its fullest degree of effectiveness when it is practiced by an individual with extensive training in the detailed and subtle system of TCM diagnosis and treatment.

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