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Manual therapy is the ART and SCIENCE of ELIMINATING PAIN and RESTORING FUNCTION. !
www.MPTAlliance.com !! ! ! www.ProtectPT.com!!
ARIZONA PHYSICAL THERAPY !DRY NEEDLING RULES !
PROPOSAL & SUGGESTIONS
Te l e p h o n e : 6 0 2 . 8 2 1 . 8 8 8 3 • f a x : 8 8 8 . 3 8 1 . 7 5 2 2 • w w w. M P TA l l i a n c e . c o m • w w w. P r o t e c t P T. c o m
Arizona Physical Therapy Board Members,!
! The recent passage of SB 1154 has solidified the right of physical therapists in Arizona to perform dry needling (DN). Now the Az PT Board has the challenge of creating rules that will set the standards for training and education of Arizona physical therapists, now and into the future. !
! We wanted to thank the board for taking the time to carefully consider the rules development, which will guide the development of our profession and this intervention into the future. The founders of the MPTA have extensive knowledge of the four largest dry needling companies that have provided DN training to licensed PTs in Arizona, and as such, we wanted to provide insights and suggestions into the rule making process.!
The following is a summary of the dry needling status of the 50 states:!
A. Only 9 states have set minimum hour requirements!
B. The highest educational requirement is 54 hours of direct in-person education,
required by 3 states: North Carolina, Utah, Virginia!
1. In addition to 54 hours of in-person education, UT, requires:!
a) PT has actively practiced physical therapy, for two years;!
b) 250 supervised patient treatment sessions!
!! We would suggest the following rules, along with reasonings of each suggestion,
as a starting point for your discussions while approaching the rule making process:!
I. Set a minimal of 50 hours of dry needling education, required to be completed
over a 12 month period. Normally dry needling certification courses are three
days in length, done in two separate 3 day sessions, which is sufficient to allow
for adequate foundational training.!
A. A 12 month completion period gives ample time and reduces the financial stress
of the practicing professional.!
M a n u a l P h y s i c a l T h e r a p y A l l i a n c e ! D r y N e e d l i n g R u l e s ! !"1
B. We recommend language that avoids “advanced” or “post-graduate training.”
We feel that, in the future, entry-level PT education programs may incorporate
DN within their education programs. This restrictive wording would prevent us
from recognizing training provided in DPT educational programs.!
C. In addition, rules should be drafted to enable foreign trained PTs the ability to
continue to perform dry needling without additional training in the US, as long
as they meet the minimum requirements set by the board. !
II. During the 12 month training period, PTs are only allowed to treat body regions
and perform techniques they were trained during their initial class until they
have completed their certification.!
A. This allows PTs to practice between their initial course and final course, allowing
them to acquire the appropriate psychomotor skills to be successful in practice.!
III. We DO NOT recommend the board place a 1-2 year experience requirement on
physical therapist that desire to perform dry needling.!
A. Thinking into the future, the majority of entry level education programs may
incorporate DN training within their curriculum, which would require a change
in rules in the future. There are already several entry level programs that
introduce DN as an entry level technique.!
B. In addition, several orthopedic residency programs have incorporated DN into
their programs. With our profession moving toward a residency model, residents
should not be restricted from practicing skills acquired during their residency.
Typically residencies are completed immediately post-graduation, during their
first year of employment. !
C. In light of the recent complaints against a newly graduated PT that performed
dry needling through the clothing of a patient, it may seem wise to set a
minimum experience requirement. However, we feel that this is an isolated
M a n u a l P h y s i c a l T h e r a p y A l l i a n c e ! D r y N e e d l i n g R u l e s ! !"2
incident and does not reflect the standard of practice performed by physical
therapists in Arizona. In addition, this newly graduated PT was being mentored
and supervised by PTs that had in excess of 5 - 15 years of experience and were
preforming DN in the exact same manner. We do not believe experience or
training caused this incident to occur, but poor judgement and clinical reasoning
on behalf of an isolated group of practitioners. !
1. Two of the MPTA board members have attended the same training as those in
the above mentioned practice, and never was it implicated or demonstrated
that needling through clothing was appropriate. !
2. In addition, two senior instructors and the owner of the training company
which trained the above mentioned group, have all indicated that this was
never taught or demonstrated. !
D. Further, PTs have one of the best anatomical foundations of any profession,
which is the key to preventing adverse events in dry needling. When first
graduating, anatomical knowledge is freshest and readily accessible to a new
graduate. In a study investigating serious complications of needling, Peuker et
al. 2001 concluded “All traumatic injuries described in the article could be
avoided if practitioners had better anatomical knowledge, applied existing
anatomical knowledge better, or both.”!
E. Childs et al 2005 (Figure 1) has shown that PT students ranked above many MD’s
in their knowledge of musculoskeletal conditions. The MPTA believes we should
honor where we are as a doctorate level profession and put the responsibility of
safe and proficient practice on the individual PT and the continuing education
companies. !
M a n u a l P h y s i c a l T h e r a p y A l l i a n c e ! D r y N e e d l i n g R u l e s ! !"3
F. ! Moreover, research from Moore, et al 2005, shows clinical diagnostic accuracy by
physical therapists and orthopedic surgeons on patients with musculoskeletal
injuries was significantly greater than non-orthopedic surgeon’s, with no
statistical difference between orthopedic surgeons and physical therapists. These
research studies suggest that PT’s have the knowledge, training, and skills
necessary to clinically diagnose and manage musculoskeletal injuries beyond
most non-orthopedic physicians.!
IV. It is recommended that dry needling be performed only by licensed physical
therapists, and should not be delegated to assistive or support personnel. !
V. It is NOT recommended that the board set up standardized documentation
procedures specific for dry needling, as informed consent and documentation are
already a part of standardized care within physical therapy.!
M a n u a l P h y s i c a l T h e r a p y A l l i a n c e ! D r y N e e d l i n g R u l e s ! !"4
FIGURE 1: Childs et al. 2005
VI. PT’s are required to attend a DN course approved by the Az Physical Therapy
Association, or submit documented proof that their dry needling training meets
the minimum hour requirements and standards set forth in AZ rules. !
A. Many PTs have been trained outside of AZ, these PTs should not be required to
take additional courses that were not performed or approved by the AzPTA.!
B. These PTs should have the option to submit proof of training to the AzPTA to
enable them to practice in AZ.!
VII. DN courses should have at a minimum:!
A. A practical and written examination component.!
B. Cover the following areas in regards to safety:!
1. Contraindication and Indications!
2. Needle Handling & Safety!
3. Management of Adverse Events!
4. Blood Borne Pathogen Regulation Review!
5. Extensive anatomical review with safe needling techniques!
! Thank you for taking the time to address this issue and allowing us to aide in the
development of the physical therapy profession. Please feel free to contact us at your
convenience with any questions, comments or concerns at [email protected] or at
520.836.5840.!
Professionally,!
Sean O. Flannagan, PT, DPT, Cert. SMT, Cert. DN, Co-Founder MPTA!Justin Dunaway, PT, DPT, OCS, Cert. SMT, Cert. DN, Co-Founder MPTA!Calvin Noonan, PT, DPT, ATC, Cert. SMT, Cert. DN, Co-Founder MPTA!Cory McKinnon, PT, DPT, Cert. SMT, Cert. DN, Founding Member MPTA!Kyle Cherney, PT, DPT, Founding Member MPTA!Sarah Hanna, PT, MPT, Cert. DN Founding Member MPTA!!
The Manual Physical Therapy Alliance is a group of concerned physical therapists who have a common mission to promote the practice and proliferation of manual therapy through political activism, provider education, consumer
education, and continuing competency promotion.!
M a n u a l P h y s i c a l T h e r a p y A l l i a n c e ! D r y N e e d l i n g R u l e s ! !"5
References!!Childs,(John(D.,(Julie(M(Whitman,(Phillip(S(Sizer,(Maria(L(Pugia,(Timothy(W(Flynn(and(Anthony(Delitto.((A(description(
of(physical(therapists'(knowledge(in(managing(musculoskeletal(conditions.((BMC(Musculoskeletal(Disorders(2005,(
6:32.(
Moore,(Jose(PT,(PhD,(SCS,(ATC,(Donald(L.(Goss,(PT,(MPT,(OCS,(ATC,(Richard(E.(Baxter,(PT,(DSc,(OCS,(ATC,(Thomas(M.(
DeBerardino,(MD,(Liem(T.(Mansfield,(MD,(Douglas(W.(Fellows,(MD,(Dean(C.(Taylor,(MD.((Clinical(Diagnostic(Accuracy(
and(Magnetic(Resonance(Imaging(of(Patients(Referred(by(Physical(Therapists,(Orthopaedic(Surgeons,(and(
Nonorthopaedic(Providers.((J(Orthop(Sports(Phys(Ther,(Volume(35,(Number(2,(February(2005.(
Peuker(E,(Gronemeyer(D:(Rare(but(serious(complications(of(acupuncture:(traumatic(lesions.(Acupunct(Med(19(2):(
103Z8,(2001.
M a n u a l P h y s i c a l T h e r a p y A l l i a n c e ! D r y N e e d l i n g R u l e s ! !"6
