North Carolina supports Dry Needling/Intramuscular Manual Therapy

Fri, 15 Oct 2010

Position Statement: NC Board of Physical Therapy Examiners

Intramuscular Manual Therapy (Dry Needling)

Approved – September 23, 2010

Definition: Intramuscular manual therapy, which is sometimes referred to as dry needling, is defined as a technique to treat myofascial pain using a dry needle (without medication) that is inserted into a trigger point with the goal of releasing / inactivating the trigger points and relieving pain.

Intramuscular manual therapy is not Acupuncture, which is defined by NCGS § 90-451 (1) as follows: “A form of health care developed from traditional and modern Chinese medical concepts that employ acupuncture diagnosis and treatment, and adjunctive therapies and diagnostic techniques, for the promotion, maintenance, and restoration of health and the prevention of disease.”

Background: In 2002, the Board was asked whether dry needling was within the scope of practice for physical therapists. At that time, there was very little research published about the use of dry needling or evidence that supported the practice of dry needling by physical therapists.

However, since the definition of physical therapy in the North Carolina Physical Therapy Practice Act and the Board’s rules contemplates modifications to the scope of practice of physical therapy as practitioners become proficient in new patient treatment techniques, it is appropriate for the Board to periodically revisit its Position Statements to determine if scope of practice developments warrant revisions to the Position Statements.

Since 2002, there have been significant developments in the use of intramuscular manual therapy in physical therapy practice. According to the “Intramuscular Manual Therapy (Dry Needling) Resource Paper” published by the Federation of State Boards of Physical Therapy (FSBPT) on March 8, 2010, “there are numerous scientific studies to support the use of dry needling for a variety of conditions” and many of the studies have been conducted by physical therapists. Additionally, in 2002, there were very few states that allowed dry needling; however, as the scope of practice of physical therapy has evolved, at least 15 other states (including neighboring jurisdictions of Virginia, South Carolina, Georgia, Maryland, Kentucky, and Washington, DC) have issued opinions that intramuscular manual therapy is within the scope of practice of physical therapists. With increased mobility within the profession, there are a number of North Carolina licensees who are skilled in intramuscular manual therapy techniques, and have lawfully utilized those techniques in other jurisdictions.

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Position Statement

Intramuscular Manual Therapy (Dry Needling)

September 23, 2010

Scope of Practice:

NCGS: 90-270.24. Definitions.

(4) "Physical Therapy" means the evaluation or treatment of any person by the use of physical, chemical, or other properties of heat, light, water, electricity, sound, massage, or therapeutic exercise, or other rehabilitation procedures, with or without assistive devices, for the purposes of preventing, correcting, or alleviating a physical or mental disability. Physical therapy includes … administration of specialized therapeutic procedures. Evaluation and treatment of patients may involve physical measures, methods, or procedures as are found commensurate with physical therapy education and training and generally or specifically authorized by regulations of the Board. …”

21 NCAC 48C .0101 PERMITTED PRACTICE

(a) Physical therapy is presumed to include any acts, tests, procedures, modalities, treatments, or interventions that are routinely taught in educational programs or in continuing education programs for physical therapists and are routinely performed in practice settings.

Practice Developments: Information furnished to the Board indicates that intramuscular manual therapy is routinely taught in continuing education programs and is routinely performed in practice settings. According to the previously referenced FSBPT Resource Paper, “It appears that there is a historical basis, available education and training as well as an educational foundation in the CAPTE criteria, and supportive scientific evidence for including intramuscular manual therapy in the scope of practice of physical therapists. The education, training and assessment within the profession of physical therapy include the knowledge base and skill set required to perform the tasks and skills with sound judgment. It is also clear; however, that intramuscular manual therapy is not an entry level skill and should require additional training.” On October 17, 2009, the Executive Committee of AAOMPT (American Academy of Orthopedic Manual Physical Therapists) adopted an official position statement that “dry needling is within the scope of physical therapist practice.” The question of whether the insertion of a needle would be “an invasive procedure that is not allowed for physical therapists” is not an issue in North Carolina as physical therapists have used needle insertion for EMG studies for more than forty years.

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Position Statement

Intramuscular Manual Therapy (Dry Needling)

September 23, 2010

Position: Based on currently available resource information, it is the position of the North Carolina Board of Physical Therapy Examiners that intramuscular manual therapy is within the scope of practice of physical therapists. Intramuscular manual therapy is an advanced skill that requires additional training beyond entry-level education and should only be performed by physical therapists who have demonstrated knowledge, skill, ability, and competence, including, at a minimum: (1) Completion of an Intramuscular Manual Therapy course of study at a program approved by the Board with a minimum of 54 hours of classroom education, or evidence of practice experience in the use of intramuscular manual therapy techniques (“experienced intramuscular manual therapy practitioner”) which consists of using the techniques for at least 100 hours per year for a period of 2 years; and (2) Forty hours of clinical mentorship under an experienced Intramuscular Manual Therapy practitioner; and (3) Two years of practice as a licensed physical therapist prior to using Intramuscular Manual Therapy. Since Intramuscular Manual Therapy requires ongoing re-evaluation and reassessment, it is not in the scope of work for physical therapist assistants or physical therapy aides.

Contact Person:

Ben F. Massey, Jr., PT, MA, Executive Director
NC Board of Physical Therapy Examiners
18 West Colony Place Suite 140
Durham, NC 27705
Phone: 1-919-490-6393 / 800-800-8982

Fax: 1-919-490-5106

Email: benmassey@ncptboard.org
Web: www.ncptboard.org <<http://www.ncptboard.org/>