Interview with Dr. Rod Schlegel

The issue of whether the performance of dry needling (sometimes referred to as trigger point dry needling or intramuscular manual therapy) is within the professional and legal scope of physical therapist practice continues to be a question posed to state regulatory boards and agencies. The American Physical Therapy Association (APTA) created this document to provide background information for state chapters, regulatory entities, and providers who are dealing with this issue.

APTA is the national professional association representing more than 77,000 physical therapists, physical therapist assistants, and students nationwide.

Dry Needling by Physical Therapists

Dry Needling is an invasive technique used by physical therapists (where allowed by state law) to treat myofascial pain that uses a dry needle, without medication or injection, which is inserted into areas of the muscle known as trigger points. A trigger point describes a taut band of skeletal muscle located within a larger muscle group. Trigger points can be tender to the touch and can refer pain to distant parts of the body. Physical therapists utilize dry needling with the goal of releasing/inactivating the trigger points and relieving pain. Preliminary research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation.

Numerous terms have been used in conjunction with dry needling. Some of the more common terms include trigger point manual therapy, trigger point dry needling, and intramuscular manual therapy. While the term “intramuscular manual therapy” may be considered by some to be a more accurate description of dry needling when performed by physical therapists as the technique is closely associated with manual therapy, APTA recognizes that dry needling is the more widely accepted and utilized term. The term ‘intramuscular manual therapy’ should not be misinterpreted as an endorsement by APTA to bill dry needling utilizing the CPT code 97140 (manual therapy). Physical therapists should check with the insurance payor to see if it has issued any policies regarding billing of dry needling

Physical Therapy Professional Organizations Positions on Dry Needling

To achieve a better understanding of the use of dry needling in the physical therapist profession nationally and internationally, APTA reached out to the following US organizations:
• Academy of Orthopaedic Manual Physical Therapists (AAOMPT)
• The Federation of State Boards of Physical Therapy (FSBPT)

In addition, APTA reached out to a number of international physical therapy organizations:
• Australian Physiotherapy Association (APA)
• Canadian Physical Therapy Association (CPA)
• United Kingdom Chartered Society of Physiotherapy

Two questions were asked by APTA of the organizations:
1) Have you adopted a formal or established an information statement on the use of dry needling? and,
2) Do you have a formal or informal process for including dry needling, or other “new” tests, measures, or interventions into your scope of practice for physical therapists/physiotherapists?

As to the first question, all groups either said “yes,” or indicated that they intentionally do not specify procedures in their scope but rather define the scope broadly. In each of those cases that did not specify but defined their scope broadly and, with the exception of the UK, they had subgroups or other documents that strongly implied or made it explicit that dry needling is performed and supported by the profession. The scope of practice in the UK would not exclude it.

The responses to the second question were more mixed; however, the majority continued to indicate that they had a process to define scope but not one that would specify procedures or interventions within the scope.

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