State Training Guidelines
State Training Guidelines
News: September 2013: Colorado Governor signs into law that Dry Needling is in the scope of practice for Physical Therapy.
Colorado Physical Therapy Licensure Rules and Regulations
4 CCR 732-1 RULE 11 – REQUIREMENTS FOR PHYSICAL THERAPISTS TO PERFORM DRY NEEDLING
A. Dry needling is a physical intervention that uses a filiform needle to stimulate trigger points, diagnose and treat neuromuscular pain and functional movement deficits; is based upon Western medical concepts; requires an examination and diagnosis, and treats specific anatomic entities selected according to physical signs. Dry needling does not include the stimulation of auricular or distal points.
B. Dry needling as defined pursuant to this rule is within the scope of practice of physical therapy.
C. A physical therapist must have the knowledge, skill, ability, and documented competency to perform an act that is within the physical therapist’s scope of practice.
D. To be deemed competent to perform dry needling, a Physical Therapist must:
1. have practiced for at least two years as a licensed Physical Therapist; and
2. have successfully completed a dry needling course of study that consists of a minimum of 46 hours of in-person (i.e. not online) dry needling training.
E. A provider of a dry needling course of study must meet the educational and clinical prerequisites as defined in this rule, paragraph D above and demonstrate a minimum of two years of dry needling practice techniques. The provider is not required to be a physical therapist.
F. A physical therapist performing dry needling in his/her practice must have written informed consent for each patient where this technique is used. The patient must sign and receive a copy of the informed consent form. The consent form must, at a minimum, clearly state the following information:
1. Risks and benefits of dry needling
2. Physical therapist’s level of education and training in dry needling
3. The physical therapist will not stimulate any distal or auricular points during dry needling.
G. When dry needling is performed this must be clearly documented in the procedure notes and must indicate how the patient tolerated the technique as well as the outcome after the procedure.
H. Dry needling shall not be delegated and must be directly performed by a qualified, licensed physical therapist.
I. Dry needling must be performed in a manner consistent with generally accepted standards of practice, including clean needle techniques, and standards of the center for communicable diseases.
J. The physical therapist must be able to supply written documentation, upon request by the Director, which substantiates appropriate training as required by this rule. Failure to provide written documentation is a violation of this rule, and is prima facie evidence that the physical therapist is not competent and not permitted to perform dry needling.
District of Columbia
District of Columbia Municipal Regulations Title 17, Chapter 67, Physical Therapy
6715 SCOPE OF PRACTICE A physical therapist may also perform intramuscular manual therapy, which is also known as dry needling, if performed in conformance with the requirements of section 6716.
6716 REQUIREMENTS FOR PHYSICAL THERAPISTS TO PERFORM INTRAMUSCULAR MANUAL THERAPY
6716.1 Intramuscular manual therapy may be performed by a licensed physical therapist who meets the requirements of this section.
6716.2 Intramuscular manual therapy shall be performed directly by the licensed physical therapist and shall not be delegated.
6716.3 Intramuscular manual therapy shall be performed in a manner that is consistent with generally accepted standards of practice, including clean needle techniques, and other applicable standards of the Centers for Disease Control and Prevention.
6716.4 Intramuscular manual therapy is an advanced procedure that requires specialized training. A physical therapist shall not perform intramuscular manual therapy in the District of Columbia unless he or she has documented proof of completing:
(a) A board-approved professional training program on intramuscular manual therapy. The training program shall require each trainee to demonstrate cognitive and psychomotor knowledge and skills. The training program shall be attended in person by the physical therapist, shall not be attended online or through any other means of distance learning, and shall not be a self-study program
(b) A professional training program on intramuscular manual therapy accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE). The training program shall require each trainee to demonstrate cognitive and psychomotor knowledge and skills. The training program shall be attended in person by the physical therapist, shall not be attended online or through any other means of distance learning, and shall not be a self-study program; or
(c) Graduate or higher-level coursework in a CAPTE-approved educational program that included intramuscular manual therapy in the curriculum.
6716.5 A physical therapist shall only perform intramuscular manual therapy following an examination and diagnosis, and for the purpose of treating specific anatomic entities selected according to physical signs.
6716.6 A physical therapist who performs intramuscular manual therapy shall obtain written informed consent from each patient who will receive intramuscular manual therapy before the physical therapist performs intramuscular manual therapy on the patient.
6716.7 The informed consent form shall include, at a minimum, the following:
(a) The patient’s signature;
(b) The risks and benefits of intramuscular manual therapy;
(c) The physical therapist’s level of education and training in intramuscular manual therapy; and
(d) A clearly and conspicuously written statement that the patient is not receiving acupuncture.
6716.8 A physical therapist who performs intramuscular manual therapy shall maintain a separate procedure note in the patient’s chart for each intramuscular manual therapy. The note shall indicate how the patient tolerated the intervention as well as the outcome after the intramuscular manual therapy.
6716.9 A physical therapist who performs intramuscular manual therapy shall be required to produce documentation of meeting the requirements of this section immediately upon request by the board or an agent of the board.
6716.10 Failure by a physical therapist to provide written documentation of meeting the training requirements of this section shall be deemed prima facie evidence that the physical therapist is not competent and not permitted to perform intramuscular manual therapy.
K.A.R. 100-29-18. Dry needling; education and practice requirements.
(A) Dry needling shall be performed only by a physical therapist who is competent by education and training to perform dry needling as specified in this regulation. Online study and self-study for dry needling instruction shall not be considered appropriate training.
(B) Each physical therapist who does not obtain dry needling education and training as part of that individual’s graduate or postgraduate education shall be required to successfully complete a dry needling course approved by the board in order to perform dry needling. Each dry needling course shall include a practical examination and a written examination.
(C) Each dry needling course shall include the following components:
Anatomical review for safety and effectiveness;
indications and contraindications for dry needling;
evidence-based instruction on the theory of dry needling practice;
sterile needle procedures, which shall include the standards of one of the following:
(a) The U.S. centers for disease control and prevention; or
(b) the U.S. occupational safety and health administration;
post intervention care, including an adverse response or emergency; and
an assessment of the physical therapist’s dry needling technique and psychomotor skills
(D) Each dry needling course shall be taught by a licensed healthcare provider who meets the following requirements:
Has a scope of practice that includes dry needling
meets the regulatory minimum educational standard in that individual’s respective state or jurisdiction
has not been disciplined by any state or jurisdictional licensing agency for any act that would be a violation of the physical therapy practice act or the healing arts act; and
has performed dry needling for at least two years.
(E) Each physical therapist taking a dry needling course shall be required to obtain a passing score on all written and practical examinations given in the dry needling course. Each physical therapist shall obtain a certificate or other documentation from the provider of the dry needling course specifying what anatomical regions were covered in the dry needling course and that the physical therapist passed all examinations.
(F) Each dry needling course shall provide sufficient instruction to ensure that each student is able to demonstrate minimum adequate competency in the following:
Current dry needling techniques;
management of dry needling equipment and supplies;
accurate point selection;
accurate positioning of the patient and the education of the patient regarding the amount of movement allowed while needles are inserted;
supervision and monitoring of the patient during treatment;
communication with the patient, including informed consent; and
clinically appropriate patient selection, including consideration of the following:
(a) The patient’s contraindications for dry needling;
(b)the patient’s ability to understand the treatment and the expected outcome; and
(c) the patient’s ability to comply with treatment requirements.
(G) After completion of a board-approved dry needling course, each physical therapist shall be required to complete 200 patient treatment sessions of dry needling before taking each successive course in dry needling. Each physical therapist shall complete all foundation-level courses before proceeding to an advanced-level course.
(H) Dry needling shall be performed solely for conditions that fall under the physical therapy scope of practice pursuant to K.S.A. 65-2901, and amendments thereto. Each physical therapist performing dry needling shall perform dry needling only in the anatomical region of training completed by the physical therapist. Each physical therapist who performs dry needling shall do so in a manner consistent with generally acceptable standards of practice.
(I) A physical therapist shall not delegate dry needling. (Authorized by K.S.A. 2016 Supp. 65-2911 and 65-2923; implementing K.S.A. 2016 Supp. 65-2901; Approved by Dept. of Administration October 27th, 2016 and Attorney General October 28th 2016.
While dry needling is within the scope of practice of physical therapy, a physical therapist must practice only those procedures that the physical therapist is competent to perform. The board can discipline a physical therapist for “engaging or permitting the performance of substandard patient care by himself or by persons working under their supervision due to a deliberate or negligent act or failure to act, regardless of whether actual injury to the patient is established.”
Subchapter B. General Provisions
§123. Definitions A. As used in this Title, the following terms and phrases, defined in the practice act, La. R.S.37:2401–2424, shall have the meanings specified here. Dry Needling—a physical intervention which utilizes filiform needles to stimulate trigger points in a patient’s body for the treatment of neuromuscular pain and functional movement deficits. Dry Needling is based upon Western medical concepts and does not rely upon the meridians utilized in acupuncture and other Eastern practices. A physical therapy evaluation will indicate the location, intensity and persistence of neuromuscular pain or functional deficiencies in a physical therapy patient and the propriety for utilization of dry needling as a treatment intervention. Dry needling does not include the stimulation of auricular points.
§311. Treatment with Dry Needling A. The purpose of this rule is to establish standards of practice, as authorized by La. R.S. 37:2405 A. (8), for the utilization of dry needling techniques, as defined in §123, in treating patients.
B. Dry needling is a physical therapy treatment which requires specialized physical therapy education and training for the utilization of such techniques. Before undertaking dry needling education and training, a PT shall have no less than two years experience working as a licensed PT. Prior to utilizing dry needling techniques in patient treatment, a PT shall provide documentation to the executive director that he has successfully completed a board–approved course of study consisting of no fewer than 50 hours of face–to–face instruction in intramuscular dry needling treatment and safety. Online and other distance learning courses will not satisfy this requirement. Practicing dry needling without compliance with this requirement constitutes unprofessional conduct and subjects a licensee to appropriate discipline by the board.
C. In order to obtain board approval for courses of instruction in dry needling, sponsors must document that instructors utilized have had no less than two years experience utilizing such techniques. Instructors need not be physical therapists, but should be licensed or certified as a healthcare provider in the state of their residence.
D. A written informed consent form shall be presented to a patient for whom dry needling is being considered, telling the patient of the potential risks and benefits of dry needling. A copy of a completed form shall be preserved in the patient treatment record and another copy given to the patient.
E. Dry needling treatment shall be performed in a manner consistent with generally accepted standards of practice, including sterile needle procedures and the standards of the U.S. Centers for Disease Control and Prevention. Treatment notes shall document how the patient tolerated the technique and the outcome of treatments.
Maine Board of Examiners in Physical Therapy:
In its report to the Maine Joint Standing Committee on Labor, Commerce, Research and Economic Development, the Maine Board of Examiners in Physical Therapy agreed that the practice of dry needling is within the scope of practice of a physical therapist. The Board agreed that the practice of dry needling is inherent to the education and practice of physical therapy and is a benefit to patients who receive this treatment in conjunction with physical therapy services. Licensed physical therapists have a responsibility to ensure that they have sufficient clinical knowledge and understanding of the dry needling modality without the Board’s governance. To obtain a physical therapist license, an applicant must have completed the education and examination requirements in Maine law. It is a licensed physical therapist’s obligation to recognize, determine and obtain education and experience prior to performing specialized modalities including dry needling. In establishing this guideline, the Board strongly recommends that licensees assess their knowledge, abilities and skill levels prior to performing dry needling. Licensees should determine whether it is necessary for them to obtain post-graduate education, knowledge and training in the following areas before engaging in any specialized treatment modality, including dry needling:
- Development of psychomotor skills to safely handle needles and palpate tissues;
- Anatomical review for safety and effectiveness;
- Indications and contraindications, precautions and possible adverse outcomes, and compliance with adverse event guidelines;
- Evidence-based instruction on the theory of dry needling practice;
- Current dry needling techniques and accurate point selection;
- Sterile needle procedures, including the standards of one of the following:
-U.S. Centers for Disease Control and Prevention; or
-U.S. Occupational Safety and Health Administration;
- Safe use of dry needles and skin penetration, including waste disposal of needles and management of blood and bodily fluids;
- Accurate positioning of the patient and the education of the patient regarding the amount of movement allowed while needles are inserted;
- Supervision and monitoring of the patient during treatment;
- Communication with the patient, including informed consent, treatment and expected outcome, and patient compliance with treatment requirements;
- Documentation and records describing the dry needling procedure and informed consent, where applicable; and
- Management of dry needling equipment and supplies.
- The Board recognizes that licensees currently performing dry needling have developed expertise in the practice modality and are, therefore, not required to obtain additional education or training, unless the licensee chooses to do so. Dry needling may not be delegated by a licensed physical therapist to a licensed physical therapist assistant. Accepted by the Maine Board of Examiners in Physical Therapy on September 14, 2018
A.To be deemed competent to perform intramuscular manual therapy a physical therapist must meet the following requirements:1. Documented successful completion of a intramuscular manual therapy course of study; online study is not considered appropriate training. a. A minimum of 50 hours of face-to-face IMS/dry needling course study; online study is not considered appropriate training. b. Three years of practice as a licensed physical therapist prior to using the intramuscular manual therapy technique.
2. The physical therapist must have board approved credentials for providing intramuscular manipulation which are on file with the board office prior to using the treatment technique.
B. The provider of the required educational course does not need to be a physical therapist. A intramuscular manual therapy course of study must meet the educational and clinical prerequisites as defined in this rule,
C(1)(a)&(b) and demonstrate a minimum of two years of intramuscular manual therapy practice techniques.
D. A physical therapist performing intramuscular manual therapy in his/her practice must have written informed consent for each patient where this technique is used. The patient must sign and receive a copy of the informed consent form. The consent form must, at a minimum, clearly state the following information:1. Risks and benefits of intramuscular manual therapy.
2. Physical therapist’s level of education and training in intramuscular manual therapy
3. The physical therapist will not stimulate any distal or auricular points during intramuscular manual therapy.
E. When intramuscular manual therapy is performed, this ust be clearly documented in the procedure notes and must indicate how the patient tolerated the technique as well as the outcome after the procedure.
F. Intramuscular manual therapy shall not be delegated and must be directly performed by a qualified, licensed physical therapist.
G. Intramuscular manual therapy must be performed in a manner consistent with generally accepted standards of practice, including but not limited to, aseptic techniques and standards of the center for communicable diseases.
(1) Dry needling is a skilled technique performed by a physical therapist using a mechanical device, filiform needles, to penetrate the skin and/or underlying tissues to affect change in body structures and functions for the evaluation and management of neuromusculoskeletal conditions, pain, movement impairments, and disability.
(2) Dry needling requires a physical therapy examination and diagnosis.
(3) Licensed physical therapists who perform dry needling must be able to demonstrate they have completed training in dry needling that must meet the American Physical Therapy Association (APTA) GUIDELINES: STANDARDS OF QUALITY FOR CONTINUING EDUCATION OFFERINGS BOD G11-03-22-69 and/or the Federation of State Boards of Physical Therapists (FSBPT) STANDARDS FOR CONTINUING COMPETENCE ACTIVITIES.
(a) Dry needling courses must include, but not be limited to, training in indications, contraindications, potential risks, proper hygiene, proper use and disposal of needles, and appropriate selection of clients.
(b) Initial training in dry needling must include hands-on training, written, and practical examination as required by this rule.
(4) A licensed physical therapist must perform dry needling in a manner consistent with generally accepted standards of practice, including relevant standards of the Center for Disease Control and Prevention, and Occupational Safety and Health Administration blood borne pathogen standards as per 29 CFR 1910.1030 et.seq.
(5) Dry needling shall only be performed by a licensed physical therapist and may not be delegated.
(6) The physical therapist performing dry needling must be able to provide written documentation, upon request by the board, which substantiates appropriate training as required by this rule. Failure to provide written documentation may result in disciplinary action.
A physical therapist who wished to perform tissue penetration for the purpose of dry needling must meet the following requirements:
1. Complete pre-service or in-service training. The pre-service or in-service training must include:a. Pertinent anatomy and physiology;
b. Choice and operation of supplies and equipment;
c. Knowledge of technique including indications and contraindications;
d. Proper technique of tissue penetration;
e. Sterile methods, including understanding of hazards and complications; and
f. Post intervention care; and
g. Documentation of application of technique in an educational environment.
2. The training program shall require training to demonstrate cognitive and psychomotor skills. Also, the training program must be attended in person by the physical therapist.
3. Maintain documentation of successful completion of training.
It is the position of the Physical Therapy Section that nothing in the Ohio Physical Therapy Practice Act prohibits a physical therapist from performing dry needling techniques. As with any specialized procedure, the physical therapist must have training and demonstrate competency in the modality. The manner in which the training is obtained and competency demonstrated are not addressed in the Practice Act.
The PT Board recommends you contact the OPTA for approved coursework in dry needling at www.ohiopt.org .
(1) In order to perform dry needling, a physical therapist must obtain all of the educational instruction described in paragraphs (2)(a) and (2)(b) herein. All such educational instruction must be obtained in person and may not be obtained online or through video conferencing.
(2) Mandatory Training – Before performing dry needling, a practitioner must complete educational requirements in each of the following areas:
(a) Fifty (50) hours of instruction, to include instruction in each of the four areas listed herein, which are generally satisfied during the normal course of study in physical therapy school:1. Musculoskeletal and Neuromuscular systems;
2. Anatomical basis of pain mechanisms, chronic pain, and referred pain;
3. Trigger Points;
4. Universal Precautions; and
(b) Twenty-four (24) hours of dry needling specific instruction.
1. The twenty-four (24) hours must include instruction in each of the following six (6) areas:(i) Dry needling technique;
(ii) Dry needling indications and contraindications;
(iii) Documentation of dry needling;
(iv) Management of adverse effects;
(v) Practical psychomotor competency; and
(vi) Occupational Safety and Health Administration’s Bloodborne Pathogen Protocol.
2. Each instructional course shall specify what anatomical regions are included in the instruction and describe whether the course offers introductory or advanced instruction in dry needling.
3. Each course must be pre-approved by the Board or its consultant. For a course to be preapproved, the provider must provide to the Board administrator the name of the course provider, a synopsis and description of the course, and a copy or description of any course materials used.
(3) A newly-licensed physical therapist shall not practice dry needling for at least one (1) year from the date of initial licensure, unless the practitioner can demonstrate compliance with paragraph (2) through his or her pre-licensure educational coursework.
(4) Any physical therapist who obtained the requisite twenty-four (24) hours of instruction as described in paragraph (2)(b) in another state or country must provide the same documentation to the Board, as described in paragraph (2)(b), that is required of a course provider. The Board or its consultant must approve the practitioner’s dry needling coursework before the therapist can practice dry needling in this state.
(5) Dry needling may only be performed by a licensed physical therapist and may not be delegated to a physical therapist assistant or support personnel.
(6) A physical therapist practicing dry needling must supply written documentation, upon request by the Board, that substantiates appropriate training as required by this rule. (7) All physical therapy patients receiving dry needling for the first time shall be provided written documentation from the patient’s physical therapist that includes a definition and description of the practice of dry needling, a description of the education and training taken by the physical therapist which qualifies the therapist to practice dry needling, and a description of any potential side effects of dry needling, and the patient must give written informed consent after acknowledging the risks before dry needling may begin.
Board of Physical Therapy Guidance on Dry Needling in the Practice of Physical Therapy Upon recommendation from the Task Force on Dry Needling, the board voted that dry needling is within the scope of practice of physical therapy but should only be practiced under the following conditions:
Dry needling is not an entry level skill but an advanced procedure that requires additional training.
A physical therapist using dry needling must complete at least 54 hours of post professional training including providing evidence of meeting expected competencies that include demonstration of cognitive and psychomotor knowledge and skills.
The licensed physical therapist bears the burden of proof of sufficient education and training to ensure competence with the treatment or intervention.
Dry needling is an invasive procedure and requires referral and direction, in accordance with § 54.1-3482 of the Code of Virginia. Referral should be in writing and specific for dry needling; if the initial referral is received orally, it must be followed up with a written referral.
If dry needling is performed, a separate procedure note for each treatment is required, and notes must indicate how the patient tolerated the technique as well as the outcome after the procedure.
A patient consent form should be utilized and should clearly state that the patient is not receiving acupuncture. The consent form should include the risks and benefits of the technique, and the patient should receive a copy of the consent form. The consent form should contain the following explanation:
Dry needling is a technique used in physical therapy practice to treat trigger points in muscles. You should understand that this dry needling technique should not be confused with a complete acupuncture treatment performed by a licensed acupuncturist. A complete acupuncture treatment might yield a holistic benefit not available through a limited dry needling treatment.