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Dry needling

DryNeedlingAcupuncturists challenge sharp new trend in physical therapy

Physical therapists in recent years have discovered the magic of the needle.

Insert them into points of pain to flush out the bad chemicals and stimulate the blood and oxygen flow to soothe away the discomfort.

“It’s just one tool in our tool box,” said Sara Demeure, a Scottsdale physical therapist.

Physical therapists call it dry needling. Acupuncturists call it false advertising and dangerous.

Demeure has been using the technique since 2009. But she and others like her are under fire from acupuncturists who contend their lack of even minimal training requirements puts the public at risk.

Acupuncturists have complained patients are led to believe they are receiving acupuncture and some physical therapists have even advertised dry needling as acupuncture.

Acupuncturists want the Arizona State Board of Physical Therapy to establish minimum training requirements.

“When you are inserting needles into people there can be some really harmful effects if you don’t know what you are doing or what you are hitting under the skin,” said Roopali Desai, an attorney who represents the Coalition of Arizona Acupuncture Safety.

Desai said the practice, done incorrectly, can puncture a lung or cause a miscarriage.

Representatives from the two professions and the two state boards that regulate them have been working for the past year to resolve the dispute, but it seems more likely the association of acupuncturists will try and settle it in court or administratively through the Attorney General’s Office, Desai said.

The Arizona State Board of Physical Therapy concluded on Oct. 22 that dry needling falls within the state’s legal definition of physical therapy, said the board’s executive director, Charles Brown.

Desai asserts that what the board actually did was expand the scope of practice for physical therapists, which only the Legislature can do.

“The PTs can’t just say, ‘PTs in the state of Arizona can now do minor surgery or extractions of teeth.’ That would not be OK,” Desai said.

Medical doctors, osteopathic physicians, naturopaths and chiropractors can practice acupuncture even though they aren’t licensed by the state of Arizona Acupuncture Board of Examiners. But they have gone through the Legislature to add it to their scope of practice, Desai said.

Brown said the board ordered him to draft a statement explaining the board’s position and to study the regulations of the 33 other states that allow physical therapists to do dry needling.

The physical therapy board meets again Nov. 19.

Dry needling has become a trend in Arizona in only the past few years, but it has been around since the early 1990s, Demeure said.

She said the difference between acupuncture and dry needling is the former is a discipline based in oriental medicine that can treat disease, infertility and depression while the latter is a Western technique for treating pain.

Demeure produced a letter from CNA Healthpro, a company that has insured physical therapists since 1992. It states that a database holding more than 5,000 closed claims includes six arising out of dry needling, with a total of $79,000 paid out for them.

Desai said, however, that acupuncturists have a minimal training requirement of 1,800 hours while physical therapists take a weekend course in dry needling.

Demeure said the initial training is a weekend course. Anyone doing needling should continue getting training, but that is on top of over 3,000 hours of training for a physical therapist.

Acupuncturists began taking notice of therapists advertising dry needling a few years ago and asked their board to start looking into it, said Pete Gonzalez, the acupuncture board executive director.

The board has no authority over professions licensed by another health care board, so all he could do is look into whether anyone was practicing acupuncture without a license, Gonzalez said.

Acupuncturists have gone to the physical therapy board to file complaints against several physical therapists, including Demeure, alleging they were practicing acupuncture in the form of dry needling.

All complaints have been dismissed.

The acupuncture board has issued a resolution stating that only doctors, physician assistants, acupuncturists and chiropractors should be permitted in the practice of inserting needles into the skin for therapeutic results.

Gonzalez said the acupuncture board is effectively asking the physical therapist board to show where it gets the authority to allow the practice.

“And secondly, if there is authority, should there not be appropriate training and educational requirements for people to do that?” Gonzalez said.

Desai said the two legal options are to sue the physical therapy board to challenge the expansion of the scope of practice or to file a declaratory judgment asking a court to decide on the law.

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