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As dry needling moves into physical therapy mainstream, AMA calls for a “standard of practice”July 6, 2016
After a pesky upper hamstring injury stopped me running after the first 100 yards of the Floppin’ Flounder 5K earlier this month, I seized the opportunity to ask a three-time U.S. Olympic Marathon Trials qualifier if she had any suggestions.
Laurie Sturgell Knowles, a 38-year-old mother of two, who ran a 17:04 (beating all but two guys), responded. “Have you tried dry needling?”
That out-of-gate question stumped me. I had “kinda” heard of it, but really knew nothing. And while I’ve always been leery of new, alternative therapies, and even some old ones (I’ve tried chiropractic, but not acupuncture), I figured Knowles knows.
So I bit the needle and gave it a shot, not knowing that I had stumbled onto some news.
According to the American Physical Therapy Association, the “dry” part of dry needling refers to one that doesn’t include medication. Dry needling is used by physical therapists, where allowed by state law, or other health professionals to treat myofascial injuries or pain by inserting filament needles into trigger points.
The needles target muscular and connective tissues that are more difficult, and often practically impossible, to stimulate blood flow and therefore healing. The therapy is primarily for sufferers of chronic pain and injuries, not athletes.
Dry needling is not acupuncture, which uses the same filament needles in one part of the body to influence the other, distant areas. But it’s probably safe to say that dry needling is a cut-to-the chase version of the ancient Chinese practice, a fusion of acupuncture, acupressure and deep tissue massage.
Despite the differences, the therapy has sparked a turf battle, pitting groups representing acupuncturists against groups representing physical therapists across the nation.
In April, a North Carolina Superior Court judge dismissed a lawsuit filed by the N.C. Acupuncture Licensing Board seeking a declaration that dry needling by physical therapists is “the unlawful practice of acupuncture” and to require the N.C. Board of Physical Therapy Examiners to advise its licensees that dry needling is outside the scope of physical therapist practice.
AMA chimes in
Complicating matters on a national level is the fact that some states allow physical therapists to perform dry needling, while others don’t. And some take just an advisory stance. Case in point, South Carolina allows it, California does not, and New York has made a statement against PTs doing dry needling but does not prohibit it.
Last week, at the American Medical Association’s annual meeting, the group issued an array of policy statements on issues of the day, including the support of a new subspecialty “addiction medicine” to help address the opioid epidemic.
The AMA also called on a standard of practice for dry needling, noting that it is an invasive procedure and that physical therapists, some with as little as 12 hours of training, are increasingly incorporating the therapy into their practices.
“Lax regulation and nonexistent standards surround this invasive practice,” says AMA Board Member Russel W.H. Kridel. “For patients’ safety, practitioners should meet standards required for acupuncturists and physicians.”
Hurts so good
As the bureaucracy sorts itself out, dry needling is gaining fans, including 56-year-old Nancy Hunsicker of Mount Pleasant.
Having had success with acupuncture for nearly a decade, Hunsicker didn’t have any qualms with needles when Michael Goldberg, a physical therapist with Progressive Physical Therapy, suggested she try dry needling to ease the pain of bursitis in her hip.
She had four sessions over eight weeks and considers herself “85 percent pain free.”
Elite runner Knowles first tried dry needling in December 2010 for a hip injury and had “amazing results.” Since then, she’s sought out dry needling multiple times for issues with her hamstrings, glutes, back and hip and “maybe calves.”
“The important thing to remember about dry needling is that it does not fix the problems causing the pain, but just helps relieve the pain. You still have to correct whatever is causing the problems, such as a muscle imbalance or tightness,” says Knowles. “But I do think it’s an important recovery tool.’
At her advice and with some guidance from another top local runner, Caitlin Batten, a physical therapist who is not certified in dry needling but performs it on herself, I found my way to Goldberg to deal with my pesky hamstring.
After the obligatory forms and a short consultation, I was on the table getting needles stuck in my right hamstring.
What I didn’t expect was Goldberg shooting some currents of electricity into the needles, which caused some involuntary twitching in my right foot.
Honestly, only two or three of the 10 or so needles inserted hurt to any significant degree. But as a endorphin junkie, I knew my payback was coming. I was able to go to my gym immediately after to lift weights, but took Goldberg’s advice to lay off the legs.
I’ve yet to return to running, but haven’t been deterred from bike commuting, weight lifting (other than lunges, which zinged the hamstring in the first set) and swimming.
As for the cost, I was ready to pay cash, but Goldberg says some insurance plans cover it, so I gave them my car.
If not covered, the evaluation and procedure will likely cost about $150, but I haven’t received the bill yet.
Dry needling, as it is practiced today, came into being since Goldberg graduated PT school in 1999. In fact, he didn’t hear about it until 2008, a year before he went for his first-level certification from Colorado-based KinetaCore.
Today, Goldberg says PT students are given a cursory introduction to it, but that it’s considered an “advanced technique.” KinetaCore requires that health professionals, including chiropractors, practice for at least two years before seeking a certification. And in order to get a second-level certification, a health professional must demonstrate that they have treated at least 200 patients with dry needling.
Despite practicing it for seven years, Goldberg says most patients he talked to about it were not familiar with the therapy and ask if it will hurt. Others (like me) seek it out, while a few rule it out, usually because of an aversion to needles.
While dry needling is still relatively new to the mainstream, Goldberg says doctors have been using the technique to stimulate healing for years.
“But doctors don’t get paid to stick needles. They only get paid if they are injecting medications, such as steroids,” says Goldberg. “This takes what’s been done for years but makes it a much more friendly procedure. These needles are so much smaller and the risk is lower and more comfortable than the standard needle.”