Dry needling remains one of the hottest topics in Physical Therapy over the past decade and consequently has fostered both ardent support and opposition. Almost the exclusive focus of my blog, strong state advocacy efforts, current best evidence momentum and unfortunately the dismay of many acupuncturist substantiates this. And with this trend comes the need for education and safety standards. This maturation process of dry needling from obscure modality to mainstream technique added a significant endorsement when the FSBPT recently released its Analysis of Competencies for Dry Needling by Physical Therapists.
And if my nerdhood has not yet been fully exposed to you all, buckle up – here it comes…
My unabashed appreciation for the FSBPT report rivals the ice cream fervor of a 12-year old and when the report was released, I read it cover to cover…twice. Like a teenage girl reading a Nicholas Sparks novel, minus most of the tears. The hard work of the FSBPT, the APTA and a group of industry leaders didn’t necessarily drop a ground-breaking revelation on a physical therapist’s ability to dry needle; what they did was quantify what we have all been trying to qualify in garnering nationwide approval of dry needling.
‘Competencies’ per the FSBPT “are defined as measurable or observable knowledge, skills, or abilities an individual must possess to perform a job effectively. They possess both descriptive and evaluative information (i.e., what characteristics an individual must possess and to what extent or level of quality)”
But what does this 47-page report on dry needling competency actually tell us? Well, it’s likely more obvious than you think.
1) More than 4/5 (86%) of the competencies required by a physical therapist are achieved in school.
Aside from the obvious comprehensive knowledge of human anatomy (which is perhaps THE most important competency to have when penetrating tissue), the Doctorate of Physical Therapy involves relevant curriculum matter like differential diagnosis, physiology, neuromusculoskeletal evaluation, manual therapy interventions, environmental safety, infection control and professional responsibility – to name a few. Basically this substantiates that once PTs are trained in dry needling, they know how to use it safely, why it is being used, what mechanisms are occurring on the tissue and neuromuscular level, and where to treat for functional and therapeutic benefit.
2) The other 14% of the competencies for dry needling must be gained through specialized training.
Carry the 1 and that leaves only a 14% gap in competency from entry-level skill to dry needling proficiency. But this also means dry needling is not an entry-level skill. No one is claiming a therapist untrained in dry needling is capable of implementing the technique based on our anatomical knowledge alone and nor should they. The psychomotor skills of manipulating a needle along with sub-specialized considerations in terms of environmental safety and patient communication are required, and reinforcement of soft tissue palpation and 3-dimensional anatomy are both noted advantages.
3) Background review distinguishes dry needling as different than acupuncture.
From a deductive evaluation of sources encompassing websites, resource papers, text publications, peer-reviewed research journals, instructional curricula, and testing materials; the FSBPT extracted 937 relevant fragments from 30 sources as a foundational definition for dry needling, it’s mechanisms, and it’s required knowledge base.
Here are just a few –
“Dry needling is a neurophysiological evidence-based treatment technique that requires effective manual assessment of the neuromuscular system”
“Anatomical knowledge of the vascular system is important as there is a potential to puncture blood vessels during needling”
“The clinician should be cognizant of anatomical structures within the treatment area that are vulnerable to [dry needling], e.g. neurovascular structures and the lung, and ensure that the needling technique avoids penetration of vulnerable anatomical structures.”
“Sustained contractures of taut bands cause local ischemia and hypoxia in the core of trigger points.”
4) Dry needling is definitively within the scope of physical therapist practice.
The purpose of this report was not necessarily to prove or disprove this point, but rather to qualify and quantify the skills required to safely and effectively implement the technique. Even with dry needling inclusion in the most recent APTA Guide to Physical Therapy Practice and endorsement by the growing majority of state legislatures, 9 states have yet to definitively endorse it as within PT practice. The hope is continued systematic definition and validation of dry needling will be more than sufficient to encourage these undefined states to ratify its use by physical therapists.
With an admitted abbreviation to an incredibly thorough process and report, these four points say a lot. A process involving background review, practitioner survey and task force meeting of industry leader essentially equates to what we as physical therapists already know, but others may not. I see this report as the springboard first for nationwide acceptance of dry needling by physical therapists, but secondarily to establish education standards for dry needling coursework in the US. All of which with the ultimate focus on patient betterment and safety, and the continued progression of physical therapy.
Paul Killoren PT, DPT
As always, I encourage feedback, commentary and professional discussion…and witty rhetoric or jokes.