Dry Needling in Indiana

Dry Needling: Indiana

By Jennifer A. M. Stone MSOM, LAc

Dry Needling is acupuncture and utilizes acupuncture needles. Under Indiana law, acupuncture falls under the definition of surgery:

Indiana Medical Practice Act section IC 25-22.5-1-1.1(a)(1)(C))

“(C) the performing of any kind of surgical operation upon a human being, including tattooing, except for tattooing (as defined in IC 35-42-2-7), in which human tissue is cut, burned, or vaporized by the use of any mechanical means, laser, or ionizing radiation, or the penetration of the skin or body orifice by any means, for the intended palliation, relief, or cure;”

Those who penetrate the skin…for the intended palliation relief or cure… in Indiana are practicing medicine, surgery without a license therefore violating the Indiana Medical Practice Act. A class D felony.

What is dry needling?

Dry Needling is a generic term for a therapeutic treatment procedure that involves multiple advances of a filament needle into the muscle.

http://www.kinetacore.com/faq/#whatis

Dry Needling is a western form of “Acupuncture” and this treatment has been described using many names.

http://www.physicaltherapyfirst.com/services/dryneedling/

Acupuncture definition:

As defined by the World Health Organization, acupuncture “involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.”

Problem: Physical Therapists, Athletic Trainers, and PT assistants are preforming Dry Needling (acupuncture) in Indiana with little (12 hours) or no training. Physical therapy is not a field that has historically included the use of needles.

http://iuhealth.org/bloomington/rehabilitation-services/

http://topflighttherapy.com/dry-needling-2/

http://priorityrehabindy.com/dry-needling/

https://www.ivyrehab.com/treatment/dry-needling/

http://www.physicaltherapyfirst.com/services/dryneedling/

Significance:

Public Health – Unnecessarily exposes the public to serious and potentially hazardous risks. Complications such as pneumothorax and severe tissue damage have occurred.

This article reports on a case where pneumothorax occurred during a dry needling training: http://aim.bmj.com/content/early/2014/09/19/acupmed-2014-010659

Legal– Physicians, MD’s and DO’s who refer to PT’s can be held liable if injury is caused by dry needling.

PT’s are fraudulently billing dry needling as manual therapy and getting reimbursed by Medicare. Medicare does not cover acupuncture.

Recommendation:

The Indiana Society of Acupuncturists requests an opinion from the Attorney General’s office on whether dry needling is within the scope of PT’s in Indiana.
The Indiana Society of Acupuncturists suggests that legislators re-evaluate dry needling in the future when appropriate training and certification is established for PT’s.

Dry Needling history and trainings for PT’s and DC’s:

KinetaCore coined the term “dry needling” in 2007. KinetaCore began when Edo Zylstra developed an introductory and advanced dry needling course in 2006. KinetaCore® was founded in 2007 and has the mission of offering quality continuing education courses for the manual therapist while actively participating in elevating the profession of physical therapy across the globe. http://www.kinetacore.com/about/history/

Fishkin Center for Dry Needling 12 hour training:

http://fishkincenter.com/dryneedlinginstitute/

Myopain Seminars:

http://myopainseminars.com/seminars/

Requirements for license to practice acupuncture in Indiana:

The practice of acupuncture in Indiana is governed by the medical licensing board IC 25-2.5-2.

IC 25-2.5-2-1 Requirements for acupuncture license

current active status as a diplomate in acupuncture of the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM);
successfully completed a three (3) year postsecondary training program or acupuncture college program that: (i) is accredited by; (ii) is a candidate for accreditation by; or (iii) meets the standards of; the National Accreditation Commission for Schools and Colleges of Acupuncture and Oriental Medicine; and
successfully completed a clean needle technique course approved by the National Certification Commission for Acupuncture and Oriental Medicine.

Note: NCCAOM requires 60 CEU’s every 4 years to recertify and maintain active status.

IC 25-2.5-2-3 Affiliated professional license

(b) An applicant may, upon the payment of a fee established by the board, be granted a professional’s license to practice acupuncture if the applicant submits satisfactory evidence to the board that the applicant is a:

(1) chiropractor licensed under IC 25-10;

(2) dentist licensed under IC 25-14; or

(3) podiatrist licensed under IC 25-29;

with at least two hundred (200) hours of acupuncture training.

Note: Physicians’ scope is unlimited in Indiana, however, the American Academy of Medical Acupuncture provides training and certification for physicians including a 330 hour training + minimum 100 clinical hours. Here is a list of AAMA certified physician acupuncturists in Indiana: http://www.medicalacupuncture.org/Find-an-Acupuncturist

PT Practice Act; unlawful practice:

Under section IC 25-27-1-2 “Unlawful Practices” of Indiana’s Physical Therapy Practice Act, it is unlawful for physical therapists to “practice medicine, surgery (as described in IC 25-22.5-1-1.1(a)(1)(C)).”

Indiana Medical Practice Act section IC 25-22.5-1-1.1(a)(1)(C))

Therefore, physical therapists practicing dry needling in Indiana are practicing medicine, surgery without a license.

Select Official Positions on Dry Needling:

American Academy of Medical Acupuncture:

Physical therapy is not a field that has historically included the use of needles. The recent trend of some physical therapists to embrace dry needling under the umbrella of physical therapy practice is one that marks a distinct departure from traditional physical therapy practice. The fact that many physical therapists receive only minimal hours of training speaks to the potential danger of their practice.

Including dry needling into the scope of practice by physical therapists unnecessarily exposes the public to serious, potentially hazardous risks. We feel a duty to inform legislators and regulating bodies about the inherent danger to the public of this practice.

The AAMA strongly believes that, for the health and safety of the public, this procedure should be performed only by practitioners with extensive training and familiarity with routine use of needles in their practice and who are duly licensed to perform these procedures, such as licensed medical physicians or licensed acupuncturists. In our experience and medical opinion, it is inadvisable legally to expand the scope of physical therapists to include dry needling as part of their practice.

AAMA December 2014, Updated 2016

http://www.nccaom.org/resource-center/press/press-releases/aama-policy-on-dry-needling/

American Medical Association:

Dry Needling is an Invasive Procedure H-410.949

The AMA recognizes dry needling as an invasive procedure and maintains that dry needling should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed medical physicians and licensed acupuncturists.

AMA 2016

http://www.asacu.org/wp-content/uploads/2017/06/AMA-Dry-Needling-Policy.pdf

American Academy of Physical Medicine and Rehabilitation:

The American Academy of Physical Medicine and Rehabilitation recognizes dry needling as an invasive procedure using acupuncture needles that has associated medical risks. The AAPMR maintains that this procedure should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed acupuncturists or licensed medical physicians.

AAPM&R June 2012

http://www.asacu.org/wp-content/uploads/2016/09/AAPMR-Position-on-Dry-Needling1.pdf

Select Attorney General Opinion letters:

New Jersey http://www.njaaom.net/resources/Documents/Dry%20Needling%20opinion%20-%20NJ%20AG%202.9.17.pdf

Texas https://texasattorneygeneral.gov/opinions/opinions/51paxton/op/2016/kp0082.pdf

Oregon http://www.oregon.gov/PTbrd/docs/Dry%20Needling%20Opinion%20May%2019%2C%202017.pdf

Washington http://www.atg.wa.gov/ago-opinions/scope-practice-physical-therapy

Illinois http://www.ipta.org/news/171339/Dry-Needling–Important-Update.htm

Ohio http://www.ohioattorneygeneral.gov/getattachment/e7388f87-37a4-48c9-9011-228d9b838794/2016-015.aspx

In the media:

USA TODAY Torin Yater-Wallace bounces back from collapsed lung with top run. https://www.usatoday.com/story/sports/olympics/sochi/2013/12/13/torin-yater-wallace-dew-tour-ion-mountain-championship-halfpipe-qualifying/4019707/

USA TODAY ‘Dry needling’ for pain therapy is under scrutiny