#Consumer Affairs
Arizona State Legislators, Governor Janice Brewer
United States of America

Physical therapists (PT) have been successfully practicing dry needling (DN) in Arizona for over 30 years as a way to treat the neuromusculoskeletal system and conditions.

Presently, after 3 decades of practice, Traditional Chinese Medicine (TCM) practitioners and organizations are wrongfully accusing physical therapists of endangering the public, fraud and trying to expand their scope of practice by practicing acupuncture without proper training.

According to The National Center for Complementary and Alternative Medicine:

The TCM view of how the human body works, what causes illness, and how to treat illness is different from Western medicine concepts, and scientific evidence of its effectiveness is, for the most part, limited.

TCM is rooted in Taoism, and in the TCM view, a vital energy or life force called qi (chi) circulates in the body through a system of pathways called meridians. Health is an ongoing process of maintaining balance and harmony in the circulation of qi.

PTs are in no way attempting to practice or simulate TCM, nor use TCM concepts. PTs do not claim to influence energy, nor balance or move energy along meridians when treating patients. PTs are not attempting to restrict the practice of TCM acupuncturists. While TCM practitioners treat a wide range of conditions, from musculoskeletal and gastrointestinal issues to mental health, reproductive and gynecological issues, PTs restrict their use of DN to the nueromusculoskeltal systems, related pain and movement dysfunctions.

PTs are practicing the modality of dry needling that is shared by many other professions both in the U.S. and worldwide.  Dry needling, like many other treatment techniques, such as spinal manipulation, is not an exclusive scope of any discipline, including TCM practitioners. 

The Arizona Physical Therapy Association defines dry needling as:

“Dry Needling is a skilled intervention performed by a physical therapist (PT) that uses a thin filiform needle to penetrate the skin and stimulate underlying neural, muscular and connective tissues for the evaluation and management of neuromusculoskeletal pain and movement impairments.”

TCM proponents have been viciously attacking the PT profession through social media, news outlets, legislative open meetings and through complaints to respective regulatory boards since 2011.

The Arizona State Board of Physical Therapy is responsible for interpreting and enforcing the laws that regulate the practice of physical therapy in Arizona. (See A.R.S.§32-2003(A)(4)). As treatment techniques are developed and utilized in the practice of physical therapy, the Board is responsible for determining if specific techniques fall within the definition of physical therapy established in statute.

In 2012 the Arizona Board of Physical Therapy adjudicated all cases regarding DN, dismissing all complaints accusing physical therapists of practicing outside their scope of practice. In October 2013 the Board concluded that Dry Needling is a modality; which is a broad intervention identified in the definition of the practice of physical therapy. (See A.R.S. §32-2001(12)(a & b)).

The primary argument TCM proponents use is one of public safety. This is dispelled from three different sources:

LOCALLY: In 3 decades of practice in AZ, the PT Board has received 0 complaints from patients or providers, of a PT injuring, harming, or mistreating a patient in regards to DN.

NATIONALLY: State of Maryland determined DN was within the scope of practice of PT’s in 1984, and in 3 decades of practice in the US, CNA, which has been the nationally endorsed professional liability underwriting company for physical therapists for over 22 years has stated: “After reviewing the CNA claim database, which includes approximately 5,800 closed physical therapist claims, there were no trends relative to dry needling identified that would indicate this procedure presents a significant risk factor.” Further more, “CNA does not forsee the practice of dry needling by licensed physical therapist as having any immediate claim or rate impact.” CNA reported only 6 closed cases over this time period that involved dry needling, with a total indemnity paid out of $79,000.00. Find CNA letter here.

RESEARCH: According to Brady et. al. the risk of a significant adverse event for dry needling by PTs was calculated to be 0.04%, which is considerably lower than the risk of taking ibuprofen: (Brady S, et. al.: Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists.  JMT 2013 o:o).

There are fundamental, scientific and philosophical differences between evidence based dry needling and TCM. To make clear these distinctions, consider these words from (Arizona School of Acupuncture and Oriental Medicine Catalog, pg. 24):

"For a number of Westerners, Qi poses conceptual problems because it fits none of the categories of phenomena to which they are accustomed. Having no form, it is clearly not a substance. Many are happy to consider it energy, but since science has been unable to determine its nature, it can at best be called energy only in an as-yet-undefined use of the word. Since science’s probes cannot detect it consistently as a single phenomenon, its existence has to be taken, to a greater or lesser degree, on faith."

Dry needling is an evidence-based technique rooted firmly in anatomy, biology, physiology, and neurophysiology. It benefits from centuries of cadaver dissections, decades of X-ray, MRI, FMRI, CT imaging findings, and histologic and hematologic studies. TCM acupuncture is an eastern based philosophical approach to treating physical ailments, and although in recent years has incorporated western medical approaches, it does not hold to the fundamental medical sciences.

Currently, TCM practitioners are attempting to restrict the practice of physical therapy. This in turn would restrict consumer choice and access to the evidence based scientific medical modality of DN, requiring all patients to subject themselves to the philosophies and non-evidence based treatment approaches of TCM. Additionally, this would limit access to affordable healthcare by patients, free enterprise, and the rights of physical therapists as practitioners who have been needling for over 30 years.

We the undersigned request that the AZ state legislative representatives, and Janice K. Brewer, the Governer of AZ to:

Protect the scope of physical therapy practice in AZ
Protect the consumers right to choose
Protect the public access to affordable healthcare

Call to action:
We are asking that the AZ State Legislature would uphold publicly, the findings of The Arizona State Board of Physical Therapy, the authorized government agency purposed to interpret and enforce the laws that regulate the practice of physical therapy in Arizona (SeeA.R.S.§32-2003(A)(4)).

We are asking the Az State Legislators to acknowledge that dry needling is within the scope of practice of physical therapy, and that physical therapists are responsible for managing, designing, implementing and modifying interventions that include modalities and mechanical modalities (A.R.S. §32-2001(12)(b)), and that in the delivery of all treatment techniques, including Dry Needling, a physical therapist must maintain a level of competence that ensures the treatment will be safe, effective and efficient, and any physical therapist delivering treatment in which they are not competent to perform may face discipline for substandard care under A.R.S.§32-2044(4).

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The Protect PT Scope petition to Arizona State Legislators, Governor Janice Brewer was written by Manual Physical Therapy Alliance, LLC and is in the category Consumer Affairs at GoPetition.