FAQ: Is Dry Needling in the Scope of Chiropractic Practice?
“Dry needling” is defined in the Illinois Physical Therapy Act as:“an advanced needling skill or technique limited to the treatment of myofascial pain, using a single-use, single insertion, sterile filiform needle (without the use of heat, cold, or any other added modality or medication), that is inserted into the skin or underlying tissues to stimulate trigger points.”The Act states that dry needling, also known as intramuscular therapy, may apply theory based only upon Western medical concepts.
The Medical Practice Act provides a broad definition of chiropractic scope as the treatment of human ailments without the use of drugs and without the use of operative surgery. Because dry needling uses neither drugs nor operative surgery, it lies within chiropractic scope.
In addition, the Acupuncture Act and the Illinois Physical Therapy Act both specifically exempt all physicians licensed under the Medical Practice Act from needing a license to perform procedures within the scope of acupuncture and physical therapy, respectively. This exemption provides additional authority for chiropractic physicians to perform physical therapy and acupuncture procedures.
While the ability to perform dry needling is well within the scope of practice of a chiropractic physician, the standard of care must be met.
As for any procedure used in practice, physicians must ensure they are appropriately and adequately trained. While the IllinoisDepartment of Professional and Financial Regulation (IDFPR) does not require chiropractic physicians to have a certain number of hours of training to perform dry needling, practitioners will need to have sufficient hours to meet the standard of care.
In the absence of a specific IDFPR requirement, the ICS has been asked to define the number of training hours chiropractic physicians need to meet the standard of care to perform dry needling. (Note that this question would only arise in the context of a patient complaint against a D.C. for negligent performance of dry needling by a chiropractic physician, to establish whether the standard of care was met.) A good starting point would be the training requirements the State enacted for physical therapists to perform dry needling. In general, physical therapists will be required to have: 50 hours of instruction in the musculoskeletal and neuromuscular system; the anatomical basis of pain mechanisms, chronic pain, and referred pain; myofascial trigger point theory; and universal precautions; 30 hours of didactic course work specific to dry needling; and 54 hours of practicum in dry needling technique, documentation, and other skills (see 225 ILCS 90/1.5 for full list of physical therapist requirements: http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1319&ChapterID=24.) Physical therapists will also be required to complete at least 200 patient treatment sessions under supervision, as determined by rule by the IDFPR.
In all likelihood, most chiropractic graduates will have completed during school the content contained in the 50 hours of instruction. Chiropractic physicians will need to weigh their own training and experience against the didactic and practicum requirements to assess the amount and substance of additional training required to meet the standard of care. Although this does not provide a fixed number of hours applicable to all chiropractic physicians, this information can serve as a baseline for the types and amount of training the IDFPR would expect in any particular case. As for any procedure used in practice, the Medical Practice Act requires physicians to ensure they are appropriately and adequately trained.