DRY NEEDLING, TURF, and the STUDY THAT NEVER WAS

A recent article in Acupuncture Today caught my eye because it is on a topic I have been meaning to offer my opinion on and seeing just how crazy this article was I thought I would offer that now. The topic is the use of so-called “dry needling” by Physical Therapists or similar health-care providers and the article that took this topic to new levels of craziness was “Dry Needling: Averting a Crisis for the Profession” by Dr. John Amaro, DC, L.Ac., Dipl. Ac.(NCCAOM), Dipl.Med.Ac.(IAMA).

There has been a great deal of understandable concern in the Licensed Acupuncturist profession over Physical Therapists employing dry needling – a technique P.T.s insist is not acupuncture and L.Ac.s insist most certainly is. Many AOM groups have been fighting the spread of P.T. dry needling to limited effect. Most these efforts center around raising alarms about public safety issues as the training a typical P.T. gets before undertaking dry needling is quite limited by Licensed Acupuncturists standards. The more honest reason the AOM groups are so concerned has less to do with public safety and more to do with (don’t hate the messenger here) – losing market share.

I share the concern that Physical Therapists and other health care professionals are jumping on the acupuncture bandwagon bringing acupuncture (or acupuncture-like techniques) into their scope of practice and leaving Licensed Acupuncturists still struggling to become part of health care’s mainstream. I do not share a belief that the most common strategies being employed to try to stop this are the way to respond. Dr. Amaro’s idea for dealing with this is to press the issue that dry needling evolved from trigger point injections and so used hypodermic needles not the solid needles used by acupuncturists. Since acupuncture needles are now being used this procedure is acupuncture and can’t be called dry needling. If Physical Therapists were forced to only use hypodermic needles, the dry needling would be so painful it would prove unpopular to their patients.

With all respect to Dr. Amaro and those in the AOM field focused on the public safety risks of under training, I believe there is a much simpler and more productive answer: All Physical Therapy facilities of sufficient size should employ fully-trained Licensed Acupuncturists and all acupuncture facilities of sufficient size doing physical medicine should employ Physical Therapists. Anyone who knows about how these two therapeutic disciplines work knows they can and should complement each other. They should be working together. Period. There is much more fully trained acupuncturists can bring to the table for patients undergoing physical therapy than even the best “dry needling” could provide and Physical Therapists have a range of important skills that Acupuncturists don’t have for rehabilitating patients. Rather than fighting over who gets to do what version of acupuncture techniques, we should be focusing on how to give the best service to our patients by bringing Physical Therapy and the full range of traditional acupuncture and newer techniques like dry needling together.

That this unfortunate situation is creating bad blood between Acupuncturists and P.T.s is particularly sad for me to witness because 23 years ago I was in charge of a project that had the potential to build bridges between these two disciplines and create thousands of jobs for Acupuncturists. While working with the leadership of a professional association then known as the California Acupuncture Association (CAA now CSOMA), I had the chance to connect with a consultant of ours who had been on the Board of Directors of one of the top rehabilitation facilities in the U.S. – the Rehabilitation Institute of Southern California. We proposed doing a study that would seek to find out what would happen when you added acupuncture to conventional physical and occupational therapy. I was convinced we would show that combining acupuncture with P.T. and O.T. would yield consistently better results than P.T./O.T alone and that Acupuncturists and Therapists could work well together. After months of discussions with the Institute’s Executive Officer and therapy staff, we were given the green light to set-up a six month study that I was to coordinate with the head of the therapy department. Although I had offered to volunteer all of my time, our consultant persuaded us to solicit grant money from major foundations as he feared the work involved would be too demanding and require additional personal so some funds would be needed. For anyone interested, I am posting the proposal that we sent to the foundations describing this project at the following link (you might have to copy and paste this address)

http://www.makingacupuncturepay.com/acu%20proposal.pdf

Long story short – we were not able to get any grant money even though we were only asking for $40k. Then, the CAA did not extend our consultant’s contract and he moved on, the rehab institute made changes to their therapy staff, and I did not get enough support from the CAA to keep trying to pull it all together so the project folded. This was one of the biggest disappointments of my career. This facility was so respected in the P.T./O.T. field that the results of the study would have been hard to ignore especially as part of the study was to discover if adding acupuncture allowed patients to progress more and thus continue to warrant more approval for treatment from insurance companies. Everyone in the P.T./O.T. field gets frustrated when a patient’s progress stops and insurance payments stop also. I am still sure that the addition of acupuncture to P.T./O.T. would get patients better results and extend their ability to progress thus warranting more insurance coverage. This study would have also shown that P.T./O.T.s and Acupuncturists could work side-by-side in a constructive manner. At least – it would have showed that 23 years ago before the dry needling issue began and the AOM “leadership” started publicly accusing P.T.s of endangering the public.

Because it is still rare for Physical Therapists and Acupuncturists to work together, the two disciplines can’t appreciate what each one brings to the table and how they could work together. Dry needling only addresses pain and muscle tightness and while you could argue over if traditional acupuncture does a better job for those problems the fact is there is so much more a well trained acupuncturist could do in a rehabilitation setting. You don’t use dry needling to help restore nerve functioning for a post stroke patient or someone with a head injury, for example. Arguing over dry needling misses the point (pardon the pun) of what traditional acupuncture and traditionally trained Acupuncturists can contribute to the rehabilitation arena and actually reinforces the misconception that acupuncture is only good for pain. That was one of the issues I thought this study would have debunked.

Maybe it is not too late. Maybe the bridges I hoped would be built by this never-done study have not yet been completely burned. Maybe leadership of the Acupuncturists communities could meet with leaders of the Physical Therapists communities and try to focus on how combining our collective strengths and reducing our collective weaknesses can better serve those patients who need our help. I don’t know. All I know is this fighting over turf does no one any good.

Matthew Bauer