An argument over a definition is headed to the courts as acupuncture practitioners in North Carolina contend the practice of “dry needling” by physical therapists constitutes acupuncture without sufficient training and is illegal.
“Both involve the use of FDA-regulated acupuncture needles,” says Cissy Majebe, founder of the Chinese Herbal and Acupuncture Clinic in Asheville. Also cofounder and clinician at Daoist Traditions College Acupuncture Clinic, she adds, “Both [techniques] pierce the skin — making them invasive — and both target specific points in the body to alleviate pain and other symptoms.”
On Sept. 2, the N.C. Acupuncture Licensing Board filed suit in Wake County, asking the court for a permanent injunction against dry needling as approved by the state’s Board of Physical Therapy Examiners.
N.C. Physical Therapy Board executive director Ben Massey referred questions on the matter to the board’s attorney, Matt Sawcheck, who declined to speak on the record. Sawcheck did send a definition, as well as a copy of a study that was not peer-reviewed and was paid for by the Federation of State Boards of Physical Therapy.
The definition sent by Sawcheck is similar to a position statement posted by the Physical Therapy Board in 2010 and revised last year: “Intramuscular Manual Therapy (IMT), which is generally referred to as dry needling, is defined as a technique to treat myofascial pain using a dry needle (without medication) that is inserted into a trigger point with the goal of releasing / inactivating the trigger points and relieving pain.”
Sawcheck’s definition also states, “Intramuscular manual therapy is not acupuncture, which is defined by [N.C. General Statute] 90-451(1) as follows: ‘A form of health care developed from traditional and modern Chinese medical concepts that employ acupuncture diagnosis and treatment, and adjunctive therapies and diagnostic techniques, for the promotion, maintenance, and restoration of health and the prevention of disease.’”
In a written statement, Sawcheck adds, “Dry needling differs from acupuncture in important ways. North Carolina defines acupuncture as ‘a form of health care developed from traditional and modern Chinese medical concepts.’” He says that “dry needling was not developed from Chinese medical concepts. Also, dry needling does not use the same diagnostic techniques that acupuncturists use. These and other differences show that dry needling is physical therapy, not acupuncture.”
Majebe, who serves on the N.C. Acupuncture Licensing Board, disagrees. Acupuncture is part of Chinese medicine, she says, and dry needling is the same therapy as acupuncture, using the same equipment and the same trigger points.
“They simply created new nomenclature to circumvent North Carolina statutes governing acupuncture,” says Majebe.
Junie Norfleet, chair of the N.C. Acupuncture Licensing Board and clinical observation director of Daoist Traditions, says the only difference the Physical Therapy Board offers is that acupuncture is derived from traditional Chinese medicine. “But you are piercing the skin and you can cause muscle damage if you are not properly trained,” she says. “When you pierce the skin with an acupuncture needle, you are performing acupuncture.”
Majebe notes that she believes the Physical Therapy Board’s definition infers that Chinese traditional medicine is not based on science.
“That is absurd,” she says. “There has been a wealth of scientific study to back up Chinese medicine. Western pathophysiology is part of our education. Physical therapists do study anatomy, but not to the degree that is required for acupuncture licensure.”
North Carolina passed regulations governing the practice of acupuncture in 1993, requiring practitioners to complete a three-year postgraduate program that requires at least 1,800 hours of training for licensure.
In 2013, the N.C. Physical Therapy Board instituted a requirement of 54 course hours of classroom training for certification in dry needling.
“Fifty-four hours of study is less than what is required of a cosmetologist,” says Majebe.
In October 2014, Majebe mentions, King County Superior Court in the state of Washington banned the practice of dry needling by physical therapists after the South Sound Acupuncture Association sued the Colorado-based training company Kinetacore for presenting 27-hour weekend workshops and then certifying physical therapists to practice dry needling.
Some physical therapists are fully trained and certified in acupuncture, Majebe notes, and patients should ask to see certification before allowing any procedure.
“Our concern is for the safety of patients,” Majebe says. “If you have the wrong angle, if you pierce too far, you can puncture organs. You can argue that acupuncture is Chinese in origin and dry needling is not, but whether a person is in China or the United States, a person’s lungs are in the same place.”