COURTNEY N. PHILLIPS, MPA
AGO 16-9
No. 16-009
Nebraska Attorney General Opinions
State of Nebraska office of the Attorney General
July 8, 2016
SUBJECT:
Whether "Dry Needling" is within the scope of
practice of Nebraska physical therapists, occupational
therapists and athletic trainers; Role and authority of
professional licensing boards to advise practitioners as to
scope of practice
REQUESTED
BY: Courtney N. Phillips, MPA, Chief Executive Officer,
Department of Health and Human Services
WRITTEN
BY: Douglas J. Peterson, Attorney General, Lynn A. Melson,
Assistant Attorney General
You
have requested an opinion from this office regarding the
definition of dry needling and whether this technique or
procedure falls within the current scope of practice of
physical therapists, occupational therapists and athletic
trainers in Nebraska. In addition, you have asked "what
is the role and limit of authority of a professional
licensing board designated in the Uniform Credentialing Act
to advise practitioners of whether a technique is within the
scope of practice to be used by practitioners licensed in the
area."
1.
What is the definition of dry needling as it applies to the
Physical Therapy Practice Act?
You
have explained in your opinion request letter that a dispute
has existed for several years concerning dry needling and
that both the Nebraska Board of Chiropractic and the Nebraska
Board of Physical Therapy have stated that the technique of
dry needling falls within that profession's scope of
practice. We begin by noting that the term "dry
needling" is not defined in any Nebraska statute or
regulation. Indeed, we found no references at all to dry
needling in Nebraska statutes and only one reference to dry
needling in regulations, which occurs in the regulations
governing the licensure of animal therapists at 172 NAC 182.
Section 182-004.02 lists dry needling as one of the
modalities which may be used by an "Animal Therapist in
Acupuncture."
First,
while you ask our office to define the term "dry
needling", we do not ordinarily attempt to define such
specialized terms as we have no expertise in the health care
field. We generally rely on the expertise of the Department
and individual professional boards in such matters. Your
staff has forwarded to our office various materials regarding
the topic of dry needling, including letters from the
chairperson of the Nebraska Board of Physical Therapy (Scott
Edwards, PT, OCS, February 21, 2016) and the chairperson of
the Nebraska Board of Chiropractic (David W. Lauer, D.C.,
February 22, 2016) which express the views of those boards
with respect to dry needling and copies of the minutes of the
Board of Physical Therapy.
The
Board of Physical Therapy gave an opinion during its meeting
of June of 2011 that dry needling is within the scope of
practice of physical therapists. The minutes of the June 20,
2011 meeting state as follows:
After discussion, including the review of 172 NAC 137-007
Fine-Wire Electromyography and reviewing documents provided
during testimony, Mr. Edwards moved, seconded by Ms. Reiman
that it is the opinion of the Nebraska Board of Physical
Therapy that a Nebraska licensed physical therapist may
perform dry needling as long as he/she can competently
perform such a procedure. . . . Dry needling is a mechanical
modality technique used to treat myofascial pain that uses a
dry needle, without medication, that is inserted into a
trigger point with the goal of releasing/inactivating the
trigger points.
Mr.
Edwards, the chairperson of the Nebraska Board of Physical
Therapy, states in his letter of February 21, 2016, that some
Nebraska physical therapists have been using dry needling in
their practices since the Board voted on its opinion in 2011.
We have
also reviewed a definition provided by The American Physical
Therapy Association in a 2013 resource paper which describes
dry needling as "a skilled intervention that uses a thin
filiform needle to penetrate the skin and stimulate
underlying myofascial trigger points, muscular, and
connective tissues for the management of neuromusculoskeletal
pain and movement impairments." Description of Dry
Needling In Clinical Practice: An Educational Resource
Paper, February 2013 at page 2. This definition appears
consistent with that provided by the Nebraska Board of
Physical Therapy.
For
purposes of determining whether the dry needling procedure
falls within the statutory scope of practice for physical
therapists in Nebraska, we will employ these two definitions.
Our opinion is, therefore, limited to whether physical
therapists may perform a procedure which fits this
description.
We note
that the Nebraska Board of Chiropractic takes a different
position and has stated that dry needling is synonymous with
acupuncture. In his letter of February 22, 2016, Dr. Lauer,
chairman of the Board, is of the opinion that there is but
one procedure, acupuncture, and that only medical doctors,
osteopathic doctors, acupuncturists, and doctors of
chiropractic are licensed for that procedure in Nebraska. Our
review of this question reveals that the issue of dry
needling is...
