??? Is dry needling manual therapy?

[advantage1]

I came across this press release from NCASI (National Center for Acupuncture Safety Institute) regarding the use of dry needling by PTs and other health care providers:

http://www.acupuncturesafety.org/

Within the release they mention that PTs refer to dry needling as manual therapy in order to circumvent state licensure requirements:

Physical therapists and other allied health professionals are attempting to circumvent state acupuncture licensure requirements by adopting the term “dry needling” for the practice of acupuncture. This conduct is coupled with attempts to claim that “dry needling” is not acupuncture but “manual therapy.”

I've argued that dry needling is not manual therapy with some PTs on twitter. I can't see how inserting needles into tissue is considered manual therapy. However, some on twitter have argued that it is manual therapy. Due to the limitations of twitter for debate I offered to start a theread here and invited some from twitter to join.

[Bas Asselbergs]

Interesting issue.

I would not consider needling manual therapy; for the same reason that I do not consider teaching movement with assistance of manual feedback, or handing someone a sheet of paper, manual therapy.

[proud]

Dry needling is certainly not manual therapy.

Dry needling is an utter fools errand wrought with placebo... induced by maximal ritual effect, novel and exciting stimulus as well as an injection of hope for those desperate enough to allow someone to stab them with a needle.

It's a gong show of a treatment as far as I can tell via injesting large amounts of literature on the topic.

I spent more time than I care to admit reading all of Jan dommerholt's work as well as following him on various blogs attempting to defend stabbing people. I wanted desperatly to "believe" but all literature avenue's (if read carefully with a keen eye on science vs psuedo-science) lead to a very high BS-o-meter. The key though is you have to have at least a decent grasp of the available pain science before applying occum's razor effectively. Few Physiotherapist's I've met have invested the required time.

I considered taking a dry neddling course just to see what hype they were selling today's Physiotherapy sheeple's....

Is that strong enough wording for you to convey my thoughts on this "treatment"?

[Diane]

[Ooh, this is gonna be fun... ]

I dislike dry needling or any kind of poke-you-puncture for all proud's reasons and more besides.

However, I will play devil's advocate here, and side with the idea that poking needles into who-knows-what (whatever "thought object" people might have in their heads) through skin, is indeed "manual" therapy. It's done by hand, and targets are chosen by palpation after all.

Don't know about the "therapy" part...

Actually, I don't know about the "therapy" part for HVLA (which also claims high ground for being "manual" therapy too), either.

Maybe the purists/poke-you-puncturists should check with Chan Gunn, who opened Pandora's box on all this for fun and profit.

[proud]

Don't know about the "therapy" part...

Anything that imparts some message to the patient that things are being "re-aligned", "re-positioned", "Released" or whatever may indeed fit the "manual" description. But it fails the "therapy" description.

Thus...t'aint manual therapy.

FYI: I don't consider subluxation based "thrusting" be it of the chiropractic variety or the Physiotherapy variety to be manual therapy either.

Therapy is in there for a reason ya know.

[advantage1]

I would agree that there is a manual component involving palpation for the elusive 'MTrP'. However, that's the bulk of manual therapy involved with dry needling. The issue with palpating for 'MTrPs' is that they have never been proven to exist:

http://www.ncbi.nlm.nih.gov/pubmed/19158550

In addition they can't be reliably assessed during a manual exam. Therefore, the validity of the underlying construct of dry needling is in question. Therefore, the manual component of dry nedling is palaption for tender areas and taut bands. It falls short when we assume this tender area is classified as an 'MTrp" that is assumed can be needled in order to releive pain. I would call it what it is 'dry needling'.

[sheld505]

I would agree that there is a manual component involving palpation for the elusive 'MTrP'. However, that's the bulk of manual therapy involved with dry needling. The issue with palpating for 'MTrPs' is that they have never been proven to exist:

http://www.ncbi.nlm.nih.gov/pubmed/19158550

In addition they can't be reliably assessed during a manual exam. Therefore, the validity of the underlying construct of dry needling is in question. Therefore, the manual componet of dry nedling is palaption for tender areas and taut bands. It falls short when we assume this tender area is classified as an 'MTrp" that is assumed can be needled in order to releive pain. I would call it what it is 'dry needling'.

This has been been my argument on LinkedIn too. Couple that with my hugely negative experience watching some residents, fellow-in-training, and fellow jab people despite their verbalizations of "no," and I think it's a bit ridiculous.

My dilemma is this: As a PT who does practice manual therapy in the sense of mobilization, manipulation, STM, and exercise, and who appreciates the support of my collegues in the support of the above-mentioned within PT scope of practice, where do I draw the line personally and professionally in support of dry needling? Based on what I've seen first-hand, I have a hard time supporting the needlers at this time, as I do anybody who supports subluxation-based manual and manipulative interventions. I'd like to take a course to be a fly-on-the wall though.

[advantage1]

90 views and no one from twitter has provided input.

[John W]

The primary reason that dry needling is being pushed as manual therapy is because in the US you have to assign a procedure code (in this case 97140) for each intervention that you perform. In order to legitimize dry needling as a therapeutic procedure, it has to be classified within the definition of one of the available reimbursable codes. That's pretty much it.

APTA, in particular the Orthopedic Section, has been strongly advocating for dry needling by PTs and are vigorously distinguishing it from acupuncture by citing much of the same evidence that Jan Dommerholdt reels off like like my 11 year-old reciting her Christmas list.

JOSPT shamefully published the Kietrys et al systematic review of dry needling, which is, in my view, fatally flawed research and never should have passed peer review. Neil O'Connell provided a critique, which he gave me permission to reproduce here.

I predict that the PT profession's embrace of dry needling will go down as the biggest mistake we've ever made- and we've made some whoppers.

[nari]

Maybe therein lurks a primitive desire to stab people with pins in the hope to dispense evil spirits? or induce them? Can't remember which....

Nari

[John W]

Nari, you may be onto to something there. Instead of driving a stake into the vampire's heart, heroic PTs are driving a needle into the dreaded and dastardly trigger point. (Maybe Patrick can doodle us a cartoon of that?)

Now who's the bloodsucker?

[Jo Bowyer]

A neurosurgeon I know does it when he can't justify a surgical approach.
He calls it 'accupuncture without the story' and charges a fortune for it.

[advantage1]

John said:

The primary reason that dry needling is being pushed as manual therapy is because in the US you have to assign a procedure code (in this case 97140) for each intervention that you perform. In order to legitimize dry needling as a therapeutic procedure, it has to be classified within the definition of one of the available reimbursable codes. That's pretty much it.

Has there ever been any defendable argument explaining how dry needling is manual therapy? Or, is it simply as stated above, a way to bill insurance?

[Bas Asselbergs]

If this holds, then US PTs can charge for manual therapy when they hand a paper to their patient.
Just like a needle, the therapy "agent" is manually transferred to the patient.

[joebrence9]

Is dry needling manual therapy?

I recently reached out to several large "prominent" dry needling groups/individuals and asked them if they could explain the potential mechanisms of "dry needling" in 4 sentences or less for an upcoming post on my site which addresses this topic. Each respectfully declined. I suppose its a secret (which could be revealed for $____).