Exploring Issues in Dry Needling and Acupuncture/TCM Practice in Illinois

1. Exploring Issues in Dry Needling and Acupuncture/TCM Practice in Illinois

2. TITLE 68: PROFESSIONS AND OCCUPATIONS CHAPTER VII: DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION SUBCHAPTER b: PROFESSIONS AND OCCUPATIONS PART 1140 ACUPUNCTURE PRACTICE ACT As used in this Act: "Acupuncture" means the evaluation or treatment of persons affected through a method of stimulation of a certain point or points on or immediately below the surface of the body by the insertion of pre-sterilized, single-use, disposable needles, unless medically contraindicated, with or without the application of heat, electronic stimulation, or manual pressure to prevent or modify the perception of pain, to normalize physiological functions, or for the treatment of certain diseases or dysfunctions of the body and includes activities referenced in Section 15 of this Act for which a written referral is not required. Acupuncture does not include radiology, electrosurgery, chiropractic technique, physical therapy, naprapathic technique, use or prescribing of any drugs, medications, herbal preparations, nutritional supplements, serums, or vaccines, or determination of a differential diagnosis. Scope of Practice/Acupuncture (IL)

3. An acupuncturist registered under this Act who is not also licensed as a physical therapist under the Illinois Physical Therapy Act shall not hold himself or herself out as being qualified to provide physical therapy or physiotherapy services. An acupuncturist shall refer to a licensed physician or dentist, any patient whose condition should, at the time of evaluation or treatment, be determined to be beyond the scope of practice of the acupuncturist. Scope of Practice/Acupuncture (IL)

4. TITLE 68: PROFESSIONS AND OCCUPATIONS CHAPTER VII: DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION SUBCHAPTER b: PROFESSIONS AND OCCUPATIONS PART 1340 ILLINOIS PHYSICAL THERAPY ACT As used in this Act: (1) "Physical therapy" means all of the following: (A) Examining, evaluating, and testing individuals who may have mechanical, physiological, or developmental impairments, functional limitations, disabilities, or other health and movement-related conditions, classifying these disorders, determining a rehabilitation prognosis and plan of therapeutic intervention, and assessing the on-going effects of the interventions. (B) Alleviating impairments, functional limitations, or disabilities by designing, implementing, and modifying therapeutic interventions that may include, but are not limited to, the evaluation or treatment of a person through the use of the effective properties of physical measures and heat, cold, light, water, radiant energy, electricity, sound, and air and use of therapeutic massage, therapeutic exercise, mobilization, and rehabilitative procedures, with or without assistive devices, for the purposes of preventing, correcting, or alleviating a physical or mental impairment, functional limitation, or disability. Scope of Practice/Physical Therapist (IL)

5. (C) Reducing the risk of injury, impairment, functional limitation, or disability, including the promotion and maintenance of fitness, health, and wellness. (D) Engaging in administration, consultation, education, and research. Physical therapy includes, but is not limited to: (a) performance of specialized tests and measurements, (b) administration of specialized treatment procedures, (c) interpretation of referrals from physicians, dentists, advanced practice nurses, physician assistants, and podiatrists, (d) establishment, and modification of physical therapy treatment programs, (e) admini-stration of topical medication used in generally accepted physical therapy procedures when such medication is prescribed by the patient's physician, licensed to practice medicine in all its branches, the patient's physician licensed to practice podiatric medicine, the patient's advanced practice nurse, the patient's physician assistant, or thepatient's dentist, and (f) supervision or teaching of physical therapy. Physical therapy does not include radiology, electrosurgery, chiropractic technique or determination of a differential diagnosis; provided, however, the limitation on determining a differential diagnosis shall not in any manner limit a physical therapist licensed under this Act from performing an evaluation pursuant to such license. Nothing in this Section shall limit a physical therapist from employing appropriate physical therapy techniques that he or she is educated and licensed to perform. A physical therapist shall refer to a licensed physician, advanced practice nurse, physician assistant, dentist, or podiatrist any patient whose medical condition should, at the time of evaluation or treatment, be determined to be beyond the scope of practice of the physical therapist. ( Scope of Practice/Physical Therapist (IL)

6. Dry Needling definition/AAAOM American Association of Acupuncture and Oriental Medicine (AAAOM) Position Statement on Trigger Point Dry Needling (TDN) and Intramuscular Manual Therapy (IMT) 1. Acupuncture as a technique is the stimulation of specific anatomical locations on the body, alone or in combination, to treat disease, pain, and dysfunction. 2. Acupuncture as a technique includes the invasive or non-invasive stimulation of said locations by means of needles or other thermal, electrical, light, mechanical or manual therapeutic method. 3. Acupuncture as a field of practice is defined by the study of how the various acupuncture techniques can be applied to health and wellness. 4. Trigger Point Dry Needling and Intramuscular Manual therapy are by definition acupuncture techniques. 5. Trigger Point Dry Needling and Intramuscular Manual Therapy are by definition included in the Field of Acupuncture as a field of practice.

7. Dry Needling definition/CCAOM It is the position of the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM) that dry needling is an acupuncture technique. Rationale A recent trend in the expansion in the scopes of practice of western trained health professionals to include “dry needling” has resulted in redefining acupuncture and re-framing acupuncture techniques in western biomedical language. Advancement and integration of medical technique across professions is a recognized progression. However, the aspirations of one profession should not be used to redefine another established profession. In addition proponents of “dry needling” by non-acupuncture professionals are attempting to expand trigger point dry needling to any systemic treatment using acupuncture needles and whole body treatment that includes dry needling by using western anatomical nomenclature to describe these techniques. It is the position of the CCAOM that these treatment techniques are the de facto practice of acupuncture, not just the adoption of a technique of treatment.

8. Dry Needling definition/West Virginia BOARD OF PHYSICAL THERAPY Task Force on Dry Needling The Board of Physical Therapy Task Force on Dry Needling met on Friday, March 30, 2007 at the Department of Health Professions, 6603 West Broad Street, 5th Floor, Conference Room #3, Richmond, Virginia Dry Needling – is a 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 and relieving pain.

9. Dry Needling definition/Dr. Ma What Is Dry Needling? by Dr. Yun-tao Ma Dry needling technique is a modern Western medical modality that is not related to Traditional Chinese acupuncture in any way. Dry needling has its own theoretical concepts, terminology, needling technique and clinical application. Dry Needling was first developed in 1940's by Janet Travell, MD, former medical adviser to White House (JFK's physician). Thus, dry needling a.k.a biomedical acupuncture is based on modern understanding of human anatomy and patho-physiology and on modern SCientific research, drawing heavily on leading-edge neurological research using modern imaging techniques such as Functional MRls of the brain. Different terminology for dry needling technique have been created; for example trigger point needling, dry needling technique, intra muscular stimulation (IMS) and biomedical acupuncture are all in use.

10. The AAAOM has the following additional specific concerns: 1) No standards of education have been validly determined to assure that Physical Therapists (PT) using TDN are providing the public with a safe and effective product; 2) There is a clear effort to redefine identical medical procedures and thereby circumvent or obscure established rules and regulations regarding practice; and 3) In many states, addition of TDN to PT practice is a scope expansion that should require legislative process, not a determination by a PT Board. The U.S. Department of Education recognizes ACAOM as the sole accrediting agency for Acupuncture training institutions as well as their Master’s and Doctoral Degree programs. Training in Acupuncture, which has been rigorously refined over the course of hundreds of years internationally and forty years domestically, is well established and designed to support safe and effective practice. Attempts to circumvent Acupuncture training standards, licensing or regulatory laws by administratively retitling acupuncture as “dry needling” or any other name is confusing to the public, misleading and creates a significant endangerment to public welfare. Dry Needling Position Paper/AAAOM

11. The actual risk has already been investigated by at least one malpractice insurance company that has stated it will cancel polices for Physical Therapists “engaging in a medical procedure for which they have no adequate education or training.” (Letter from Allied Professional Services [on file at AAAOM] ). Recent actions by state medical regulatory authorities have identified and acted upon the aforementioned risk. In conclusion, the AAAOM strongly urges legislators, regulators, advisory boards, advocates of public safety, and medical professional associations to carefully consider the impact of these actions. Dry Needling Position Paper/AAAOM

12. A current author and provider of dry needling courses, Yun-tao Ma, Ph.D., extends dry needling beyond trigger points to include acupuncture points. He describes the points according to the neuroanatomical location and effects and calls them “Acu reflex” points. It is this adaptation and renaming of acupuncture to provide total body treatment that poses the greatest risk to the public, as it circumvents established standards for identical practice, i.e., acupuncture, without the rigorous training of acupuncture and the licensing of such. Summary Position of the CCAOM on Dry Needling It is the position of the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM) that dry needling is an acupuncture technique. It is the position of the CCAOM that any intervention utilizing dry needling beyond trigger point dry needling is the practice of acupuncture, regardless of the language utilized in describing the technique. Dry Needling Position Paper/CCAOM

13. APPROVED • BOARD OF PHYSICAL THERAPY • Task Force on Dry Needling • The Board of Physical Therapy Task Force on Dry Needling met on Friday, March 30, 2007 at the Department of Health Professions, 6603 West Broad Street, 5th Floor, Conference Room #3, Richmond, Virginia • The Task Force will make the following recommendations to the Board of Physical Therapy: • Dry Needling is within the scope of practice of physical therapy; • A PT using dry needling should complete at least 54 hours of face-to-face IMS/dry needling course study; online study is not considered appropriate training; • Prescriptive written referral should be specific for dry needling and required, if received orally must be followed up with written referral; • In order to be obvious to the reader, if dry needling is performed, a separate procedure note should be required and notes must indicate how the patient tolerated the technique as well as the outcome after the procedure. • Consent Form should clearly state that the patient is not receiving acupuncture. It should also include the risks and benefits. The patient should receive a copy of the consent form.

14. Dry Needling as taught by Dr. Ma/ Explained by Dr. Ma Excerpted from What Is Dry Needling? by Dr. Yun-tao Ma Please, note: Traditional Chinese Acupuncture (TCM-style acupuncture) is based on ancient Chinese concepts of meridian systems, such as Qi or energy channels, using tongue and pulse assessment, and uses a variety of needle manipulation techniques. TCM Acupuncture does not share any medical ground with Dry Needling Techniques. It is pointless to compare hours of training for TCM acupuncturists and medically trained physical therapists. Definitely physical therapists will have more oranges and TCM acupuncturists will have more apples.

15. Dry Needling as taught by Dr. Ma/ Explained by Dr. Ma Systemic Integrative Dry Needling .• SIDN represent effective techniques for resolving soft tissue dysfunction: inflammation, contracture, tissue adhesion, microcirculation and edema, and biomechanical balance of musculoskeletal system. Our approach is both systemic and analytical. We emphasize both local anatomy and systemic functional effects. We treat both local injuries and assure physiological and mechanical balance of the whole system -human body. Systemic Integrative Dry Needling techniques allow practitioner to predict the prognosis of the treatments such as how many treatments the patients will need and how long the symptom relief can be achieved. Dr. Ma's 40-year background in clinical and Western (biomedical, no meridians, no classic acupoints) Dry Needling acupuncture and neuroscience research has enabled him to address specifically neuro-immunological and neuro-muscular mechanisms of Systemic Integrated Dry Needling and created SIDN.

16. Dry Needling by Dr Ma Integrative Dry Needling, Orthopedic Approach™ is a contemporary dry needling therapy developed by Dr Yun-tao Ma (2005, 2010) and based on the works of Dr Janet Travell (1982, 1992), Dr Chan Gunn (1978), clinical evidence, evidence-based research and Dr Ma’s own 40 years of clinical and research experience and neuroscience training. Email: Ma@DryNeedlingCourse.com Tel: 303-516-0595 3 Wildwood Lane, Boulder, CO, 80304 USA http://dryneedlingcourse.com/

17. melissa@dryneedlingcourse.ca <melissa@dryneedlingcourse.ca> Mon, Sep 26, 2011 at 4:14 PM To: Jeannette Hoyt <j@chgocam.org> Hello Jeannette We will be offering dry needling training in Chicago, Dec 9-11 and it is the Pain Management course. The course is being held at Core Fitness Chicago, 1030 w. North Ave Suite 300 and the cost is $1295.00. You can register online at www.dryneedlingcourse.ca Please let me know if you have any other questions. Thanks, Melissa

18. Feedback… What is dry needling? Is dry needling an acupuncture technique, a physical therapy technique, both or neither? What amount, type, length, etc. of training should Physical Therapists have in order to perform dry needling? What is your response to Dr. Ma’s Dry Needling course (24 classroom hours) being offered at Core Fitness that will allow Physical Therapists to offer dry needling to their clients in Illinois?

19. Thank you for listening! Thank you for your feedback! Any questions, please contact Coalition for Safe Acupuncture Practice, CSAP@aardvarksfly.com To view this power point, please visit the CSAP page at aardvarksfly.com