Commonwealth of Massachusetts

Board of Registration in Medicine

200 Harvard Mill Square, Suite 330 Wakefield, Massachusetts 01880
(781) 876-8200
oeVAL L. PATRICK
GOVERNOR

TIMOTHY P. MURRAy
LIEUTENANT GOVERNOR

Enforcement Division Fax: (781) 876-8381 Legal Division Fax: (781) 876-8380 Licensing Division Fax: (781) 876-8383 June 22, 2011

STANCEL M. RILEY, JR. MD.

EXECUTIVE DIRECTOR

James Zachazewski, PT, ATC, Chair

Board of Allied Health Professionals
1000 Washington Street, Suite 710
Boston, Massachusetts 02118-6100
Re: Dry Needling and Physical Therapist Scope of Practice

Dear Mr. Zachazewski: The Committee on Acupuncture of the Board of Registration in Medicine ("COA") is aware that the Board of Registration in Allied Health Professionals ("Allied Health Board") is currently considering whether the practice of dry needling is within the scope of practice for physical therapists in Massachusetts. It is the understanding of the members of the COA that, at theMay 26, 2011 meeting of the Allied Health Board, at least one member expressed the view that, because it is not specifically prohibited by law, .dry needling falls within the scope of practice for physical therapists. At its June 9, 2011 meeting, the COA considered this issue, with particular emphasis on the relevant statutes put forth by the state legislature, including the definition of acupuncture. In particular, members of the COA reviewed the following:

M.G.L. c. 112, 149: The practice of acupuncture: the practice of medicine based upon traditional oriental medical theories, primarily the insertion of metal needles through the skin at certain points on the body, with or without the use of herbs, WIth or without the application of electric current, and with or without the application of heat to the needles, skin, or both, in an attempt to relieve pain or improve bodily function. Electroacupuncture, whether utilizing electrodes on the surface of the skin or current applied to inserted needles, and laser acupuncture are considered the practice of acupuncture. (emphasis added) M.G.L. c. 112, 162: Nothing contained in sections one hundred and forty-nine to one hundred and sixty-two, inclusive, shall prohibit any person employed as an acupuncturist by an agency of the federal government from practicing acupuncture while discharging his official duties as such employee. Nothing contained herein shall prevent physical therapists from practicing transcutaneous nerve stimulation, the stimulation of muscle contractions for the purpose of

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diagnosis or rehabilitation, or other techniques in the context of standard Western Medical Procedure and neither defined as nor held out to be acupuncture. Nothing contained herein shall prevent licensed physicians from practicing acupuncture. (emphasis added)
M.G.L. c. 112, 23A: "Physical therapy," a health profession that utilizes the application of scientific principles for the identification, prevention, remediation and rehabilitation of acute or prolonged physical dysfunction thereby promoting optimal health and function. Physical therapy practice is evaluation, treatment and instruction related to neuromuscular, musculoskeletal, cardiovascular and respiratory functions. Such evaluation shall include but is not limited to performance and interpretation of tests as an aid to the diagnosis or planning or treatment programs. Such treatment shall include but is not limited to the use of therapeutic exercise, physical activities, mobilization, functional andendurance training, traction, bronchopulmonary hygiene postural drainage, temporary splinting and bracing, massage, heat, cold, water, radiant energy, electricity or sound. Such instruction shall include teaching both patient and family physical therapy procedures as part of a patient's ongoing program. Physical therapy also shall include the delegating of selective forms of treatment to physical therapist assistants and physical therapy aides; provided, however; that the physical therapist so delegating shall assume the responsibility for the care of the patient and the supervision of the physical therapist assistant or physical therapy aide.

Physical therapy shall also include the providing of consultation services for health, educational, and community agencies.
M,G,L, c. 112, 23L: Nothing in this section shall be construed as authorizing an athletic trainer, occupational therapist, occupational therapy assistant, physical therapist, or physical therapist assistant to practice medicine or any other form or method of healing not specified in said section.

The eGA discussed its position that dry needling is the practice of acupuncture, with dry needling listed prominently within the definition of the practice of acupuncture and, further, with acupuncture defined in the statutes as the practice of medicine. To ensure that the eGA and the Allied Health Board are addressing the same technique in connection with this discussion, the members of the eGA have requested from your board its written definition of "dry needling." The eGA further expressed interest in knowing what, if anything, the Allied . Health Board has decided in connection with this issue and whether any formal decisions have been made. If the Allied Health Board is taking the position that dry needling falls within the scope of practice for physical therapists in Massachusetts, the members of the eGA would like to know, in light of the statutes listed above, upon which laws the Allied Health Board has relied in reaching this determination. In addition, the eGA requests to know what educational and training requirements the Allied Health Board will be

instituting should it reach the conclusion that the laws put forth by the Massachusetts Legislature allow physical therapists to practice dry needling. At our June 9, 20 II meeting, I reiterated that the CGA must do all within its power to promote the public health, safety and welfare. To protect the public, the CGA has long recognized that the practice of dry needling, a surgical procedure involving insertion of a needle into a patient's body, requires very stringent educational and training standards. The CGA's position is that dry needling may be performed only by licensed acupuncturists and, more specifically, by licensed acupuncturists who have demonstrated competency in this practice, to the Committee's satisfaction, following the receipt of a highly specialized education and a significant period of training. It is in the interest of the health, safety, and welfare of the citizens of Massachusetts that the CGA requests further information from the Allied Health Board. Please be advised that the next meeting of the CGA is currently scheduled for September 15,2011. In the interest of reaching further understanding of the viewpoints of our respective agencies, I would like to extend an invitation to the Allied Health Board to participate in this discussion at the September meeting. In the meantime, the CGA would be interested in your responses to the inquiries posed herein. Thank you for your consideration and for the Allied Health Board's cooperation in connection with this matter.

Very Truly Yours,

Weidong Lu, Lie. Ac.

Chair, Committee on Acupuncture

Cc:

. Rose M. Foss, Director of Licensing and Acupuncture Sarah E. Weber, Counsel to the Committee on Acupuncture