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Delaware Physical Therapy Dry Needling

Dry needling is "an intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying muscular tissue, connective tissues and myofascial trigger points for the management of neuromusculoskeletal pain and movement impairments; is based upon Western medical concepts; and requires a physical therapy examination and diagnosis." 

Dry needling is within the scope of practice for a Physical Therapist. 

It is not in the scope of practice for Athletic Trainers, Physical Therapy Assistants or Physical Therapy Aides.

Requirements for Physical Therapists to Perform Dry Needling

The PT must have no less than two (2) years of active clinical experience in the treatment of patients as a licensed PT and shall hold a current license in good standing.

The PT shall have current CPR certification by the American Red Cross, American Heart Association, National Safety Council or other agency approved by the Board and posted on the Division of Professional Regulation's website.

Dry needling shall be performed directly by the PT and shall not be delegated.

Dry needling shall be performed in a manner that is consistent with generally accepted standards of practice, including clean needle techniques and the bloodborne pathogen standards of the Occupational Safety and Health Administration ("OSHA").

Course Requirements

A PT may not perform dry needling on a patient until completion of at least twenty-five (25) hours of education in a Board approved dry needling program.

A PT may not perform dry needling on high risk areas until completion of at least fifty-four (54) hours of education in a Board approved dry needling program. High risk areas are the anterior cervical region, abdominal region, and the region directly over the ribs, unless the pincher technique is performed.  The program shall be a minimum of fifty-four (54) hours, which shall be completed within two (2) years.

Dry Needling Training Programs

A dry needling training program shall include the following to be eligible for Board approval:

    • A dry needling training program shall require each trainee to demonstrate successful psychomotor and cognitive performance through practical and written examination.
    • A dry needling program shall be attended in person by the Physical Therapist, shall not be attended online or through any other means of distance learning and shall not be a self-study program.
    • The program curriculum shall include the following:
      • History and current literature review of dry needling and evidence based practice;
      • Pertinent anatomy and physiology;
      • Choice and operation of supplies and equipment;
      • Knowledge of technique including indications/contraindications and precautions for use;
      • Proper technique of tissue penetration;
      • Knowledge of hazards and complications;
      • Safe practice guidelines and generally accepted standards of practice including clean needle techniques and OSHA's bloodborne pathogen standards;
      • Post intervention care, including an adverse response or emergency;
      • Documentation of successful completion of psychomotor and cognitive performance through practical and written examination; and
      • Supervised training.

The dry needling program, including the required supervised training, shall be taught by a PT who meets the qualifications.

Examination and Informed Consent

Examination: A PT shall only perform dry needling following an examination and diagnosis for the purpose of treating specific anatomic entities selected according to physical signs.

Informed consent: At the first visit, a PT performing dry needling shall obtain written informed consent from the patient before the PT performs dry needling on the patient. The patient shall receive a copy of the informed consent, and the PT shall retain a copy in the patient's record.

The informed consent shall include, at a minimum, the following:

    • The patient's signature;
    • The risks and benefits of dry needling;
    • The PT’s level of education regarding supervised hours of training in dry needling; and
    • A clearly and conspicuously written statement that the patient is not receiving acupuncture, including the following language: "Dry needling is a technique used in physical therapy practice to treat myofascial, muscular, and connective tissues for the management of neuromuscular pain and movement dysfunction. Dry needling technique should not be confused with an acupuncture treatment performed by a licensed acupuncturist."

Standard of Practice and Documenation

Referral required: A physician referral specific for dry needling is required. If the initial referral is received orally, it must be followed up with a written referral.

Procedure notes: A Physical Therapist who performs dry needling shall maintain documentation in the patient's chart or record for each dry needling session. The note shall include the treatment received, the response to treatment and any adverse response.

Documentation of training: The Physical Therapist bears the burden of proof of sufficient education and training to ensure competence with the treatment or intervention. If requested by the Board or a member of the public, the Physical Therapist practicing dry needling shall provide documentation of completion of the training required by this regulation. Failure to provide written documentation to the Board of meeting the training requirements shall be deemed prima facie evidence that the Physical Therapist is not competent and shall not be permitted to perform dry needling.

Reference

24-2600 Del. Admin. Code ยง 15.4

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