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Maryland PT Dry Needling

"Dry needling" means a physical therapy intervention, also known as intramuscular manual therapy, that:

  • Involves the insertion of one or more solid needles, a mechanical device, into the muscle and related tissues to affect change in muscle and related tissues;
  • Requires ongoing evaluation, assessment, and re-evaluation of the impairments; and
  • Is only utilized in parts of the body with neuromuscular or musculoskeletal links to the impairments.

Dry needling is not performed for:

  • The purposes of acupuncture; or
  • Any purpose outside the scope of physical therapy.

Minimum education and training necessary to perform dry needling

In order to perform dry needling, a physical therapist shall have at least 80 total hours of instruction, which includes:

A total of at least forty (40) hours of instruction in the following dry needling-specific course content areas:

  • Theory and application of dry needling;
  • Dry needling technique, including spine and extremities;
  • Dry needling indications and contraindications;
  • Infection control, the Occupational Safety and Health Administration’s Bloodborne Pathogen Protocol, and safe handling of needles;
  • Emergency preparedness and response procedures related to complications associated with dry needling; and
  • Appropriate documentation of dry needling.


At least forty (40) hours of practical, hands-on instruction in the application and technique of dry needling, under the supervision of a licensed health care practitioner competent in dry needling procedures who has:

  • Completed the requisite course work; and
  • Practiced dry needling for at least five (5) years.

The instruction shall be provided by a continuing education course sponsored by the:

  • American Physical Therapy Association;
  • The APTA of Maryland; or
  • The Federation of State Boards of Physical Therapy.

The instruction shall be offered:

  • In person at a face-to-face session; or
  • In real time through electronic means that allow for simultaneous interaction between the instructor and the participants.

A physical therapist may not fulfill any portion of the practical, hands-on instruction required with online or distance learning.


A physical therapist shall have practiced physical therapy for at least two (2) years before performing dry needling in the State.

A physical therapist shall be registered with the Board as having the appropriate education and training required by this regulation before the physical therapist may practice dry needling.

In order to be registered to practice dry needling, a physical therapist shall:

Standards of practice

A physical therapist shall: 

    • Fully explain dry needling to the patient in advance of treatment; and
    • Obtain written informed consent specific to dry needling that shall be included in the patient’s medical record.

A physical therapist shall perform dry needling in a manner consistent with standards set forth in the Maryland Occupational Safety and Health Act, Labor and Employment Article, Title 5, Annotated Code of Maryland.

A physical therapist shall document the provision of dry needling services in accordance with the documentation requirements of COMAR

A physical therapist who practices dry needling in a manner inconsistent with the standards of practice enumerated in this regulation shall be subject to discipline pursuant to COMAR

Dry needling is not within the scope of practice of limited physical therapy and shall only be performed by a licensed physical therapist.


COMAR 10.38.12

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