Acupuncturists, Physical Therapists Battle Over Treatment

May 4, 2018

Acupuncturists and physical therapists are waging a war --- over needles.

As a growing opioid epidemic has made patients leery of continued use of the drugs, the Florida Board of Physical Therapy has proposed a rule that would authorize certain physical therapists to treat patients with a “dry needling” technique.

But the move is opposed by the Florida State Oriental Medical Association, which, among others, recently requested that the board hold a public meeting on the proposed rule. The issue was on the agenda of a board meeting scheduled to start Thursday night in Lake Mary.

“This is a great opportunity to provide alternatives other than opioids,” said Rob Stanborough, a St. Augustine physical therapist and owner of First Coast Rehabilitation, who defends allowing physical therapists to offer the treatment.

Stanborough, who also teaches dry-needling techniques for the Myopain Seminars company, is the only physical therapist in the state who has been authorized by the Board of Physical Therapy to perform the procedure.

The board last year issued a declaratory statement saying that dry needling is within a physical therapist’s scope of practice and gave Stanborough approval to begin using the technique on his patients.

Dry needling is the name physical therapists use to describe a technique of inserting filiform needles into the skin at various “trigger points,” which causes certain responses.

Filiform needles ---which are used for acupuncture --- are solid. They cannot be used to inject substances or medicine, hence the word “dry.”

Stanborough said he doesn’t know how many patients he has used the treatment on in the nine months since getting board approval and said he’s reluctant to estimate the numbers.

“But it’s not like I’m needling everybody who comes to the door,” he said.

While he acknowledges that there is a turf war between the professions, Stanborough said that doesn’t have to be the case and said he has “wonderful professional relationships” with acupuncturists who work in St. Augustine and Jacksonville.

Stanborough said he uses the dry-needle technique to treat patients for problems that can involve such things as an inability to perform activities of daily living, such as bathing and eating, or an inability to work. He said clients visit acupuncturists for treatment of diseases and that there isn’t overlap.

“Each profession has their own special skill set. We each have our own set of knowledge, but we each have our own set of limitations as well,” he said. “But it’s all for the betterment for the patient.”

But acupuncturist David Bibbey views things somewhat differently. He sees about 200 patients a month at his Crystal River practice and said about 80 percent of them are there for pain control.

Acupuncture is a component of traditional Chinese medicine. Acupuncturists insert filiform needles into the skin at certain trigger points to balance the flow of energy through pathways in your body.

Licensed to practice acupuncture in Florida since 2011, Bibbey said dry needling is acupuncture and that there’s a reason the Legislature doesn’t allow just any health-care professional to perform the procedure.

“They want to protect the public from the inherent risks of injury,” said Bibbey, who also serves as treasurer of the Florida State Oriental Medical Association.

The Board of Acupuncture also maintains that dry-needling proposal would improperly expand the scope of practice for physical therapists.

The fight between acupuncturists and physical therapists goes beyond Florida’s borders. Physical therapists in more than 30 states practice dry needling.

But it has been rejected in larger states such as California and New York.

Florida law includes acupuncture in the practice of physical therapy. But the law makes clear that there can be no penetration of the skin and that therapists who want to practice acupuncture must comply with rules set by the Florida Board of Medicine.

The Florida Board of Medicine, though, hasn’t passed rules on the issue.

Meanwhile, after giving Stanborough approval to practice, the Florida Board of Physical Therapy moved ahead with a proposed rule that could apply to all physical therapists.

Board members agreed earlier this year on requirements that would allow physical therapists to perform dry-needle techniques so long as they had taken courses recognized by the Commission on Accreditation in Physical Therapy Education, the American Physical Therapy Association, the Federation of State Boards of Physical Therapy or any branch of the United States Armed Forces.

But the rule appears to run afoul of the law, said Marjorie Holladay, general counsel of the Legislature’s Joint Administrative Procedures Committee.

She sent a letter to the Board of Physical Therapy noting the proposed dry-needling rule allows therapists to penetrate the skin, which exceeds statutory authority, she said.

Holladay’s letter also noted that the Board of Medicine had not set any criteria for the practice of acupuncture.

But attorneys for the statewide physical therapy association argue that that Board of Physical Therapy, and not the Board of Medicine, should be charged with setting the standards for dry needling.

Moreover, the attorneys said in correspondence sent to the Board of Physical Therapy that dry needling doesn’t expand a physical therapist’s scope of practice because therapists are authorized to use apparatuses and equipment on their patients, including needles.

Tad Fisher, executive director of the Florida Physical Therapy Association, said the state’s health-care licensing boards generally have “stayed within their own regulatory authority” and that having the Board of Medicine develop rules for physical therapists who have an interest in acupuncture “probably raises questions.”

What raises questions for Bibbey is why physical therapists don’t want to take additional training. For the last 30 years, he said, acupuncturists have made the case to the public that the treatment is safe and effective.

“And we have done it over the objections of most Western medical providers,” he said. “And now we are finding they all want to perform acupuncture.”

Bibbey said there are six physicians in the state who --- in addition to maintaining a medical license from the Board of Medicine --- have also taken required courses to be licensed by the Board of Acupuncture.

But, he said, the physical therapists who want to perform acupuncture “want to do it with little-to-no additional training and no real understanding of how or why it works.”