Why Is Dry Needling Illegal in Some U.S. States?

Dry needling has become increasingly popular as a treatment for musculoskeletal pain, yet its legal status varies significantly across different regions. This therapeutic technique involves more than simply inserting needles into the body—it represents an intersection of different healing philosophies and professional territories.

What Is Dry Needling?

Dry needling is a manual therapy technique where monofilament needles (similar to acupuncture needles) are inserted into specific points in the body, particularly myofascial trigger points. The purpose is to stimulate a twitch response in the painful muscle, which may help reduce musculoskeletal pain and improve function. These trigger points are tight bands within the muscle tissue that can cause pain patterns throughout the body.

The procedure typically targets muscular trigger points to address various neuromusculoskeletal pain conditions. Unlike “wet” needling techniques that involve injecting substances, dry needling uses only sterile needles for mechanical disruption of tissue.

How It Differs from Acupuncture

Though both practices involve the insertion of needles into the body for therapeutic purposes, dry needling and acupuncture stem from fundamentally different approaches:

Acupuncture is one of the earliest forms of medicine, rooted in Traditional Chinese Medicine with a history spanning thousands of years. It works with concepts of energy flow (or “qi”) through meridian pathways in the human body. Acupuncturists believe that balancing this energy can address not only pain but also various medical conditions.

In contrast, trigger-point dry needling developed within Western medicine frameworks. It focuses specifically on muscular pain and physical dysfunction rather than the broader energy balance principles of Chinese medicine concepts.

Who Commonly Performs It? (PTs, Chiropractors, etc.)

In regions where it’s permitted, dry needling is frequently performed by allied health professionals, particularly:

• Physical therapists
• Athletic trainers
• Chiropractors
• Some massage therapists
• Medical professionals with specific training

The majority of dry needling procedures in the United States are conducted by physical therapists as part of a comprehensive physical therapy practice. However, the question of who can legally perform this technique lies at the heart of many legal challenges.

Legal Status of Dry Needling in the U.S.

The regulatory landscape for dry needling varies dramatically across the country, creating confusion for both practitioners and patients seeking this form of therapy.

States Where Dry Needling Is Restricted or Prohibited

Several states have explicitly prohibited physical therapists from performing dry needling, considering it outside their physical therapy scope. In these states, only licensed acupuncturists or medical professionals with specific acupuncture licenses may legally insert filiform needles into the body.

States where dry needling is explicitly illegal for physical therapists include:

• California
• Hawaii
• New York
• Oregon
• Washington

These restrictions often come after challenges from the acupuncture profession, which argues that the insertion of acupuncture needles constitutes a form of acupuncture regardless of the theoretical framework applied. These states generally align with acupuncturists’ views that dry needling is indistinguishable from acupuncture and should therefore be performed only by those with extensive training in acupuncture techniques.

States Where Dry Needling Is Legal

In many states, dry needling has been explicitly included within the physical therapy practice acts. These states have determined that the technique falls within the scope of practice for physical therapists when performed with proper training.

States where dry needling is explicitly permitted for physical therapists (provided they meet certain training and certification requirements) include:

• Arizona
• Colorado
• Georgia
• Idaho
• Illinois
• Indiana
• Iowa
• Kentucky
• Maryland
• Mississippi
• Missouri
• Montana
• North Carolina
• North Dakota
• Ohio
• Oregon
• South Carolina
• Tennessee
• Utah
• Virginia
• Washington
• Wisconsin
• Wyoming

Some of these states require specific postgraduate training and documentation of competence in the technique before therapists can incorporate it into their practice.

Variation in Scope of Practice Laws

The considerable variation in scope of practice laws reflects the ongoing debate within the healthcare community. Notably, a large number of states maintain ambiguous positions, having neither specifically authorized nor prohibited the practice:

• Alabama
• Alaska
• Arkansas
• Connecticut
• Delaware
• Florida
• Kansas
• Louisiana
• Maine
• Massachusetts
• Michigan
• Minnesota
• Nebraska
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• Oklahoma
• Pennsylvania
• Rhode Island
• South Dakota
• Vermont
• West Virginia

In these states with unclear regulations, practitioners face uncertainty about what is permissible, leading to inconsistencies in enforcement. Some regulatory bodies have established specific standards for dry needling therapy.

For example, South Dakota mandates that approved dry needling courses cover comprehensive topics, including surface anatomy, emergency preparedness, safety protocols, and theoretical foundations.

Other states have different requirements for hours of instruction and clinical training. Some maintain that the practice of acupuncture encompasses any needle insertion technique, regardless of the theoretical approach.

This disparity in training requirements and regulatory frameworks has led to confusion in the healthcare professions and challenges for practitioners who move between states.

Reasons Why Dry Needling Is Illegal in Some Areas

Licensing and Scope of Practice Issues

The primary legal concern revolves around whether dry needling falls within the physical therapy scope or constitutes the practice of acupuncture. Licensed acupuncturists typically complete between 2,000-3,000 hours of training specifically in needle techniques, while physical therapists’ training in dry needling might consist of weekend courses totaling 27-54 hours of instruction.

This disparity raises questions about the adequacy of training and whether physical therapists are stepping beyond their professional boundaries when performing what could be considered a form of acupuncture.

Safety and Training Concerns

Concerns about safety stem from the inherent risks associated with inserting needles into the body. These risks include:

• Potential injury to blood vessels
• Nerve damage
• Infection
• Pneumothorax (particularly when needling near the chest wall)

Acupuncturists argue that their extensive training provides them with the knowledge to avoid these complications, while questioning whether abbreviated training programs offer sufficient preparation for allied health professionals.

Opposition from Acupuncturists and Medical Boards

The acupuncture profession has strongly opposed the expansion of dry needling by physical therapists, viewing it as unauthorized practice of acupuncture. Many acupuncturists consider trigger-point dry needling simply a rebranding of traditional acupuncture techniques without acknowledging its origins or ensuring comprehensive training.

Some medical boards have sided with acupuncturists in this debate, expressing concerns about public safety and the potential for adverse effects from inadequately trained practitioners.

Lack of Standardized Regulation

The absence of consistent educational standards across healthcare providers performing dry needling has contributed to regulatory challenges. Without uniform requirements for:

• Hours of training
• Supervised clinical practice
• Demonstrated competence
• Ongoing review of skills

Many regulatory bodies have chosen to restrict the practice until more standardized professional standards can be established.

Controversy and Professional Debate

Physical Therapists’ Perspective

From the perspective of physical therapists, dry needling represents a natural extension of their expertise in musculoskeletal disorders. They argue that their understanding of anatomy, physiology, and pain patterns makes them well-positioned to use this technique as part of manual therapy.

Physical therapists typically approach dry needling as a modern healthcare intervention based on current practices in pain science rather than on the foundational principles of Eastern medicine. Many point to systematic reviews suggesting therapeutic effects for certain conditions like neck pain and shoulder pain.

Acupuncturists’ Perspective

Practitioners of acupuncture generally view dry needling as a simplified application of techniques developed within Traditional Chinese Medicine. They express concerns that qualified practitioners should have comprehensive training in all aspects of needle insertion, including understanding both the physical and energetic effects on the body.

Many acupuncturists from professional organizations like Acupuncture Atelier argue that the sale of acupuncture needles should be restricted to those with an acupuncture license, ensuring public health protection.

Role of Professional Organizations and State Boards

Professional bodies representing both physical therapists and acupuncturists have been active in this debate, advocating for their respective positions before regulatory bodies. State boards responsible for protecting public safety must weigh competing claims about:

• What constitutes adequate training
• How to ensure patient safety
• Whether dry needling falls within existing scopes of practice
• How to balance access to therapies with public safety concerns

Legal Cases and Policy Changes

Notable Legal Challenges

Several high-profile legal challenges have shaped the landscape of dry needling regulation. Cases have focused on questions such as:

• Whether trigger-point dry needling constitutes acupuncture
• If physical therapy practice acts encompass needle insertion techniques
• What level of training should be required for safe practice

Legal opinions have varied widely, reflecting the complexity of determining where one healthcare profession’s boundaries end and another’s begin.

Impact of Advocacy and Lobbying

Both sides have engaged in significant advocacy efforts. The acupuncture profession has worked to protect what they see as their professional territory, while physical therapists have lobbied for the expansion of their scope to include this technique.

Insurance providers have also influenced this debate, as they determine whether to cover dry needling as part of physical therapy services or classify it as a non-covered service when performed outside traditional acupuncture.

Recent Legislative Trends

The trend in recent years has shown a gradual expansion of dry needling privileges in many states, often with increased training requirements. However, this expansion has frequently been met with ongoing review and legal challenges from the acupuncture community.

Some states have taken middle-ground approaches, permitting dry needling by physical therapists but with stipulations regarding training that go beyond brief weekend courses.

What This Means for Patients and Practitioners

How Legal Restrictions Affect Access to Care

For patients suffering from chronic pain, musculoskeletal pain, or specific conditions like plantar fasciitis, these legal restrictions can significantly impact their access to care. In states where dry needling is prohibited for physical therapists, patients may need to:

• Seek separate providers for different aspects of their care
• Pay out-of-pocket if insurance plans cover physical therapy but not acupuncture services
• Travel farther to find qualified practitioners

What Practitioners Can and Cannot Do

Healthcare providers must be vigilant about staying within their legal scope of practice, which varies by state:

• In some areas, physical therapists may perform dry needling but cannot call it “acupuncture”
• In others, they cannot insert needles at all without an acupuncture license
• Some states permit dry needling but with specific supervision requirements
• Others allow the technique but restrict certain applications, such as electrical stimulation through needles

Finding a Qualified Provider Legally

Patients seeking relief from hip pain, shoulder pain, or other muscular pain conditions should:

• Verify that their provider is legally permitted to perform the technique in their state
• Ask about specific training and experience in dry needling
• Check whether their insurance provider will cover the procedure
• Consider both physical therapists and licensed acupuncturists depending on their specific needs and the legal framework in their location

Conclusion

The question of why dry needling is illegal in some areas reflects broader tensions in modern healthcare: between traditional and newer approaches to healing, between different professional territories, and between competing perspectives on what constitutes appropriate training.

As systematic reviews continue to examine the effectiveness of dry needling for various conditions, and as experienced practitioners on both sides advocate for their positions, the legal landscape will likely continue to evolve. For now, patients and practitioners must navigate a complex patchwork of regulations that vary significantly across the country.

The ongoing debate ultimately centers on important questions about patient safety, professional competence, and how we integrate different healing traditions into our healthcare system. Resolution will require thoughtful consideration of these issues by regulatory bodies, healthcare professionals, and the public they serve.

FAQ

In what states is dry needling illegal?

Dry needling is explicitly illegal for physical therapists in California, Hawaii, New York, Oregon, and Washington. In these states, only licensed acupuncturists or medical professionals with specific acupuncture credentials may legally perform techniques involving filiform needles. These regulatory bodies have determined that dry needling constitutes the practice of acupuncture and requires the extensive training that licensed acupuncturists receive.

Additionally, in 23 states including Alabama, Alaska, Arkansas, Connecticut, Delaware, Florida, and others, the legal status remains ambiguous without explicit authorization or prohibition. Physical therapists in these regions face uncertainty about what is permissible within their scope of practice, leading to inconsistent enforcement and professional confusion.

Are there any dangers in dry needling?

Several potential risks are associated with dry needling, which highlights why proper training and technique are crucial for practitioners. The most serious risk is pneumothorax (collapsed lung), which can occur when needling near the chest wall if the practitioner lacks thorough understanding of anatomy.

Other significant risks include nerve damage from improper needle placement, which may cause temporary or permanent numbness, tingling, or pain; vascular injury that can lead to bruising or more serious bleeding complications; infection (though rare when using sterile needles); and syncope (fainting), particularly during first-time treatments.

These risks are generally minimized when dry needling is performed by qualified practitioners with adequate training, which is why many acupuncturists argue that their extensive clinical training (typically 2,000-3,000 hours) is necessary for patient safety compared to shorter courses for physical therapists (often 27-54 hours).

Who shouldn’t do dry needling?

Certain individuals should avoid dry needling or approach it with significant caution due to increased risks. People with bleeding disorders, including those with hemophilia or on blood thinners, face higher risks of bleeding or bruising from the procedure.

Immunocompromised patients may have an elevated risk of infection, though this remains minimal with proper sterile technique.

Pregnant women, particularly in the first trimester or when targeting certain points that may stimulate uterine contractions, should generally avoid the treatment.

Those with severe needle phobias may experience extreme anxiety or vasovagal responses. Special care must be taken with patients who have certain implants like pacemakers, and people with lymphedema require specific precautions when treating affected areas.

Dry needling should never be performed through infected skin or on individuals unable to communicate pain or discomfort, including very young children or those with certain cognitive impairments.

Additionally, people with uncontrolled epilepsy, unstable heart conditions, or acute systemic infections may need to avoid treatment altogether.

Before receiving dry needling, patients should always discuss their complete medical history with their healthcare provider to ensure this treatment is appropriate and safe for their specific situation.