Dry Needling in Washington State

May 19, 2023
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The Washington State legislation recently passed an amendment to the Physical Therapy Act allowing physical therapists (PTs) to provide dry needling (DR) on and after July 23, 2023. The requirements for providing DR are relatively burdensome. The following is a summary of the law which can be found here.

Many of the requirements are not particularly clear at this point. I expect that the WA PT Board will issue additional guidance prior to the July 23 effective date and more guidance will eventually be provided in the Washington State PT Rules but that may not be for a few months.

  • DR Definition
    • DR is defined as a skilled intervention that uses a single use, sterile filiform needle to penetrate the skin and stimulate underlying myofascial trigger points and connective and muscular tissues for the evaluation and management of neuromusculoskeletal pain and movement impairments
    • Requires an examination and diagnosis
    • Does not include needle retention without stimulation or the stimulation of auricular and distal points
    • Also referred to as “intramuscular needling”
  • Requirements for a PT to provide DR
    • DR endorsement by WA Secretary of Health
    • At least one year of postgraduate direct patient care practice experience averaging at least 36 hours/week
    • 325 hours of instruction and clinical experience that meet or exceed the following criteria:
      • A total of 100 hours of didactic instruction in the following areas:
        • Anatomy and physiology of the musculoskeletal and neuromuscular systems;
        • Anatomical basis of pain mechanisms, chronic pain, and referred pain;
        • Trigger point evaluation and management;
        • Universal precautions in avoiding contact with a patient’s bodily fluids; and
        • Preparedness and response to unexpected events including but not limited to injury to blood vessels, nerves, and organs, and psychological effects or complications.
      • A total of 75 hours of in-person DR instruction in the following areas:
        • DR technique;
        • DR indications and contraindications;
        • Documentation and informed consent for DR;
        • Management of adverse effects;
        • Practical psychomotor competency; and
        • Occupational safety and health administration’s blood borne pathogens protocol.
    • A successful clinical review of a minimum of 150 hours of at least 150 individual DR treatment sessions by a qualified provider. A physical therapist (PT) seeking endorsement must submit an affidavit to the department demonstrating successful completion of this clinical review.
    • After receiving 100 hours of didactic instruction and 75 hours of in-person DR instruction, a PT seeking endorsement has up to 18 months to complete a minimum of 150 treatment sessions for review.
    • A PT may not delegate DR and must remain in constant attendance of the patient for the entirety of the procedure.
    • A PT can apply for endorsement before they have one year of clinical practice experience if they can meet the requirement of 100 hours of didactic instruction and 75 hours of in-person DR through their pre-licensure coursework and has completed all other requirements set forth in this chapter.
    • If a PT is intending to perform DR on a patient who the PT knows is being treated by an acupuncturist or acupuncture and Eastern medicine practitioner for the same diagnosis, the PT shall make reasonable efforts to coordinate patient care with the acupuncturist or acupuncture and Eastern medicine practitioner to prevent conflict or duplication of services.
    • All patients receiving DR from a PT must sign an informed consent form that includes: (a) the definition of DR; (b) a description of the risks of DR; (c) a description of the benefits of DR; (d) a description of the potential side effects of DR; and (e) a statement clearly differentiating the procedure from the practice of acupuncture.
    • DR may not be administered as a stand-alone treatment within a physical therapy care plan.