Board hears experts and VA staff on dry needling safety, training and scope

Stockton, Calif. — The Physical Therapy Board of California on March 19 heard two outside presentations and public comment on dry needling, the practice of inserting solid filiform needles into soft tissue to treat neuromusculoskeletal conditions. Leslie Adrian, director of professional standards at the Federation of State Boards of Physical Therapy (FSBPT), and clinicians from the Department of Veterans Affairs described how regulators, educators and large federal health systems train clinicians and track safety. Representatives of California acupuncture organizations told the board they consider dry needling to be acupuncture and said it should be performed only by licensed acupuncturists.

The presentations matter because dry needling raises questions about who may safely perform needling in California, what education or rules should apply, and how access to care would change if the state were to explicitly authorize the practice by physical therapists.

Leslie Adrian, Director of Professional Standards at the Federation of State Boards of Physical Therapy, told the board that in the United States “dry needling is an established treatment.” She described a multi‑year program of practice analyses and competency studies the federation and outside researchers have run to map what knowledge and skills are needed for safe practice. Adrian said the most recent dry‑needling competency analysis identified 144 work activities, 133 knowledge requirements and 20 skills and abilities relevant to the intervention, and that roughly “88% of what you needed to do dry needling … are already in a PT’s entry level education.” She added, however, that some dry‑needling–specific knowledge must be acquired post‑graduate: needle selection and insertion techniques, emergency preparedness related to needling, and other details of needle handling.

Adrian reviewed regulatory variation nationwide and disciplinary data. She said that, as of December 2024, 40 U.S. jurisdictions had specifically allowed physical therapists to perform dry needling, six were silent and five specifically prohibited it; she tied that history to a mix of board policies, rulemaking and attorney general opinions in various states. On reported discipline, Adrian cited the Federation’s Examination, Licensure and Disciplinary Database and said that between Jan. 1, 2010 and Oct. 31, 2023 there were 5,025 disciplinary actions across participating jurisdictions and 22 entries related to dry needling. “Most of these had to do with getting proper informed consent … documentation, and billing, rather than actual issues with performing the technique,” she said. Adrian identified a small number of more serious cases that appear in the records — including a reported pneumothorax in 2021 and a retained needle in 2023 — and said such major events are rare in the database.

Speakers from the Department of Veterans Affairs — including Theo Dernell, Jerome Sabrian and Rick Castillo — told the board that the VA and Department of Defense have long used needling in clinical care and have developed standardized training and a national VA training and research effort. “We have a national dry needling training healthcare system and research enterprise,” said Theo Dernell, describing training deployments across VA facilities, clinical uses that range from pain and range‑of‑motion work to neurorehabilitation and spasticity management, and ongoing efforts to collate clinical outcomes for future publications. VA presenters described cases in which needling was used as part of interdisciplinary care in acute and primary care clinics and shared patient quotes describing rapid symptom relief. They said the VA allows needling by qualified clinicians within VA facilities regardless of a state’s civilian scope rules because care is delivered under federal auspices.

Public comment included sharply divergent views. Niccolo DeLuca, speaking for the California Acupuncture Coalition, said the coalition “does feel strongly that dry needling is acupuncture and that any dry needling needs to be performed by a certified licensed acupuncturist.” Michelle Lau, president of the Council of Acupuncture and Oriental Medicine Associations, and Benjamin Bodia, executive officer of the California Acupuncture Board, also addressed the board, noting that California law defines needling within the Acupuncture Act and urging strict training requirements and enforcement when non‑acupuncturists needle outside their stated scope.

Board members reacted to both perspectives. Dr. Rubina Amin, a board member and licensed physical therapist, said she found the presentations complementary and said she would “really like to see this modality become an option for physical therapists in California to help our consumers.” Other board members asked technical questions about training, adverse events and the VA’s clinical model; VA presenters said they will pursue multisite research and offered to share safety and outcomes data as they publish it.

No formal rulemaking or vote by the board took place at this meeting. Board members and staff discussed adding follow‑up items to future agendas, including additional presentations and requests for data from the VA and FSBPT resources. Presenters identified several sources the board could review if it chooses to consider policy changes: the FSBPT dry‑needling competency studies (2015, 2020, 2024 updates), the HUMRO practice analyses used to link competencies to the National Physical Therapy Examination and the FSBPT disciplinary database (ELDD) summary data cited by Adrian.

What happened next: the board did not take an action during the March 19 session. Members asked staff to place follow‑up presentations and data requests on future agendas so the board could consider whether any regulatory changes, rulemaking or guidance are warranted.

Why it matters locally: California currently has regulatory and statutory frameworks for both physical therapy and acupuncture; any change that explicitly authorizes needling by physical therapists would likely require board rulemaking or legislation and would raise questions about education, minimum training, supervision, informed consent, documentation and enforcement. Presenters emphasized that most of the technical knowledge needed for dry needling is taught in entry‑level physical therapy education but that a defined subset of needling‑specific skills requires postgraduate training. The VA presenters said their system’s experience suggests the intervention is useful across inpatient and outpatient settings and that standardized training plus integrated interdisciplinary care can limit risk.

Reporting note: direct quotations in this article come from meeting speakers and are attributed to the first instance of the speaker’s full name and role as recorded in the meeting transcript.