Physical Therapy Board hears national and VA briefings on dry needling as acupuncturists press safety and scope concerns

Leslie Adrian, director of professional standards at the Federation of State Boards of Physical Therapy, told the Physical Therapy Board of California on March 19 that "dry needling is an established treatment," and reviewed national regulatory, competency and safety data as the board considered next steps on the practice.

The presentations — one from the Federation of State Boards of Physical Therapy (FSBPT) and a separate briefing by clinicians from the Department of Veterans Affairs (VA) — described dry needling as an intervention used for neuromusculoskeletal conditions, outlined a multi‑step competency review the federation has led, and said the VA has implemented standardized training and a national program for VA clinicians. At the meeting, representatives of California acupuncture organizations and the California Acupuncture Board urged caution, saying any practice that punctures the skin should be treated as acupuncture under state law.

Why it matters: the board regulates physical therapists and their scope under the Physical Therapy Practice Act, and any change in policy or rulemaking on dry needling could affect licensing, education expectations and consumer access to a treatment that presenters said is now widely used outside California.

FSBPT findings and framing

"Dry needling is an established treatment," Adrian said, describing the FSBPT's multi‑year competency work and a 2024 update that mapped dry‑needling work activities and knowledge requirements to the National Physical Therapy Examination (NPTE) content outline. Adrian said the FSBPT and external contractors identified numerous "work activities" and "knowledge and skills requirements" linked to dry needling and concluded that most — about 88 percent — are part of entry‑level PT education, while roughly 12 percent of competencies are dry‑needling specific and would require post‑graduate or specialized training.

Adrian reviewed the patchwork of state regulation nationwide: "If you look at the ... state of dry needling in the USA as of December of 2024, all of the green states allow it specifically, so that is 40," she said, adding that some states allow dry needling by board policy, some by statute, and a small number specifically prohibit PTs from puncturing the skin. She said disciplinary reports tied to dry needling are few: across a 2010–2023 sample the federation reviewed, 22 of 5,025 disciplinary actions were related to dry needling (about 0.43 percent), and the most common complaints were about informed consent, documentation and billing rather than direct patient harm.

Adrian also warned against conflating dry needling with traditional acupuncture. "Acupuncture is based on traditional Chinese medicine," she said. "Physical therapists using dry needling are not basing it on ancient Chinese medicine. Dry needling is based on neuromusculoskeletal evaluation and management." She said a discipline determination should rely on whether clinicians use acupuncture diagnostics or terminology: "If they use acupuncture diagnosis like tongue and pulse... they should be brought before a board."

VA experience and practice model

Speakers from the VA Palo Alto health system described a decade of clinical use, training and an internal national training network that the presenters said standardizes practice across Veterans Health Administration sites. "We have a national dry needling training healthcare system and research enterprise," said Theo Dernell, identifying himself and colleagues from the VA, and adding that VA clinicians treat both active‑duty service members and veterans and align training with Department of Defense practice where practical.

VA presenters said dry needling is used in interdisciplinary clinics, in emergency departments to avoid admissions for acute musculoskeletal pain, in primary care settings and as an adjunct to physical therapy plans of care. Rick Castillo, a VA clinician, described clinical aims beyond pain relief — "We're really trying to increase range of motion because as physical therapists, we want to make sure that we improve function" — and said the VA is now collecting outcomes and plans to publish multisite research.

Public comment and stakeholder positions

Public commenters and organizational representatives urged different approaches. Niccolo DeLuca, speaking for the California Acupuncture Coalition, said the coalition believes "dry needling is acupuncture and that needs to be ... performed by a certified licensed acupuncturist." DeLuca said the coalition would like to work with the board and other regulators on public‑safety protections.

Benjamin Bodia, executive officer of the California Acupuncture Board, told the meeting the Acupuncture Act defines needling in California and said his agency "sees any form of needling as needling," stressing that both boards share a public‑protection mission.

Individual clinicians and association representatives at the meeting urged the PT board to consider allowing dry needling in California or to study the question further. "I would really like to see this modality become an option for physical therapists in California to help our consumers," Board Member Rubina Amin said after the VA presentation. A PTA educator and clinician, Paul Jones, described personal benefit from dry needling in a public comment: after receiving treatment through a VA clinician he said he had marked relief and greater shoulder range of motion.

Board next steps and context

Board members and staff discussed follow‑up. Several board members asked the executive officer to place a follow‑up agenda item on a future meeting to continue discussion and to consider next steps, including whether to request more data from the FSBPT, VA research, or to initiate a formal stakeholder process. Staff indicated they would schedule a follow‑up item for the June meeting cycle. Board members noted differences in legal authority and that any change that affects practice scope should be undertaken through the board's rulemaking authority and consistent with the Physical Therapy Practice Act.

Clarifying details from presentations and comments

- National status (FSBPT): presenters said 40 states specifically allow dry needling as of December 2024; six states are silent; five states were described as specifically prohibiting PTs from puncturing the skin. (FSBPT presenter Leslie Adrian) - Competency mapping (FSBPT): the FSBPT task force and external research partners identified a dry‑needling competency set in 2015, revised with linkage to NPTE practice analyses in 2020 and 2024; presenters said roughly 88 percent of dry‑needling competencies are in entry‑level PT education while ~12 percent are unique to dry needling and require additional training. (Leslie Adrian) - Disciplinary data (FSBPT): in a 2010–2023 ELDD review, 22 of 5,025 disciplinary entries were related to dry needling; examples noted included retained needles (2023), a pneumothorax (2021) and needle placement outside PT scope (2017). (Leslie Adrian) - VA practice: VA Palo Alto presenters said the VA has a national training network and a VA research effort underway; they reported clinical uses in ED, primary care, inpatient and rehabilitation settings and described instances where needling enabled earlier discharge after surgery in a case example. (VA presenters)

What the article does not assert

This report summarizes statements and examples presented at the March 19 meeting and public comment. It does not conclude whether the Physical Therapy Board of California will change the PT scope of practice or regulations. The meeting record showed the board asked staff to place follow‑up discussion on a future agenda; no formal rulemaking or vote on scope occurred at the March meeting.

Where to find more information

Presenters referenced FSBPT resources (FSBPT dry‑needling competency reports and ELDD disciplinary summaries) and VA internal program materials; the board requested staff collect additional materials and research reports for future agenda consideration.