OK, since my last blog post, I have received several email regarding the chiropractic dry needling issue that is currently being discussed in Oregon.

In a nutshell: The insertion of a filament-gauged, solid needle into fascia and myofascial trigger points can produce many physical effects. Most are similar to what a skilled manual medicine practitioner can do (massage therapists, physical therapists, chiropractors etc.). It has been determined that chiropractors can utilize these types of needles as instruments to treat trigger points and myofascial lesions that we currently diagnose and treat. This apparently has some acupuncturists scared that their profession is in danger.

First, it’s not, look at one of the other 16 states where chiropractors are allowed to perform dry needling; if licensed, acupuncturists have continued to grow in number in these states.

Some of the other concerns that have been emailed to me:

Pneumothorax, AKA collapsed lung, this happens as a result of a needle piercing the chest wall and can occur pretty much anywhere in the thorax if the needle is not carefully placed. The only time I have heard of this happening has been in acupuncturists’ offices. In the 16 states where chiropractors are allowed to perform dry needling, I am sure at least a couple of them have produced pneumothorax but I doubt the number is higher (percentage-wise) than with the acupuncture population.

“Chiropractors are minimally trained…” OK, this is just downright offensive! We have over 4000 hours of training; our programs are clinical doctorates…. we are NOT minimally trained. We take classes in diagnosis (western diagnosis; meaning, we have within our scope, the ability to render a diagnosis of myofascial trigger points), physical examinations including, heart and lung, classes on phlebotomy and in Oregon, minor surgery.

“If chiropractors want to do acupuncture, they should become acupuncturists…”

I actually agree with this but is dry needling acupuncture? I am not an acupuncturist so I am not an expert as to what ans what is not acupuncture but I thought using a needle to treat myofascial trigger points and other myofascial lesions is not acupuncture per say…..according to some acupuncturists, I am wrong.

Here’s an analogy, is adjusting a vertebral motion segment the entirety of chiropractic? I hope not, I can’t see why laboratory diagnosis and phlebotomy classes prepared me to do that (tongue-in-cheek ). I know there are a few chiropractors out there who would vehemently disagree with me, that’s fine. I don’t think adjusting is all we do as chiropractors and as such, I have no problem with physical therapists mobilizing joint or even doing high velocity adjusting is they have been trained.

If I am wrong about dry needling not being the entirety of what acupuncturists do, then I am mistaken,; although I don’t think so. Why would the acupuncture community want to sully their art, their craft by distilling it down to be defined as the placement of a needle into a trigger point? Why would anyone spend all the time and money becoming an acupuncturist if that’s all is was?

Can acupuncturists do dry needling? Again, I am not the expert here but I think so….. here’s a question though? Can they diagnose myofascial trigger points (ICD-9 codes: 728.89, 729.1 etc)? If so, what is the standard of care for acupuncturists and trigger points? Can they diagnose joint adhesions and fibrosis to be treated with the insertion of a needle to promote fibroblast activity? If so, what ICD codes would they use?

My point is this, acupuncturists can perform dry needling just as naturopaths and physical therapists can perform high velocity adjusting, dry needling is to acupuncture what high velocity adjusting is to chiropractic….. a tool.

Another argument: “24 hours of training is not enough to perform dry needling…”. See the above retort, we have over 4000 hours of training on the human body; the extra 24 is to tie some of that information into the context of dry needling. Most of it is about safe needle selection and placement and adequate hands on time. This is plenty of time to teach doctors, who have an excellent working knowledge of the body, including precise placement of nerves, vessels, bones, muscles and depth of chest-wall cavity. In addition, we know when to use one of the other tools in our toolbox if an area is dangerous or prone to pneumothorax…. it’s really kind of simple. Answer this question, how long did it take until you (acupuncturists) were able to insert a needle into someone’s musculoskeletal system? Not long, huh? Most of the time you spent was on point location and other aspects of oriental medicine….. right?

In conclusion, let’s be fair and honest with what this is all about….. MONEY; and actually it’s only the perceived effects that chiropractors performing dry needling will have on the money in Oregonian acupuncturists’ pockets. I think we will all find out, it’s not going to have much of an effect, the rate of pneumothoraxs will not increase, patients will have access to another helpful, effective tool to treat myofascial lesions….. period.

What Oregon has the unique opportunity to do is makes sure the health care world knows that chiropractors cannot perform acupuncture without going through an approved acupuncture program but they CAN perform dry needling with some training on how to utilize needles in an effective and safe way. By doing this, the barrier to care perceived by the public regarding needling of any kind will be diminished and the acupuncture community in Oregon will actually benefit from this; the problem is, a few of them are just to short-sighted to see this

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