Dry Needling and OTPs

Many OTPs ask NMOTA about dry needling and the occupational therapy scope of practice. 

NMOTA has identified three resources that can guide OTPs in determining if they should include the preparatory method of dry needling into their practice: 

NM Statute 61-12A-4. Occupational therapy services: 

(n) application of physical agent modalities and use of a range of specific therapeutic procedures such as wound care management; techniques to enhance sensory, perceptual and cognitive processing; and manual therapy techniques to enhance performance skills

Source: Current NM Statues

Occupational Therapy Practice Framework: Domain and Process Fourth Edition (p. 59)

Intervention Type - Physical Agent Modalities (PAMs) and mechanical modalities: Modalities, devices, and techniques to prepare the client for occupational performance. Such approaches should be part of a broader plan and not used exclusively.
When used with a person: Practitioner administers PAMs to decrease pain, assist with wound healing or edema control, or prepare muscles for movement to enhance occupational performance.
Source: American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

AOTA Policy E.18: Interventions to Support Occupations 

    • AOTA asserts that interventions to support occupations including but not limited to physical agent modalities (PAMs), dry needling, and other techniques may  be used in preparation for, or concurrently with occupations and activities or interventions that ultimately enhance a client’s engagement in occupation. 
    • Use of interventions to support occupations may include the application of PAMs, mechanical modalities, instrument-assisted (manual) modalities (e.g., dry needling), and other new and emerging techniques. It is important to differentiate that little or no published evidence for new and emerging techniques does not equate to a lack of effectiveness. It is an indicator that further research is needed.
    • In the case of new and emerging techniques in which there is not a strong body of evidence, it is essential that practitioners fully disclose the benefits, risks, and potential outcomes of an intervention and reasonable alternatives. Informed consent should be obtained after disclosing information and answering questions to ensure autonomous and voluntary participation in the treatment plan or research study.
    • Decisions on whether to continue or discontinue use of new and emerging techniques should be based on professional reasoning and outcomes including documented progress toward clients’ goals to ensure the client is receiving benefit to engage and participate in meaningful occupation.
    • Interventions to support occupations may not be entry-level skills and may require advanced training and/or certification. New treatment techniques and interventions are routinely developed based on currently available evidence. Practitioners are responsible for maintaining their awareness of these developments as well as their competency in the safe and effective application of new treatment approaches. 
Source: AOTA Policy E.18: Interventions to Support Occupations 

Summary of sources: 

  • The physical agent modality of dry needling is neither specifically allowed nor prohibited by NM State Regulation or national policy guidance. As such, OTPs may consider using dry needling as a preparatory activity / physical agent modality in the context of a treatment plan that also includes occupation-based interventions. OTPs are advised to indicate a direct connection from any PAM they use to the specific occupations for which the PAM is an appropriate intervention (e.g.: ________ [PAM] used with client toward improvements in ________ [pain, range of motion, strength...] so that client could begin direct ADL training for _______ [occupation]).
  • NMOTA recommends that any OTP using PAMs in their practice ensure that they are adhering to the standard of care for the modality. In the case of dry needling, this will include developing and maintaining competence for the modality.  In the case of dry needling, which is an emerging PAM, specialty training and certification is warranted. 
  • AOTA policy experts advise that occupational therapy practitioners (OTPs) who use dry needling in states where it is not explicitly permitted—such as New Mexico—should carry their own malpractice insurance. They should also notify their insurance provider of the certification program they completed and their intention to use dry needling when it is clinically appropriate to support a client’s return to meaningful occupations.