Is dry needling a safe acupuncture replacement, or a shortcut around years of essential training?

Torin Yater Wallace, a 21-year-old Olympic freeskier and lover of extreme sports, has suffered his share of broken bones and hospital visits. But none of those injuries rivaled the pain he felt after he believes a physical therapist punctured his lung just before the 2014 Winter Olympics. The therapist was trying to help his shoulder pain with an increasingly popular type of therapy called dry needling.

“Collapsing my lung was one of the worst things medically,” Yater-Wallace said. “And I’ve gone through so many different broken bones. I would hate for anyone to go through what I did from going to a physical therapy appointment.”

But dry needling hasn’t just been a problem for Olympians. Steven Torres, a 30-year-old hairstylist and avid weight lifter from New Jersey who suffers from shoulder pain, questioned the benefits of dry needling after a physical therapist bore needles into his body that caused bleeding.

“They kind of just explained it was relaxing the muscles,” Torres said. “It did not help, not one bit.”

As patients continue to search for ways to ease their pain, physical therapists are offering them relief by applying dry needles to the body with a process they call dry needling. It has become so popular among practicing physical therapists that training companies like Kentucky-based Kinetacore have taught roughly 6,000 physical therapists in recent years, the company’s chief executive Edo Zylstra has told the press. Its popularity is also growing among future physical therapists as schools like Columbia University include it in the doctoral physical-therapy curriculum.

But the rise of dry needling troubles acupuncturists who say that it’s just acupuncture without the years of training. Acupuncturists typically complete three-year graduate programs, whereas physical therapists start dry needling after a weekend course. Acupuncturists are having their worst fears about dry needling confirmed as they watch physical therapists and patients post their dry-needling experiences on social media. One troubling tweet featured a photo of a Columbia University doctoral physical-therapy student with a banana she stuck with needles and wrote “when you’re too nervous to stab yourself so you have to dry needle a banana.”

 Acupuncturists typically complete three-year graduate programs whereas physical therapists start dry needling after a weekend course.  “Dry needling is acupuncture. This is a huge public-safety issue,” said James Shinol, acting president of Acupuncture Society of New York, who is a member of the group’s task force to combat dry needling in New York State.

The battle about whether it’s legal for physical therapists to use needles for therapy is playing out across the nation. Six* states, including New York and California, have banned it entirely. Both patients who have had bad dry needling and local acupuncture societies have been filing lawsuits. Brent Foster, an Oregon-based lawyer, has worked on six lawsuits involving dry needling since 2014 and only sees inquiries about potential cases growing.

“Over the last year, there has been a major upsurge in interest,” Foster says, who has added three of his six cases since last summer.

There have been some wins for acupuncturists. This past summer, the American Medical Association issued a statement that only licensed acupuncturists and doctors should be able to perform acupuncture. Courts in California and Washington State have banned Kinetacore from teaching workshops there.

Dry needling is expanding laregely because the physical-therapy industry is far larger and more influential than the acupuncture community. In New York State, there were 22,077 licensed physical therapists compared to 4,146 acupuncturists in 2015, according to the New York State Office of the Professions. Physical therapists also have more influence in Washington, DC; the American Physical Therapy Association has a $43.5 million budget and represents more than 95,000 members, according to its website. By comparison, the American Association of Acupuncture and Oriental Medicine does not even have a contact phone number on its website.

Mona Lee Yuan, a licensed acupuncturist and physical therapist from New York, has been working with both state and national groups to stop physical therapists from performing dry needling. But she recognizes it may be difficult.

 There’s also a push to continue teaching dry needling even in states like New York, where it is illegal. “Because of the vast numbers of PTs in the United States, numbers matter,” Yuan said. “They are able to do more. They have more funds for lobbying.”

There’s also a push to continue teaching dry needling even in states like New York, where it is illegal. Acupuncture groups have been contacting the New York State Board of Education and Columbia University asking why it can still teach dry needling to its doctoral physical-therapy students when it’s banned in the state. In a July 26, 2016 email that Melissa Begg, vice provost for Columbia’s academic programs, sent to state officials, she wrote that because dry needling is allowed in 19 states, “we therefore introduce the topic to our students so that they are aware of it, should they return to practice in a state where it is permissible.” Karin Eskenazi-Tzamarot, a Columbia University Medical Center spokeswoman wrote in an email that “we don’t have any plans to modify our doctoral PT program.”

Because the physical-therapy industry is so much larger, dry needling cases also aren’t as big of a problem as they seem to be to the far smaller acupuncture community. A Jan. 2016 report released by the HealthCare Providers Service Organization, which provides malpractice insurance to physical therapists, noted that while there was only one complaint about dry needling in its 2011 report, it handled “several dry-needling-related claims” in the years that followed. The study highlighted four cases where patients were hospitalized.

But Justin Elliott, vice president of government affairs for the American Physical Therapy Association, noted in an email that the 25 dry needling complaints made between 2011 and 2015 made up less than 1% of the industry’s overall 3,877 complaints.

In the end, the biggest victim of this are patients. Acupuncturists argue that they’re receiving dangerous care. Physical therapists rebut they’re helping heal patients.

“There’s no shortage of patients who need health care services.” Elliott said. “We need to stop these turf battles.”

*An earlier version of this article listed the number of states that ban dry needling as eight. The sentence has been corrected.

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