I saw this in the newspaper from Louisville ( my hometown ) I am loving how well the technique has been adopted.  Is a good idea to know how long your therapist has been performing dry needling, and where they obtained their certification.

Pain sufferers turn to dry needling

Darla Carter, @PrimeDarla 2:46 p.m. EDT October 15, 2015

Muscle pain sufferer Hal Taylorson says the dry needling procedure has relieved his muscle pain more than any other treatment to date. Sam Upshaw, The C-J

Physical therapist Jon Holland performs a dry needling procedure on Hal Taylorson to relieve muscle pain at the U of L Sports Medicine Clinic which is part of KentuckyOne Health. Oct. 12, 2015 (Photo: Sam Upshaw Jr.; The C-J)

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As a Buddhist, Hal Taylorson has an aversion to taking medication, but as a neck pain sufferer, he needed some relief.
He started getting dry needling treatments from a physical therapist as an alternative to medication.
The therapy involves inserting thin needles into muscles to ease pain and tension.
Basically, it’s for almost “any patient that has soft-tissue problems, so muscle sprains and strains, even chronic muscle pain,” said Jon Holland, a physical therapist at the University of Louisville Sports Medicine Clinic, part of KentuckyOne Health downtown.
“We also use it for joint problems if the joint problem is being driven by a muscle that’s not functioning properly,” he said.

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Therapists target "trigger points" or irritable, hard "knots" within a muscle or connective tissue that may cause pain over a large area, according to an explainer for patients in the Journal of Orthopaedic & Sports Physical Therapy last year. The trigger points are associated with tight muscle bands, and the pain can hinder daily activities and movement.
When a patient comes in for treatment, “we feel where muscles have trigger points or painful areas in them,” Holland said. “Then we put the needle in it and it causes a biochemical reaction that helps the muscle and the trigger point relax."
Taylorson, an interior designer with Chic Designs Interior and Exterior, developed neck pain after a car crash several years ago and has had spine surgery twice. He’s had a half-dozen dry needling treatments over the course of five weeks to soothe muscles in his neck area.
“I have seen a difference,” said Taylorson, who was treated by Holland earlier this week. “It does release a lot of the tension.”
Dry needling is usually done as part of a larger treatment plan that includes other therapies. "It’s a great adjunct to a lot of the interventions that we like to do with patients … and it's very safe," said Chad Garvey, a physical therapist with KORT (the Kentucky Orthopedic Rehab Team) Downtown.
Research on dry needling is limited and the findings have been mixed.
A 2001 systematic review in the Archives of Physical Medicine and Rehabilitation found "direct needling of myofascial trigger points appears to be an effective treatment, but the hypothesis that needling therapies have efficacy beyond placebo is neither supported nor refuted by the evidence from clinical trials."

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A 2010 article in the Journal of the American Board of Family Medicine noted that dry needling's effectiveness has been confirmed in "numerous studies" and two comprehensive systematic reviews but that more research is needed.
A systematic review and meta-analysis published this year in the Archives of Physical Medicine and Rehabilitation suggests that dry needling is effective for short- and medium-term relief of neck and shoulder pain.
Dry needling is often used with physical therapy patients who have “hit a plateau with their progress,” Garvey said. “We see a fair amount of folks with significant pain that has not responded to standardized treatments.”
Through the use of dry needling, "we want to try to break the pain cycle and the needle can help access the body’s own pain-relieving chemicals," Garvey said.
If successful, the therapy allows patients "to exercise and move better" after dry needling is performed.
A study in the Journal of Orthopaedic & Sports Physical Therapy last year found dry needling seemed to be helpful for neck pain.
In that study, which involved 17 neck patients, half of them received dry needling and the other half got no treatment. The dry needling group reported decreased pain immediately after treatment and one week later. They also were better able to bend their heads forward and backward and to turn their heads toward the painful side of their necks.
Therapists may manipulate the needles using their fingers alone or with the aid of an electrical stimulator.
The needles vary in size, said Holland, displaying various lengths, from an inch and half long to 4 inches long.
“Some people don’t feel the needle going in at all," Holland said. "Some people do feel a little pressure when the needle goes in. ... Occasionally, you may get a drop of blood but not often.”

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Potential side-effects include soreness and less commonly, pain or light-headedness, Holland said. Sometimes, there also is a risk of severe problems, involving the lungs and large blood vessels, according to published literature.
But “the most common by far would be just soreness — like you’ve worked out," Holland said.
Some people confuse dry needling with acupuncture, but the therapies are different, physical therapists say.
Dry needling is “based on a western medicine model," Garvey said. "We only utilize dry needling for neuromusculoskeletal pain and impairments ... and we don’t do it in the guise of treating energy meridians and things that are within Chinese acupuncture medicine.”
Taylorson said he doesn’t feel pain during dry needling nor does he have lingering soreness from it.
“I would not consider it painful,” he said. At the end, “I feel relieved. The tension is gone. As long as I don’t stress the muscles afterwards, it lasts a nice time — several days.”
The number of treatments vary, Holland said.
“You get some results with one (treatment)," he said. "But, typically, we’ll do multiple treatments (such as six to nine)."
Check with your insurance company to see if it will cover the treatments.
The treatment may not be right for everyone. Those it might be inappropriate for include pregnant women, people with bleeding disorders and people who fear needles, Holland said.
If a patient has had surgery, they'd typically have to wait six to 12 weeks before starting dry needling, he said.
But for the right patient, it “gets good results," he said.
Courier-Journal reporter Darla Carter can be reached at (502) 582-7068 or dcarter@courier-journal.com.

APTA position on Direct Access for Physical Therapy and Physical Therapists

This is a nice summary for Direct Access to Physical Therapy which in Kentucky is available to all. This comes directly from the American Physical Therapy Association/ 

Direct Access to Physical Therapy Services: Overview

The Problem

While state law generally allows patients to seek evaluation and treatment from a licensed physical therapist without a prescription or referral from a physician, patients are limited in their ability to do so in many states by arbitrary and unnecessary restrictions. These restrictions are typically in the form of time and visit limits, previous diagnosis requirements, limited patient populations, or requiring a referral for certain types of treatment. These restrictions do not recognize the professional training and expertise of the licensed physical therapist nor do they serve the needs of those patients who require physical therapy but whose care is unnecessarily interrupted by these restrictions..

The Solution

Amend current statutes at the state level to remove arbitrary limitations on direct access to physical therapy services.

Rationale

In the age of health care reform, state legislatures continue to seek solutions that will expand access to the health care services the citizens of their state need while also addressing the growth in health care costs. One of the most effective tools for cost control and increased access is easily attainable yet often overlooked and underutilized by the legislatures - that of direct access to the services of nonphysician health care professionals.

Physical therapy is the case in point. Entry into the profession and practice of the profession are stringently regulated by all states, and as highly trained health care professionals, physical therapists have a proven track record of effectively treating millions of patients. Physical therapists are well-qualified, both through formal education and clinical training, to evaluate a patient's condition, assess his or her physical therapy needs and, if appropriate, safely and effectively treat the patient. Physical therapists are also well-qualified to recognize when patients demonstrate conditions, signs and symptoms that should be evaluated by other health care professionals before therapy is instituted. Physical therapists recognize when it is appropriate to refer patients to these other health care professionals for consultation.

Every state, the District of Columbia, and the US Virgin Islands have all recognized the safety and benefits of direct access to physical therapy by removing from their statutes, all or some of the referral requirements or provisions for a physical therapy evaluation and treatment. However, if your state laws continue to include out-dated and unnecessary barriers to direct patient care by physical therapists, please consider the benefits of reform. By amending the physical therapy practice act in your state, you will be providing your constituents with an additional entry point into the traditional medical system, increased choice in the selection of a health care professional, access to less expensive and more timely care, and a simple, yet, extremely effective way to meet the goals of increased access and cost containment.

For additional information on direct access, please contact APTA's state government affairs department at 800/999-2782, ext. 3161.

Chose one that 

Specializes in Dry Needling 

with Advance Training

By making your own decision as to your Physical Therapist then you are taking charge of you, as the most important member of your health care team

You are entitled to choose the most appropriate health care professional to meet your goals. 

You have that Freedom of Choice! 

You have the freedom to choose your own Physical Therapist

How does the dry needling method work: Mechanism of Action
it appears to allow the sarcomere to resume its resting length³ and activate inhibitory dorsal horn interneurons? This implies that DN causes opioid-mediated pain suppression and also blocks any incoming noxious stimulus into the dorsal horn by activating the serotonergic and noradrenergic descending inhibitory systems.⁴

In addition, the levels of two biochemical drop significantly following DN. There is a decrease in local concentrations of substance P and calcitonin gene–related peptide; this development may correlate with the systematic reduction of pain following deep DN.⁵

Furthermore, there are studies currently under way that are using multiple imaging techniques to visualize the cascade of physiologic changes that are possible with the introduction of filiform needles into an MTrPs.

Many of us have areas in our body that feel tense all the time or feel like a hard ball in the muscle.By inserting fine needles into these tight areas, we elicit a “twitch response” or a brief contraction followed by an immediate and long lasting relaxation. 

The needle can treat very deep parts of the muscle, the technique can achieve amazing pain relief that you never thought possible.

Muscular tightness and spasm can lead to compression and irritation of the nerves. When nerves are irritated, they cause a protective spasm of all the muscles to which they are connected. This contributes to the decreased mobility and pain in the area. 

I treat multiple orthopedic and neurological conditions helping patient achieve long-term benefits

I specialize in Dry Needling, an extremely effective technique that uses a very fine acupuncture needle to “deactivate” or “shut down” a trigger points or painful knotted areas in your muscles therapy to improve and maximize a patient’s performance and ability.  

Benefits:
Pain control

1.      Normalizes biochemical electrical dysfunction of motor end plates

2.      Reduces muscle tension Restores/increases motion and function

3.      Desensitizes super-sensitive structures

4.      Promotes healing response in tissue Accelerates return to active rehabilitation

Choosing Your Physical Therapist You are the most important member of your health care team, and you are entitled to choose the most appropriate health care professional to meet your goals. Freedom of Choice You have the freedom to choose your own physical therapist. 

Currently, you may be evaluated by a physical therapist without a physician’s referral in all 50 states and the District of Columbia. In addition, 48 states and the District of Columbia allow some level of treatment by a physical therapist without a physician’s referral (all but Michigan and Oklahoma).* Keep in mind that your insurance policy may require a visit to the primary care physician first or may limit your access to preferred providers only.

Your physician may refer you for physical therapy that is to be provided in the physician’s office, or to a facility in which the physician has a financial interest. If this is your situation, be aware that you have the right to choose your own physical therapist and that you are not obligated to receive physical therapy in any specific facility.

Always insist that your physical therapy be provided by a licensed physical therapist.

How to Choose a Physical Therapist Make sure that you receive physical therapy from a licensed physical therapist. Physical therapists are professional health care providers who are licensed by the state in which they practice. 

If you are receiving physical therapy from a physical therapist assistant, be sure that he or she is supervised by a licensed physical therapist. Ask the physical therapist’s clinic if it participates with your insurance company.

Receiving care from a participating physical therapist should minimize your financial responsibility. There may be good reasons, however, to see a physical therapist who does not participate with your insurance plan.

If you need a physical therapist who has special skills related to your particular condition or if the location or other aspects of the care or the facility meet your needs ,this may be a good choice for you.

Some policies require copayments for services, and the amount of the copayment will depend on whether the physical therapist is part of the insurer’s provider network. You also will have to meet your deductible.

Your physical therapist’s clinic should be able to help you calculate an estimate of your financial responsibilities.

Your first visit should include an evaluation by the physical therapist. Your physical therapist will perform an examination to identify current and potential problems. Based on the results of the examination, and considering your specific goals, your physical therapist will design a plan of care to include specific interventions and will propose a timetable to achieve these goals and optimize your movement and function.

Your physical therapist will likely provide you with instructions to perform exercises at home to facilitate your recovery. You should feel comfortable asking your physical therapist any questions regarding your course of care, including specifics regarding interventions and expectations.

Find a physical therapist in your area at www.moveforwardpt.com

Acknowledgment: Shannon L. Hoffman, PT, DPT

Medicare and Direct Access to Physical Therapy

As promised here is some more information on Direct Access and Medicare ;

Direct Access and Medicare

Medicare beneficiaries are able to go directly to physical therapists (PT) without a referral or visit to a physician. This policy became effective in 2005 through revisions to the Medicare Benefit Policy Manual (Publication 100-02).

Medicare beneficiaries are able to go directly to physical therapists (PT) without a referral or visit to a physician. This policy became effective in 2005 through revisions to the Medicare Benefit Policy Manual (Publication 100-02). The 2005 revisions eliminated the physician visit requirement. However, a patient must be "under the care of a physician," which is indicated by the physician certification of the plan of care. Learn more from a summary of the 2005 revisions..
 

The following information is offered to help physical therapists provide access to PT services to patients and remain in compliance with laws and regulations. For more detailed information on CMS requirements, review section 220.1.1-3 of the Medicare Benefits Policy Manual (.pdf) and national and local coverage determinations.

What the Rules Say

·         PTs must comply with the laws in their state related to the need for a referral for physical therapy. Review your state practice act.

·         The plan of care developed by the PT must be certified by a physician or nonphysician practitioner (NPP) within 30 days of the initial therapy visit.

·         The plan of care must include, at a minimum, (1) diagnoses; (2) long-term treatment goals; and (3) type, amount, and duration of therapy services.

·         Certification requires a dated signature on the plan of care or some other document that indicates approval of the plan of care. Stamped signatures are not acceptable. If the order to certify is verbal, it must be followed within 14 days by a signature.

·         Medicare does not require that the patient visit the physician/NPP. However, a physician/NPP may require the visit.

·         Medicare does not require a physician order for PT services.

·         Recertification of the plan of care is required if changes in a patient's condition requires revision of long-term goals or within 90 calendar days from the date of the initial treatment, whichever is first.

What This Means for PTs

To be paid by Medicare for their services, PT practices should have procedures in place to ensure that the plan of care is certified. Medicare does not require certification of the plan of care before treatment is initiated. However, if the PT does not have a relationship with the physician or is not confident that the physician will sign the plan of care, it may be prudent for the PT to contact the physician for verbal authorization before initiating treatment. If state law is more restrictive that Medicare regulations, physical therapists must comply with state law.

Filing Medicare Claims Under Direct Access

Medicare regulations specify how to report information on the certifying physician/NPP on claims for outpatient therapy services:

·         Effective October 1, 2012, providers must report the name and NPI number of the certifying physician/NPP on the claim for therapy services.

·         For claims processing purposes, the certifying physician/NPP is considered a referring provider. The term “referring provider” is used by Medicare in this case simply because this is the term that is currently on the claim form.

·         The use of the term “referring provider” does not change existing regulations stating that Medicare does not require a patient visit with the physician/NPP.

DIRECT ACCESS FOR PHYSICAL THERAPY -- YES YOU ARE IN CONTROL IN WORKING WITH YOUR PHYSICAL THERAPIST

In the State of Kentucky, each individual is allowed direct access to Physical Therapy.  What this means is that you are not only allowed to choose who you want to go to for your physical therapy, but when.  Of course it is a given that early intervention is important in gaining a quick and positive outcome.  There are some caveats for certain insurances like Medicare and Medicaid and I will post that later. However, even with these you are allowed direct access.

Below is a short summary of what Direct Access actually means

"What is Direct Access to Physical Therapy

Question: What is Direct Access to Physical Therapy?

In the past my doctor prescribed physical therapy for me. Now she says that I can have direct access to physical therapy. What is direct access?

Answer:

Direct access refers to the ability of patients to be evaluated and treated by a physical therapist without being referred by a doctor or other healthcare practitioner. If you feel you have a problem that may benefit from the skilled services of a physical therapist, you may be able to refer yourself to physical therapy for treatment. Sometimes direct access is called self-referral.

In the United States, provisions for physical therapy services are governed by each individual state through a "state-practice" act. The practice act is legislation that outlines how physical therapy services will be delivered. Historically, each state's practice act provided that physical therapy services would be provided only if ordered by a licensed physician or other licensed healthcare practitioner. Each state lists different professionals who may refer patients to physical therapy, including podiatrists, dentists and nurse practitioners.

The American Physical Therapy Association (APTA) has lobbied successfully in many states to help change the law to allow patients direct access to physical therapy. By having direct access in each state, physical therapists are recognized as the licensed professionals of choice to initially manage musculoskeletal and movement disorders in patients. You can check to see if your state allows direct access on the APTA's website.

Why Is Direct Access Important?

Healthcare is expensive. It seems that with every passing year, more money is being spent on healthcare, with no objective data that patients are achieving better outcomes. A system that allows the patient to directly seek the services of a physical therapist can help save healthcare dollars by eliminating unnecessary tests or other specialist referrals. Many conditions can be successfully evaluated and treated with no expensive diagnostic testing.

Is Direct Access Safe?

Some opponents of direct access to physical therapy services argue that patients may be put at risk if they visit a physical therapist directly. Physical therapists lack the ability to order certain diagnostic tests or prescribe medication to help manage pain.

To date, there is no objective data indicating that self-referral to physical therapy puts patients at increased risk. Also, there is nothing indicating that self-referred patients consume more healthcare dollars during or after their physical therapy care episode.

Physical therapists are also trained to recognize "red flags" that may signal the need for more invasive medical intervention. In those cases, referral to your physician or healthcare provider is made immediately.

Many states also have safety nets built into the legislation that governs the practice of physical therapy. For instance, some states allow direct access only to therapists who have been practicing for three or more years. Others allow a certain time frame or specific number of physical therapy visits during an episode of care. If the patient requires skilled physical therapy after the time frame or visit threshold is reached, referral to the patient's doctor is mandatory.

If you are suffering from a musculoskeletal condition that causes functional movement limitations, use your best judgment when deciding which healthcare practitioner to see. A visit to your local physical therapist is a safe place to start on the road to recovery. Remember that not all states allow for direct access to physical therapy. You can check the APTA direct access map to see if your state allows direct access. If you are unsure if physical therapy is right for you, a discussion with your doctor may be necessary to help you decide.

_Sources:

_{APTA Direct Access in Practice} http://www.apta.org/directaccess/

_{Pendergast J, Kliethermes SA, Freburger JK, Duffy PA. A comparison of health care use for physician-referred and self-referred episodes of outpatient physical therapy. Health Services Research "}

_{I hope this encourages to take your health care needs into your own control, seeking out your family Physical Therapist}