14 February 2024 (Falls Church, VA) For the second time in as many weeks, the International Chiropractors Association (ICA) has submitted a strong rebuttal against scope expansion in the State of Florida. Today, the ICA submitted a letter to Florida State Representatives opposing a suggestion expansion to include the invasive medical procedure known as Dry Needling in the chiropractic scope of practice. If you are a Florida chiropractor, its time to call your Representative in Tallahassee.

Excerpts of our comments:

At the request of our Florida members, the International Chiropractors Association (ICA)  has reviewed the proposed legislation “HB 1063  Practice of Chiropractic Medicine”  introduced by Rep. Christine Hunschofsky and Rep. Allison Tant.  We stand in strong opposition to this legislation.

• Dry Needling is an invasive technique with risks to patient and doctor. 
• Dry Needling is NOT chiropractic.
• Dry Needling is NOT Evidence-Based.
• Doctors of Chiropractic do not need dry needling to meet the needs of their patients.

… The ICA objects to any scope expansion that increases risks to patients through the puncturing of skin for a therapeutic intervention such as IVs, joint injections, injections of any kind, or dry needling which is referenced in HB 1063 as “the use of monofilament intramuscular stimulation treatment for trigger points or myofascial pain.” 

… Nowhere within the definition of chiropractic in the Florida statute does or should inserting needles fit into the science, art, and philosophy of the chiropractic profession.

 “..a noncombative principle and practice consisting of the science,  philosophy, and art of the adjustment, manipulation, and treatment of the human body in which vertebral subluxations and other malpositioned articulations and structures that are  interfering with the normal generation, transmission, and expression of nerve impulse between the brain, organs, and tissue cells of the body, thereby causing disease, are adjusted, manipulated, or treated, thus restoring the normal flow of nerve impulse which produces normal function and consequent health by chiropractic physicians using specific chiropractic adjustment  or manipulation techniques taught in chiropractic colleges accredited by the Council on Chiropractic Education. No person other than a licensed chiropractic physician may render chiropractic services, chiropractic adjustments, or chiropractic manipulations.”

The ICA strongly opposes expanding the Florida scope of practice to include any invasive techniques or procedures such as dry needling.  It is in the interest of the public’s safety as well as the preservation of chiropractic as a separate and distinct profession.  The entire profession is based upon our philosophy that our doctors identify subluxations through evaluations and imaging when needed, and then correct the subluxation (or misalignment) to remove the interferences and allow the body to optimize its innate self-healing, self-generating capacity. 

If a patient has additional needs of care that would include invasive techniques, our doctors should be referring to the appropriately trained and credentialed health professional. The ICA is confident that the chiropractic system of healing as a profession is ‘enough’ on its own and does not need to be expanded to include medical procedures and invasive techniques such as dry needling.  We arrived at our stance on this matter by a review of two primary issues.  First – the risk/benefit ratio of dry needling.  We do not find the evidence substantial enough to support the risks both to patient and to the provider (needle sticks are a very real concern and can spread hepatitis, HIV, etc.).  Second, and equally important is the evaluation based on whether dry needling is in the lane of chiropractic or the lane of medicine?  Clearly as an invasive technique dry needling is in the lane of medicine; and thus, does not belong in the chiropractic scope of practice…

Risks Associated with Dry Needling:

• The top three recognized adverse events associated with dry needling are: bleeding, bruising, and pain.
• The same paper goes on to report that “Since dry needling involves a needle penetrating the skin, iatrogenic injury to vessels, nerves, spinal cord, internal organs, implanted devices, or infection are possible hazards for patients.”

• Other reported major adverse events in this study were pneumothorax (A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall and can be life threatening.) Additionally , nerve injury, infection, or excessive symptom exacerbation. [7] 
• Acute onset chest pain, haemoptysis and exertional dyspnoea following a dry needling session. Diagnosis Chest x-ray showed bilateral pneumothoraces, worse on the right side were also reported in a case study. [8]

…In Conclusion:  ICA urges the Florida Senate to reject scope dry needling in the scope. Dry needling is in the lane of medicine, not the lane of chiropractic.  Our patients benefit most from a focus on identifying and correcting subluxations through appropriate evaluation and the chiropractic adjustment. 

To read the full response below.