This chapter establishes standards for the provision of dry needling as an intervention performed by physical therapists. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the State Board of Physical Therapy Examiners. “Dry needling” means a physical therapy intervention, also known as intramuscular manual therapy, that: Involves the insertion of one or more solid needles, a mechanical device, into the muscle and related tissues to affect change in muscle and related tissues; Requires ongoing evaluation, assessment, and re-evaluation of the impairments; Is only utilized in parts of the body with neuromuscular or musculoskeletal links to the impairments; and Is not performed for: The purposes of acupuncture as defined in Health Occupations Article, §1A-101, Annotated Code of Maryland; or Any purpose outside the scope of physical therapy. In order to perform dry needling, a physical therapist shall have at least 80 total hours of instruction, which includes: A total of at least 40 hours of instruction in the following dry needling-specific course content areas: Theory and application of dry needling; Dry needling technique, including spine and extremities; Dry needling indications and contraindications; Infection control, the Occupational Safety and Health Administration’s Bloodborne Pathogen Protocol, and safe handling of needles; Emergency preparedness and response procedures related to complications associated with dry needling; and Appropriate documentation of dry needling; and At least 40 hours of practical, hands-on instruction in the application and technique of dry needling, under the supervision of a licensed health care practitioner competent in dry needling procedures who has: Completed the requisite course work under §A(1) of this regulation; and Practiced dry needling for at least 5 years. The instruction required under §A(1) of this regulation shall be provided by a continuing education course sponsored by the: American Physical Therapy Association; The APTA of Maryland; or The Federation of State Boards of Physical Therapy. A continuing education course taken before June 19, 2018 shall qualify for instruction if the same course, in substantially similar form, is later sponsored by the American Physical Therapy Association, the APTA of Maryland, or the Federation of State Boards of Physical Therapy. All instruction required under this regulation shall include an assessment of competency. The instruction required under §A(1) of this regulation shall be offered: In person at a face-to-face session; or In real time through electronic means that allow for simultaneous interaction between the instructor and the participants. A physical therapist may not fulfill any portion of the practical, hands-on instruction required under §A(2) of this regulation with online or distance learning. A physical therapist shall have practiced physical therapy for at least 2 years before performing dry needling in the State. Registration. A physical therapist shall be registered with the Board as having the appropriate education and training required by this regulation before the physical therapist may practice dry needling. In order to be registered to practice dry needling, a physical therapist shall: Submit a completed application on a form supplied by the Board; and Pay a registration fee as established by COMAR 10.38.07. A physical therapist who practices dry needling without the education and training required by this regulation shall be subject to discipline pursuant to COMAR 10.38.10.04A(4). This regulation shall take effect October 1, 2018. A physical therapist shall: Fully explain dry needling to the patient in advance of treatment; and Obtain written informed consent specific to dry needling that shall be included in the patient’s medical record. A physical therapist shall perform dry needling in a manner consistent with standards set forth in the Maryland Occupational Safety and Health Act, Labor and Employment Article, Title 5, Annotated Code of Maryland. A physical therapist shall document the provision of dry needling services in accordance with the documentation requirements of COMAR 10.38.03.02-1. A physical therapist who practices dry needling in a manner inconsistent with the standards of practice enumerated in this regulation shall be subject to discipline pursuant to COMAR 10.38.10.04A(14). Dry needling is not within the scope of practice of limited physical therapy and shall only be performed by a licensed physical therapist. Health Occupations Article, §13-101 and 13-206, Annotated Code of Maryland Effective date: June 19, 2017 (44:12 Md. R. 588) Regulation .03J amended effective August 27, 2018 (45:17 Md. R. 804)