This chapter establishes standards for the provision of dry needling as an intervention performed by chiropractors. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the State Board of Chiropractic Examiners. “Dry needling” means a chiropractic intervention, also known as intramuscular manual therapy, that: Is performed only by chiropractors with physical therapy privileges; 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 chiropractic. A chiropractor registered to perform dry needling shall: Fully explain dry needling to the patient in advance of treatment; Obtain informed written consent specific to dry needling, which shall be included in the patient’s medical record; Perform dry needling in a competent manner consistent with patient health and safety; and Document the provision and the specific location of the dry needling service in accordance with the requirements of COMAR 10.43.14.03. A chiropractor who performs dry needling in a manner inconsistent with the standards of practice enumerated in this regulation may be subject to discipline pursuant to COMAR 10.43.15.06. Dry needling is not within the scope of practice for: A registered chiropractic assistant; A chiropractic assistant trainee; A preceptor; or An extern. A chiropractor with physical therapy privileges shall be in good standing before registering to perform dry needling. The Board shall accept a dry needling course completed before May 18, 2020, if: The same course, in substantially similar form, is sponsored by a continuing education provider approved by the Board; and The chiropractor seeking to perform dry needling provides the Board with a certificate of completion of 3 hours of a recertification course in dry needling. In order to perform dry needling, a chiropractor with physical therapy privileges shall complete a minimum of 80 hours of total instruction in the following content areas, including: 60 hours of: Academic coursework obtained through completion of a college program accredited by the Council of Chiropractic Education, as part of the Doctor of Chiropractic program, including the following minimum requirements: Foundations; Basic sciences; Clinical sciences; and Professional practice; or Coursework required to sit for Part I, Part II, Part III, Physiotherapy, and Part IV of the examination administered by the National Board of Chiropractic Examiners; and Board-approved coursework consisting of 20 hours to be done in a hands-on classroom setting, including but not limited to the following learning topics: Philosophy and historical perspective of dry needling; Indications, contra-indications, and qualifications for treatment; Protocols, doctor and patient safety, usage of dry needling, and dry needling as a diagnostic tool; Case management and jurisprudence; and Direct, hands-on implementation and testing for competency in dry needling of: Cervical, thoracic, lumbar, and pelvic regions; Anterior and posterior thoracic and ribs; The upper and lower extremity; The face and head; Technique; and Needle size and gauge appropriateness. The Board shall register a chiropractor with physical therapy privileges as qualified to perform dry needling in the State, provided the chiropractor submits to the Board: Evidence of completion of the education and training requirements outlined in Regulation .04 of this chapter; and An application for registration on a form provided by the Board. A chiropractor with physical therapy privileges may not perform dry needling without registering with the Board. Health Occupations Article, §§3-101, 3-205(a), 3-307, 3-403, and 13-101, Annotated Code of Maryland Effective date: May 18, 2020 (47:10 Md. R. 519) Regulation .03A, C amended effective April 4, 2022 (49:7 Md. R. 467) Regulation .04 amended effective April 4, 2022 (49:7 Md. R. 467) Regulation .05A amended effective April 4, 2022 (49:7 Md. R. 467)