Physical therapists are the most common providers of dry needling in the United States, with 39 states and Washington, D.C. explicitly authorizing them to perform it. But they aren’t the only professionals allowed to needle. Chiropractors, physicians, and in some cases other licensed healthcare providers can also perform dry needling, depending on state law and their scope of practice.
Physical Therapists in the U.S.
Physical therapists have led the push to include dry needling in their scope of practice, and as of mid-2024, they have legal authorization in 39 states plus D.C. The list includes most of the country: Alabama, Alaska, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
Four states explicitly prohibit physical therapists from performing dry needling: California, Hawaii, New York, and Oregon. Seven more have no formal ruling either way, leaving the practice in a legal gray area: Connecticut, Massachusetts, Michigan, Minnesota, Missouri, Oklahoma, and Pennsylvania. In those states, a physical therapist performing dry needling could face regulatory scrutiny since there’s no clear authorization on the books.
States that do permit dry needling typically require additional training beyond what physical therapists learn in school. Kansas, for example, mandates that a physical therapist complete a dry needling course taught by a licensed provider with at least five years of experience. New Jersey requires a minimum of 40 hours of hands-on practical instruction under the direct supervision of an experienced physical therapist or a licensed physician. The specifics vary by state, but the pattern is consistent: a PT license alone isn’t enough. You need documented postgraduate training in dry needling technique.
Chiropractors
Chiropractors can also perform dry needling in several states, though the regulatory landscape is less standardized than it is for physical therapists. Missouri’s State Board of Chiropractic Examiners, for instance, determined in 2024 that dry needling falls within the chiropractic scope of practice because myofascial trigger point therapy is commonly taught in chiropractic universities. Other states have reached similar conclusions through their own chiropractic boards, but authorization varies widely. If you’re considering dry needling from a chiropractor, it’s worth checking whether your state’s chiropractic board has issued a formal position.
Physicians and Other Providers
Medical doctors and doctors of osteopathic medicine can perform dry needling in all 50 states. Their broad scope of practice generally covers any procedure they’re trained to do, and needling techniques fall comfortably within that. In practice, though, most physicians don’t perform dry needling themselves. They’re more likely to refer patients to a physical therapist or other specialist who does it regularly.
Some states also allow athletic trainers, occupational therapists, or naturopathic doctors to perform dry needling, but these authorizations are far less common and often come with additional supervision requirements. The patchwork nature of these rules means the answer to “who can do it” depends heavily on where you live.
The Acupuncture Distinction
One reason dry needling regulation is so complicated is its relationship to acupuncture. Both techniques use the same thin, solid needles, which the FDA classifies as Class II medical devices. The tools are identical. The theoretical framework is different: dry needling targets tight bands of muscle tissue called trigger points, while acupuncture is rooted in traditional Chinese medicine and follows a system of meridians and energy flow.
This distinction matters legally. Acupuncturists in many states argue that inserting acupuncture needles into a patient is, by definition, acupuncture, regardless of the practitioner’s rationale. Physical therapy advocates counter that dry needling was developed independently and uses its own clinical reasoning. The debate has played out in state legislatures for years, and it’s a major reason why four states still prohibit PTs from needling. In those states, acupuncture practice acts are broad enough that regulators consider dry needling to fall under acupuncture’s legal umbrella, requiring an acupuncture license.
Rules Outside the U.S.
In Australia, the regulatory model is unusually open. The title “acupuncturist” is legally protected and restricted to endorsed Chinese medicine practitioners and physicians, but the actual act of inserting needles is not. Physiotherapists and chiropractors can freely perform dry needling as long as they avoid calling it acupuncture. There are no statutory training requirements governing dry needling for these professions, though professional associations set their own standards and Australia’s Chiropractic Board has issued safety advisories about the risk of lung puncture when needling near the upper back and chest.
Canada takes a province-by-province approach. Chiropractors and physiotherapists can use acupuncture needles in most provinces and territories. Ontario requires chiropractors to complete 200 hours of acupuncture training before needling patients, while physiotherapists in the same province are left to judge their own competency. Quebec takes a different path entirely, allowing physiotherapists to use only dry needling terminology rather than acupuncture language.
In the United Kingdom, a voluntary certification body recommends that physiotherapists complete at least 300 hours of acupuncture training before needling. This isn’t a legal mandate, but it sets the professional standard that insurers and employers typically expect.
How to Verify Your Practitioner
Before booking a dry needling session, you can take a few practical steps. First, confirm that your state authorizes dry needling for the type of provider you’re seeing. A quick search of your state’s physical therapy board or chiropractic board website will usually have a position statement or regulation on file. Second, ask the practitioner directly about their training. Look for providers who have completed a structured postgraduate course with hands-on clinical hours, not just an online seminar. Many states require this, but even in states that don’t, it’s a reasonable baseline for safety.
Any provider performing dry needling must follow standard bloodborne pathogen protocols. This means wearing gloves, using single-use sterile needles, disposing of needles in a sharps container (never recapping them), and disinfecting all surfaces after treatment. These are federal workplace safety requirements, not optional best practices. If a clinic doesn’t follow visible hygiene protocols during your visit, that’s a clear red flag regardless of the practitioner’s credentials.