License Endorsements - Physical Therapist

General Information

Physical therapists who meet certain training and education requirements are eligible to apply for endorsements under WAC 246-915 and RCW 18.74. Endorsements are not a requirement of licensure. However, if you're physical therapist and you're going to perform any of the following activities, you must have the endorsement(s).

Endorsements

The following endorsement applications are optional:

• Verification of Electroneuromyographic Training (PDF)
• Verification of Mentored Sharp Debridement (PDF)
• Spinal Manipulation Endorsement (PDF)
• Intramuscular Needling Endorsement (PDF)

Additional forms

• Intramuscular Needling Endorsement Qualified Provider Attestation Form (PDF)

Intramuscular Needling Endorsement Frequently Asked Questions

What is intramuscular needling?

Intramuscular needling is defined under RCW 18.74.010 as follows: "Intramuscular needling," also known as "dry needling," means a skilled intervention that uses a single use, sterile filiform needle to penetrate the skin and stimulate underlying myofascial trigger points and connective and muscular tissues for the evaluation and management of neuromusculoskeletal pain and movement impairments. Intramuscular needling requires an examination and diagnosis. Intramuscular needling does not include needle retention without stimulation or the stimulation of auricular and distal points.

What are the requirements to qualify for the intramuscular needling endorsement?

• The physical therapist must have at least one year of postgraduate practice experience that averages at least 36 hours a week and consists of direct patient care.
  • If the didactic and in-person instruction detailed below was completed through pre-licensure coursework, you do not need one year of postgraduate practice experience.
• A total of 100 hours of didactic instruction in the following areas:
  • Anatomy and physiology of the musculoskeletal and neuromuscular systems;
  • Anatomical basis of pain mechanisms, chronic pain, and referred pain;
  • Trigger point evaluation and management;
  • Universal precautions in avoiding contact with a patient's bodily fluids; and
  • Preparedness and response to unexpected events including but not limited to injury to blood vessels, nerves, and organs, and psychological effects or complications.
• A total of 75 hours of in-person intramuscular needling instruction in the following areas:
  • Intramuscular needling technique;
  • Intramuscular needling indications and contraindications;
  • Documentation and informed consent for intramuscular needling;
  • Management of adverse effects;
  • Practical psychomotor competency; and
  • Occupational safety and health administration's bloodborne pathogens protocol.
• After completing the 100 hours of didactic instruction and 75 hours of in-person instruction, the physical therapist must complete a successful clinical review of a minimum of 150 hours of at least 150 individual intramuscular needling treatment sessions by a qualified provider. The physical therapist has up to 18 months to complete the successful clinical review. 

Review RCW 18.74.200 and WAC 246-915-390 for further details.

My Commission on Accreditation in Physical Therapy Education (CAPTE) accredited physical therapy pre-licensure coursework covered the 100 hours of didactic training. Do I have to submit my transcripts again?

If you graduated from a CAPTE accredited physical therapy program, you will likely have completed all 100 hours of didactic instruction covering the required topics. Since you submitted transcripts to apply for your Washington state physical therapy license, you may not need to submit them again. If you feel you fall into this category, please submit your application with all additional supporting documentation, and the department will pull your transcripts from your existing record. If we are unable to access your transcripts, we will contact you.

How do I apply for the intramuscular needling endorsement?

You may access the application on our licensing information webpage. Currently, we are only able to accept paper applications for the intramuscular needling endorsement. When the online application is available, our website will be updated. Submit your application along with your supporting documentation and the $100 one-time fee to the address listed on the application. Only physical therapists (not physical therapist assistants) are eligible for this endorsement.

When can I start working on the intramuscular needling hours required under clinical review?

You can work through those hours once you have completed the 100 hours of didactic instruction and 75 hours of in-person instruction. The statute requires physical therapists to complete a successful clinical review of a minimum of 150 hours of at least 150 individual intramuscular needling treatment sessions under a qualified provider. You must complete this qualification after completing the didactic and in-person training and before applying for the endorsement.

Can I practice dry needling on an individual who is not a regular patient in my work setting to meet the 150 hours of at least 150 treatment session requirement?

Although it is not always recommended, you are not precluded from treating individuals that are known to you. A person does not have to be registered or necessarily paying for services to be considered a patient. Anyone you provide treatment to would need to have some kind of indication that dry needling could help them. A meaningful clinical review would not be possible for services provided to a person who had no indication for treatment. You must record and maintain chart notes which could be evaluated for the clinical review. You also need to be aware that under RCW 18.74.200, dry needling cannot be administered as a stand-alone treatment within a plan of care.

How do I find a qualified provider to supervise my training hours?

Your qualified provider must have knowledge of intramuscular needling. A qualified provider can be one of the following: 

• A physician licensed under chapter 18.71 RCW; an osteopathic physician licensed under chapter 18.57 RCW; a licensed naturopath under chapter 18.36A RCW; a licensed acupuncture and Eastern medicine practitioner under chapter 18.06 RCW; or a licensed advanced registered nurse practitioner under chapter 18.79 RCW;
• A physical therapist credentialed to perform intramuscular needling in any branch of the United States armed forces;
• A licensed physical therapist who currently holds an intramuscular needling endorsement; or
• A licensed physical therapist licensed under the laws of another jurisdiction who meets the requirements of the intramuscular needling endorsement but does not currently hold a Washington endorsement. RCW 18.74.200 and WAC 246-915-390.

What if I have been performing intramuscular needling out of state already?

Any physical therapist performing intramuscular needling in Washington state is required to hold the endorsement, regardless of prior experience. The statute details specific training and education requirements for individuals to qualify for the endorsement.

A physical therapist licensed in Washington state and trained out of state to perform intramuscular needling may qualify for the endorsement. However, they must meet all the requirements under RCW 18.74.200, including the required time frames for completing the training and education.

This means a physical therapist trained to perform intramuscular needling out of state would need to complete the training and education requirements under RCW 18.74.200. This includes 150 hours of 150 treatment sessions under clinical review completed within 18 months of completing the didactic and in-person training.

What if I trained to perform intramuscular needling in the military?

Physical therapists licensed in Washington state and trained to perform intramuscular needling in any branch of the military qualify for the endorsement, WAC 246-915-390. The physical therapist applicant must submit evidence of their military credentials with their application.

Will I be able to delegate intramuscular needling?

No, the statute does not allow physical therapists to delegate intramuscular needling to physical therapy assistants or any other assistive personnel. You must remain in constant attendance of the patient for the entirety of the procedure.

What if my patient is also seeing an acupuncturist?

Under RCW 18.74.200 physical therapists shall make reasonable efforts to coordinate care with the acupuncturist or acupuncture and Eastern medicine practitioner to avoid duplication of services when they intend to perform intramuscular needling on a patient who is being treated by an acupuncturist or acupuncture and Eastern medicine practitioner for the same diagnosis. 

Does my patient need to sign an informed consent form?

Yes. Under RCW 18.74.200 and WAC 246-915-390 physical therapists shall have patients receiving intramuscular needling sign an informed consent form that includes the following information:

• The definition of intramuscular needling as set forth in RCW 18.74.010;
• A description of the risks of intramuscular needling;
• A description of the benefits of intramuscular needling;
• A description of the potential side effects of intramuscular needling; and
• A statement clearly differentiating the procedure from the practice of acupuncture. Acupuncture shall be defined in accordance with the definition of "acupuncture and Eastern medicine" under RCW 18.06.010.

The Board of Physical Therapy, with input from our community partners, has developed an example of an informed consent form that includes all the required information (PDF). You are not required to use this example form, but feel free to copy some or all of the form for your own use. If you choose to create your own informed consent form or edit the example form, it must contain all the information listed above.