The practice of chiropractic care centers on the diagnosis and treatment of musculoskeletal and nervous system disorders, primarily through manual adjustment and manipulation. Acupuncture is a centuries-old practice rooted in Traditional Chinese Medicine (TCM), involving the insertion of thin needles into specific body points. While these disciplines have distinct origins, a Doctor of Chiropractic (DC) can often perform needling techniques, but this ability is not universal. Whether a DC can integrate needling into their practice depends entirely on meeting specific legislative and educational criteria.
State Laws Governing Scope of Practice
The authority for a chiropractor to use needles is governed by their state’s individual chiropractic licensing board, which defines the legal boundaries known as the “scope of practice.” This regulatory environment creates a spectrum of allowance across different jurisdictions. Some states explicitly include needling techniques, such as dry needling or acupuncture, within the chiropractic scope of practice, sometimes requiring only minimal continuing education.
Other state boards mandate extensive post-graduate training and a separate certification or registration. For example, some states require passing a specialized examination, such as the National Board of Chiropractic Examiners (NBCE) Acupuncture examination, plus completing a set number of training hours. A smaller number of states prohibit chiropractors from performing any needling techniques, either by requiring a separate Licensed Acupuncturist (L.Ac.) license or by explicitly excluding the procedure from the chiropractic practice act. The regulatory distinction often lies in whether the technique is viewed as a musculoskeletal procedure or as an Eastern medical therapy. Chiropractors must always consult the specific rules of the state in which they are licensed before offering needling services.
Specialized Training and Certification
When state law permits a chiropractor to perform needling, it requires specialized post-graduate education separate from the standard Doctor of Chiropractic curriculum. The required training hours vary widely, typically ranging from a minimum of 20 hours for limited dry needling practice to 300 hours for comprehensive acupuncture certification.
Programs offering dry needling certification often involve intense, hands-on courses lasting between 27 and 54 hours. These courses focus on anatomical landmarks and safe needle insertion techniques.
For the broader practice of acupuncture, some jurisdictions require a minimum of 100 hours of study, culminating in a board examination. This training ensures the practitioner understands the application of the needles, contraindications, safety protocols, and clean needle techniques necessary for patient care. The goal of this mandated education is to establish a standard of competency and safety for DCs integrating these advanced procedures.
Certification in dry needling is often granted upon the successful completion of a foundational and advanced course series, which typically includes a practical assessment. Many state boards require that this certification be maintained through periodic continuing education specific to the technique. This highlights that the ability to use needles is a specialized skill set added to the chiropractic license.
Differentiating Needling Techniques Used by Chiropractors
The two primary needling techniques encountered in a chiropractic setting are dry needling and traditional acupuncture, which are fundamentally distinct in philosophy and application.
Traditional acupuncture, rooted in Traditional Chinese Medicine (TCM), focuses on stimulating specific points along energetic pathways (meridians) to restore the flow of Qi (life energy). This holistic approach aims to balance the body’s entire system to treat a wide range of conditions, including pain, digestive issues, and stress.
Dry needling, in contrast, is an evidence-based technique grounded in Western anatomical and neurophysiological principles. It is primarily used to treat musculoskeletal pain and movement impairment by targeting myofascial trigger points—hyperirritable spots within skeletal muscle. The needle insertion aims to elicit a localized twitch response, promoting muscle relaxation, reducing local inflammation, and improving blood flow to the affected area.
Chiropractors who perform needling typically favor dry needling because its focus on the neuromusculoskeletal system aligns closely with the chiropractic scope of practice. Dry needling sessions are generally shorter and focused on localized pain relief, often serving as an adjunct therapy to spinal manipulation or other manual treatments. While both techniques use the same type of thin, solid filament needles, dry needling is applied directly to the site of muscular dysfunction, whereas traditional acupuncture points may be distant from the area of pain.