THE NORTH CAROLINA BOARD OF PHYSICAL THERAPY EXAMINERS
PTBoard@NCPTBoard.org
RegulatomSpotlight
Scope of Practice Questions concerning use of Musculoskeletal
Ultrasound and the physical therapy practice of cupping
Is Musculoskeletal Ultrasound within the NC PT Scope of
Practice? Can it be used to guide needle placement with
dry needling?
Both the Public Protection Task Force (PPTF) and the Board,
at their respective June 2023 meetings, reconsidered the
Board response in 2019 to the musculoskeletal ultrasound
scope of practice questions. The Board attorney, NC PT
subject matter experts, and CAPTE accredited DPT
programs in NC were consulted. Musculoskeletal
ultrasound (MSK US) scholarly sources were also reviewed.
The Board must consider training and practice
throughout the state for consistency which allows the
Board to meet its legislative mandate of protecting the
safety and welfare of the citizens of NC and establishing
minimum standards for physical therapy practice.
In summary, research by the Board determined only one
of the six CAPTE accredited DPT programs in NC that
responded to the Board inquiry offer instruction beyond
“introducing” or “mentioning” MSK US in their curriculum.
None of the six offers MSK hands-on lab training.
The Board review highlighted the broad nature of the term
MSK US. The term, “ultrasound imaging,” synonymous with
MSK US, was found to be the most descriptive when
considering practical application in physical therapy
practice. Scholarly sources suggested MSK US be further
divided into either two general categories: procedural and
diagnostic; or four descriptive categories: diagnostic,
rehabilitative, interventional, and research.
Board review also emphasized distinct differences in MSK
US and “therapeutic ultrasound;” the latter term referring to
the more traditional, decades-old physical therapy
treatment technique involving the heating of soft tissue.
MSK US, on the other hand, is emerging as a physical
therapy evaluation and treatment imaging tool.
Consequently, there is extensive variability in the
understanding, education, and implementation of MSK US in
physical therapy practice.
Additionally, the FSBPT 2022 Practice Analysis Report
from FlumRRO determined ultrasound imaging of the
musculoskeletal system (and other systems as well) be
“selected for omission from the NPTE Content Outline.”
Results from the 2022 Practice Analysis Report were
“very similar” to the 2016 report. Lastly, while
musculoskeletal ultrasound can be found in continuing
education offerings, it is often not the primary subject
matter taught.
While the Board acknowledges MSK US has promising
research to support its use in physical therapy practice,
none of the information gleaned from extensive review
provides evidence to support a change in the 2019 Board
response. While MSK US categorization was considered
in the Board scope of practice review, the categorization
creates additional complexity and variance.
As stated in the 2019 response, the Board reviews and
makes determinations regarding scope of practice
questions for licensees based, first and foremost, on Board
Rule 21 NCAC 48C .0101 PERMITTED PRACTICE. According
to this rule (a) “Physical therapy is presumed to include any
acts, tests, procedures, modalities, treatments, or
interventions that are routinely taught in educational
programs or in continuing education programs for physical
therapists and are routinely performed in practice settings.”
Therefore, the use of Musculoskeletal Ultrasound for
diagnostic purposes or guiding needle placement during
dry needling is not currently within the scope of physical
therapy practice in North Carolina. Further, clients
receiving this technique should not be advised or led to
believe they are receiving physical therapy.
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