I am writing to express my support for the approval of athletic trainers performing dry needling. Athletic trainers are considered a certified health care professional who need at least 6 years of higher education (4 years of undergrad + 2 years of masters). Athletic Trainers are extensively trained in musculoskeletal anatomy, injury management, and clinical decision-making. To be a certified Athletic Trainer, one must complete a minimum of a master’s degree in athletic training through an accredited program by the board of certification for the Athletic Trainer (BOC). Additionally, Athletic Trainers must be licensed through the Virginia Department of Health Professions. Athletic Trainers are highly qualified health care professionals who provide service and treatment, under the direction and in collaboration of a physician. Athletic trainers are able to do emergency IV’s, lidocaine administration through injection, and suturing as the curriculum standard on any accredited program. This means that athletic trainers are thought to safely break the skin with more invasive procedures.

Acupuncture is a traditional Chinese medicine technique. It focuses specific points on the body, called acupoints, connected to the flow of energy focusing on clearing up meridians in the body. By inserting needles into specific points along these meridians, acupuncture practitioners believe that your energy flow will re-balance. Acupuncture is used to treat various conditions/ diseases including pain, headaches, stress, and many other general medical conditions. Acupuncture originating from China 2000 years ago, and since then medicine has evolve.

In contrast, Western medicine has a different point of view on how to use microfilament needles to ONLY treat musculoskeletal conditions, NOT general medical conditions. Needle insertion creates substantial mechanical stress on connective tissues, primarily collagen fibers. This initiates mechanotransduction (the conversion of mechanical stimuli into cellular responses). The sensation felt during needle insertion reflects this strong mechanical interaction. Mechanotransduction activates fibroblasts and other cells via focal adhesions. Intracellular signaling pathways (e.g., Rho/Rac GTPase) are activated. This leads to alterations in cytoskeletal dynamics and increased metabolism of cells in the area (muscle, fibroblast, collagen, etc.). This stimulation boosts your body's natural painkillers.

Muscle tightness, strains, sprains, an overworked body needing recovery, muscle activation, swelling reduction and pain modulation are all clinical examples for the use of dry needling. As athletic trainers we work with active individuals and we are trained to prevent, assess, diagnose, and treat SPORTS INJURIES. Dry needling would allow the Athletic Training profession to provide better care/treatments to our patients by being able to specifically target a muscle or body part.

As an athletic trainer that is dry needle certified, we use needle insertion points as places to stimulate nerves, muscles and connective tissue. If athletic trainers are allowed to dry needle, we would do it under a physician’s order, and we would use dry needling for only sports related injuries. If I’m treating a complicated case, I would refer my patient to a more qualified professional. Athletic trainers work in conjunction with Physicians, Chiropractors, and Physical therapist, so it’s a collaborative effort to have the best medical care. In my experience working in NCAA Division I sports, having a quick and effective treatment is very important. It can make the difference on an athlete’s performance. Instead of making an appointment and having to wait multiple days/ weeks to have a Physical Therapist or Chiropractor dry needle an athlete, it can be done right away in the training room if athletic trainers can do it. We don’t typically refer athletes to acupuncturist unless our team physician think it’s needed. It would be more efficient and would allow schools to save money and paperwork. With how NCAA sports have evolved now a days the demands of our athletes have increased, there are more games with less recovery time, seasons are longer, and roster sports have been decreasing. Athletic trainers must adjust and find better ways to help the recovery process, otherwise most teams would struggle to end the season in a healthy manner. Dry needling would be a very impactful modality for athletic trainers. As a certified athletic trainer that is also certified to dry needle, we are taught to use standard precautions, use of barriers (acupuncturist do not use gloves when inserting needles), and safe injection practices when you take the certification course. Additionally, there are different type of certification for dry needling. For example, the certification I have is Foundations in Dry Needling for Orthopedic Rehab and Sport Performance (SFDN1). It’s a course that only focuses on orthopedic conditions and sport performance. I took the certification course with Physical Therapists, Chiropractors and other athletic trainers. I am not trained to treat any conditions in the thoracic region (where the damage to vital organs can be done). I would have to take an advance course such as “Advanced for Orthopedic Rehab and Sport Performance (SFDN2)” or “Craniofacial and Upper Quarter Dysfunction (CUQ)” or “Lumbo-Pelvic-Hip Complex for Sport Performance (LPH)” or “Pelvic Health (PH)”. As you can see, depending on what certification you take, athletic trainers and other health care professions will perform dry needling in what they are trained for and will stay in their scope of practice.

Medicine is evolving every day and as health care providers, it is our job to stay updated and maintain competence and learn about new and developing areas of sports medicine. Athletic trainers need 50 CEUs every 2 years (that’s more that most health care professions because we treat a wide variety of conditions). Dry needling is a technique that multiple professions use on a day-to-day basis. There are multiple modalities that can be used with different professions with the proper training. We need to put aside our differences as health care professionals, no treatment is owned by a specific profession. Just like Homeopathic and Naturopathic physicians and acupuncturists all prescribe herbs; Physical Therapists, Chiropractors, and Osteopaths all perform manipulation; and Athletic Trainers, Physical Therapists, and Chiropractors all use tape, exercise and physical agent modalities. All health care professions need to work together in order to provide the best evidence-based practices. That’s why athletic trainers need to be allowed to dry needle.

Sincerely,

Diego Guerron, MS, LAT, ATC, DN-1