I read every comment here as of 8am on 4/24/25. There are many with misconceptions as to who and how Athletic Trainers are educated. Prior to commenting, I did further research into the education of Accupuncture. Both Athletic Trainers and Acupuncture are licensed by the Virginia Board of Medicine, both require continuing education (although different amounts - AT requires 50 hours every 2 years; acupuncture requires 60 hours every 2 years). I read many comments that listed the hours needed for acupuncture - between 1800-2000, although a significant percentage of those hours are for herbology and other aspects of acupuncture, while not a bad thing, it isn't pertaining to the question at hand. Athletic Trainers are required to complete a nationally accredited, Master’s level, education program  and pass a national certification exam (BOC). This program is based on the medical model with significant hands on learning. 

Athletic Trainers are asking for dry needling for musculoskeletal injuries in the active population, not to be acupuncturists. Athletic trainers have extensive training in anatomy, physiology, kinesiology, evaluation, treatment and rehabilitation, plus emergency care. In Virginia, Athletic trainers are allowed invasive procedures, including IV access, lidocaine injection, sutures & staples, as well as vaccine injections during COVID19. There is an overlap of skills between Athletic Trainers and acupuncturists, just as there is an overlap of skills between many medical providers. As healthcare evolves, we need to assess and adapt to the needs of patients.

I have included a friend's note below for more information:

Dry needling has emerged as a valuable therapeutic technique in the management of musculoskeletal pain and dysfunction. As healthcare evolves, it’s imperative to assess and adapt scopes of practice to meet patient needs effectively. I support the inclusion of dry needling within the athletic training scope of practice in Virginia.  The Virginia State leadership and public should review the comprehensive education, training, and clinical competencies of ATs.  By fulling understanding these components, you may also support this change. 

Understanding Dry Needling

Dry needling involves the insertion of fine, filiform needles into myofascial trigger points, muscles, and connective tissues to alleviate pain and improve function. Distinct from acupuncture, which is rooted in traditional Chinese medicine, dry needling is based on Western anatomical and neurophysiological principles. It’s a technique utilized by various healthcare professionals to address musculoskeletal issues.

Educational Foundation of Athletic Trainers

Certified Athletic Trainers possess a robust educational background that equips them for various clinical interventions:

• Academic Requirements: ATs are required to obtain a master’s degree from an accredited program, encompassing extensive coursework in anatomy, physiology, kinesiology, and therapeutic interventions.

• Certification: Post-graduation, ATs must pass the Board of Certification (BOC) examination, ensuring proficiency in five domains: injury/illness prevention, clinical evaluation and diagnosis, immediate and emergency care, treatment and rehabilitation, and organizational and professional health and well-being.

• Clinical Experience: ATs undergo rigorous clinical rotations, gaining hands-on experience in diverse settings, from sports teams to healthcare facilities.

This comprehensive education ensures that ATs are well-versed in musculoskeletal anatomy, pathology, and therapeutic techniques, laying a solid foundation for integrating dry needling into their practice.

Clinical Competence and Scope of Practice

Athletic Trainers are adept at various clinical procedures that involve skin penetration and tissue manipulation:

• Wound Care: ATs are trained in wound assessment, cleansing, debridement, and dressing, ensuring optimal healing and infection prevention.

• Injection Administration: During the COVID-19 pandemic, many ATs were instrumental in vaccine administration, demonstrating their competence in needle-based procedures under strict aseptic techniques.

• Emergency Care: ATs are proficient in emergency response, including airway management, hemorrhage control, and immobilization, showcasing their ability to perform invasive procedures under pressure.

Given these competencies, integrating dry needling into the AT scope aligns with their existing skill set and clinical responsibilities.

Regulatory Landscape and Precedents

Several states have recognized the capability of ATs to perform dry needling:

• West Virginia: The state permits ATs to perform dry needling under specific educational and supervisory conditions, acknowledging their proficiency in musculoskeletal care.

• Maryland: Legislation allows ATs to perform dry needling upon completion of approved training, reflecting trust in their clinical judgment and skills.

These precedents highlight a growing recognition of the role ATs can play in delivering dry needling services, ensuring patient access to comprehensive musculoskeletal care.

Patient Safety and Public Protection

Ensuring patient safety is paramount. Incorporating dry needling into the AT scope can be achieved with stringent safeguards:

• Standardized Training: Mandating completion of accredited dry needling courses that cover anatomy, technique, contraindications, and emergency procedures.

• Certification and Competency: Requiring demonstration of proficiency through practical assessments and continuing education.

By implementing these measures, Virginia can ensure that ATs provide safe and effective dry needling services.

Addressing Concerns and Misconceptions

Some opposition to expanding the AT scope includes concerns about:

• Overlap with Other Professions: While dry needling is utilized by various professionals, the focus should be on patient access and outcomes. Collaborative practice enhances care quality.

• Training Adequacy: As outlined, ATs possess a strong educational foundation. Supplementary dry needling training can bridge any gaps, ensuring competence.

• Regulatory Oversight: Establishing clear guidelines and oversight mechanisms will maintain high standards and accountability.

By addressing these concerns proactively, Virginia can facilitate a smooth integration of dry needling into athletic training practice.

Certified Athletic Trainers in Virginia are well-equipped, both educationally and clinically, to incorporate dry needling into their scope of practice. Doing so would enhance patient access to effective musculoskeletal care, promote interdisciplinary collaboration, and uphold high standards of safety and efficacy. It’s time for Virginia to recognize and leverage the full potential of its athletic training professionals in meeting the evolving healthcare needs of its population

I fully support Athletic Trainers access to dry needling with well established guidelines as has been done with other medical professions in Virginia (ex. PT).