On behalf of Bluebird Acupuncture, Inc. and our licensed acupuncturists, we respectfully oppose the proposed amendment to 18VAC85-120-110, which seeks to grant licensed athletic trainers the authority to perform dry needling following training and physician screening.

Dry needling is an invasive procedure involving the insertion of filiform needles into myofascial trigger points and other soft tissue structures to relieve pain and dysfunction. While it is often distinguished from acupuncture in terminology, the technique is fundamentally identical to acupuncture as defined in traditional and contemporary medical practice. Allowing athletic trainers—who do not possess the requisite education, clinical training, or licensure in acupuncture—to perform this procedure poses significant risks to public health and safety.

Concerns Regarding Patient Safety & Proper Training

1. Insufficient Training Standards: Athletic trainers undergo extensive training in musculoskeletal assessment and rehabilitation, but their education does not include the rigorous study of needling techniques, pulse diagnosis, acupuncture points, meridian theory, or safety protocols for needle insertion that licensed acupuncturists undertake. The proposed amendment does not specify adequate training standards to ensure the safe and effective practice of dry needling by athletic trainers.
2. Risk of Injury and Infection: Improper needling techniques can result in serious complications and life-threatening incidents, including nerve damage, pneumothorax, infection, and excessive bleeding. Licensed acupuncturists in the state of Virginia undergo a minimum of 1,900 hours of comprehensive training, including needle insertion safety, sterilization techniques, and extensive supervised clinical practice. The proposed amendment does not ensure equivalent or sufficient training standards for athletic trainers to mitigate these risks.
3. Lack of Regulatory Oversight: The practice of acupuncture, including dry needling, is prescribed under Virginia law and regulated by the Board of Medicine’s acupuncture regulations. Allowing athletic trainers to perform dry needling under a separate regulatory structure, without the same rigorous oversight required of licensed acupuncturists, creates a dangerous precedent that compromises patient safety. Licensed acupuncturists in Virginia also maintain national board certification that further ensures patient safety with ongoing recertification requirements and a national ethics and disciplinary review process.

Legal & Professional Scope of Practice Issues

1. Violation of Scope of Practice: Athletic trainers are not currently authorized under Virginia law to perform invasive procedures involving needle insertion. Expanding their scope of practice to include dry needling would require clear legislative action (similar to physical therapists in § 54.1-3482), rather than a regulatory amendment, to ensure proper accountability and public protection. The side-by-side definitions (§ 54.1-2900) of the practice of acupuncture and the practice of athletic training clearly delineate the use of needles for acupuncturists and not athletic trainers. 
2. Public Misperception and Consumer Confusion: Patients seeking dry needling may not be fully aware of the differences in training and qualifications between licensed acupuncturists, physical therapists and athletic trainers. This amendment could lead to consumers receiving treatment from inadequately trained practitioners, thereby undermining public trust in regulated healthcare professions.

Given the substantial risks associated with inadequate training, the potential for patient harm, and the need to uphold professional standards in healthcare, Bluebird Acupuncture, Inc.strongly  opposes the proposed amendment to 18VAC85-120-110. We urge the Board to reject this petition and uphold the current regulatory framework, which ensures that invasive needling procedures remain within the scope of appropriately trained and licensed healthcare providers.