12/20/2025
With recent media coverage of an NFL player who sustained a pneumothorax following dry needling, I’ve received an increase in questions and concerns from both current and prospective patients. This provides an opportunity to clarify the facts and place the risk in proper context.
There is ongoing debate between some acupuncturists and dry needling practitioners, often centered on training length and safety. It is true that acupuncturists undergo longer, more standardized training specifically in needling techniques. Dry needling education, by contrast, varies by state and country. However, training alone does not inherently make one approach safer—the two disciplines are fundamentally different.
Training Pathways
Acupuncture
• Typically requires a bachelor’s degree followed by a 3–4 year Master’s degree in Acupuncture or Oriental Medicine
• National certification and state licensure are required
• Ongoing continuing education is mandated
Dry Needling
• Requires a healthcare degree prior to training, including physical therapists, chiropractors, and medical doctors
• Physical therapists complete a bachelor’s degree followed by a 3-year clinical doctorate (DPT) with extensive education in anatomy and physiology
• National and state licensure are required, with ongoing continuing education
• Dry needling coursework is completed post-licensure, and many states require supervised practice hours before independent use
While acupuncture training is longer and more standardized in needling itself, dry needling is taught to clinicians who already possess advanced medical education and clinical decision-making skills. The training emphasis is different—not inferior.
Techniques (Brief Overview)
• Acupuncture involves inserting monofilament needles at specific points, often along meridians, typically at shallower depths.
• Dry needling involves inserting monofilament needles into myofascial tissue at variable depths to address neuromusculoskeletal pain and dysfunction.
Both disciplines are trained to avoid vital organs, though neither completely avoids anatomical regions where vital structures are present.
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Safety and Pneumothorax (collapsed lung) Risk
Both acupuncture and dry needling carry risks of adverse events, including rare serious complications such as pneumothorax. Both are considered safe when performed by trained, experienced practitioners.
Estimated pneumothorax risk based on available literature:
• Acupuncture: ~0.001%
• Dry needling: up to ~0.1%, with most estimates well below this threshold
While dry needling may carry a slightly higher risk, this is largely attributable to technique and depth, as dry needling may intentionally target deeper structures in certain regions. Importantly, the absolute risk remains extremely low.
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Risk in Perspective
To contextualize these numbers:
• Serious complication from dry needling:
