Pneumothorax and Dry Needling

In December 2025, Pittsburgh Steelers star linebacker TJ Watt reportedly suffered a pneumothorax (collapsed lung) following a dry needling session. Watt developed chest pain and shortness of breath after treatment and was later diagnosed with a pneumothorax, requiring surgery. The incident drew national attention to the safety of dry needling, a few patients even reached out to me about it.
While we may never know exactly what happened, a teammate was quoted as saying he would “rather get acupuncture than dry needling after seeing what happened,” which leads me to believe the practitioner was a non-acupuncturist - likely a physical therapist or even a medical doctor. Cause for acknowledging not all needling practitioners are the same.
Dry needling and acupuncture both use thin, solid needles, but are often framed as completely different modalities. The reasons for this distinction are generally about finding ways to avoid completing acupuncture educational requirements for licensure. Dry needling outside of New York State is often performed by physical therapists or other manual therapists who complete relatively short, add‑on courses focused on releasing myofascial trigger points and tight bands of muscle to reduce pain and improve movement. 
Acupuncture, in contrast, is a full medical system within East Asian medicine, practiced by licensed acupuncturists who receive thousands of hours of dedicated training. They use needling based on meridians, specific acupuncture points, and a broader diagnostic framework that considers the whole person, not just a single muscle or pain area. As a result, while the tools may look similar, acupuncture generally involves more extensive, standardized education in safe, precise needling than most short-course dry needling programs.
Risk of Pneumothorax: Overall Low, But Real
Pneumothorax is a known, though rare, complication of any needling procedure that penetrates tissues near the lungs, including injections, biopsies, acupuncture, and dry needling. The mechanism is straightforward: if a needle passes too deeply through the muscles between the ribs or around the upper back and neck, it can puncture the pleura and allow air into the chest cavity, causing partial or complete collapse of the lung.
Published data suggest that:
The overall risk of pneumothorax from acupuncture is very low, with large surveys over millions of treatments reporting incidences on the order of a few cases per million sessions.
For dry needling, high-quality, large-scale incidence data are more limited, in part because it is a newer and more variably regulated practice. Case reports and small series do document pneumothoraces, especially when needling in the upper trapezius, thoracic paraspinals, and chest wall.
Training and Safety: Licensed Acupuncturists vs. Short-Course Dry Needlers
A key issue raised by this incident is who is doing the needling and how they were trained. Licensed acupuncturists (L.Ac.) in the United States typically complete:

• 2,000–3,000+ hours of graduate-level education, including:
• Hundreds of hours in anatomy, physiology, and pathology
• Extensive, supervised clinical practice in needling
• Detailed instruction on depth, angle, and contraindications for specific body regions, including the thorax
• National board exams and state licensure, often with continuing education requirements focused on safety and competence.

Non-acupuncturist dry needlers (e.g., many physical therapists, chiropractors, or other professionals) often:

• Hold strong primary clinical credentials, but with much shorter supplemental training in needling—sometimes as little as 20–80 hours spread over weekend courses.
• May have less structured, supervised clinical exposure specific to needling around high-risk areas such as the chest, neck, and upper back.
• Practice under variable state regulations; in many regions, dry needling standards (hours, content, assessment of competency) are not as clearly defined or enforced as acupuncture licensure.

While many non-acupuncturist clinicians practice dry needling safely, the discrepancy in dedicated needling education is significant. In a procedure where millimeters can separate a safe insertion from a potentially serious complication, depth of anatomical and procedural training matters.
Reducing Risk: Why Practitioner Background Counts

• Both acupuncture and dry needling can be practiced safely when performed by clinicians who:
• Understand detailed regional anatomy, especially near the lungs
• Are trained to adjust needle depth and angle based on body habitus and clinical situation
• Recognize early signs of complications and respond appropriately

Licensed acupuncturists, whose entire profession centers on safe, precise needling, generally receive more comprehensive and standardized training in these areas than practitioners whose primary discipline is unrelated to needling and who rely on short courses to acquire those skills.
The Steelers player’s pneumothorax will likely spur further scrutiny of dry needling protocols in professional sports. For athletes and the public, a reasonable takeaway is not to fear all needling, but to:

• Ask about the practitioner’s specific training in needling, not just their primary license
• Be especially careful with any needling around the chest, neck, and upper back
• Consider choosing a licensed acupuncturist—particularly when regular or more complex needling is planned—because of their depth of training and long-established safety standards.

Pneumothorax from needling remains rare, but the visibility of this incident underscores an important point: in invasive procedures, even minimally invasive ones, the quality and focus of a practitioner’s training are central to patient safety.