T.J. Watt Injury Highlights Dry Needling Risks
Pittsburgh Steelers star T.J. Watt recently required surgery for a collapsed lung after a dry needling session at the team’s practice facility. While this type of complication is rare, it highlights an important conversation about training, safety, and the significant differences between licensed acupuncturists and practitioners who perform dry needling.
As an acupuncturist, I believe it’s crucial that patients understand these differences to make informed decisions about their care.
Training Requirements: Acupuncturists vs. Dry Needling Practitioners
What Training Do Licensed Acupuncturists Receive?
In California, licensed acupuncturists must complete a minimum of 3,000 hours (2,050 theoretical hours and 950 clinical hours) through a Board-approved master’s or doctoral degree program, or 3,798 hours through a tutorial/apprenticeship program. This extensive education includes:
- Comprehensive study of anatomy and physiology (350 hours in basic sciences)
- Training in East Asian Medicine principles, theories, and treatment (1,255 hours, including 450 hours in herbs)
- Clinical medicine, patient assessment, and diagnosis (240 hours)
- Clean Needle Technique (CNT) certification with both written and practical exams
- Extensive supervised clinical practice (950 hours minimum)
- National board certification through the National Certification Board for Acupuncture and Herbal Medicine (NCBAHM)
- Passing the California Acupuncture Licensing Examination (CALE)
- Ongoing continuing education (50 hours every two years) to maintain licensure
Most licensed acupuncturists in California have earned a master’s or doctoral degree, completing a rigorous 3-4 year program that far exceeds the training of any dry needling certification.
Dry Needling Certification and Training Overview
In contrast, dry needling training requires a minimum of only 24 hours of face-to-face course study. The training landscape for dry needling is notably different:
- Courses typically last 27 hours over three days, with no prerequisites required
- Training duration ranges from 14 hours to 2 years, with some courses requiring no medical background at all
- No standardized national certification or regulatory body exists
- There is no requirement for extensive training, and no regulatory agency controls training, licensing, or supervision for the procedure
Many physical therapists, who are highly trained in their own profession, receive their dry needling education through weekend certification courses, which is vastly different from the years of needling-specific training acupuncturists undergo.
Acupuncture vs. Dry Needling: What Safety Data Shows
Both acupuncture and dry needling are generally safe when performed properly. However, the data reveals important distinctions.
Is Acupuncture Safe? Statistics and Research
Research on acupuncture safety is extensive:
- Serious acupuncture-related adverse events are rare, occurring at a rate of approximately 1.01 per 10,000 patients
- A British review of 66,229 treatments between 1998-2000 found zero serious adverse events
- Meta-analyses suggest at least one adverse event occurring in 9.31% of patients, with most being minor issues like mild bleeding or bruising
What Are the Safety Risks and Adverse Event Rates of Dry Needling?
The safety data for dry needling is more limited:
- A study of 20,464 dry needling treatments found that 36.7% resulted in a minor adverse event, with bleeding (16%), bruising (7.7%), and pain during needling (5.9%) being the most common
- Major adverse events occurred at a rate of less than 0.1%, or approximately 1 per 1,024 treatments
- High-quality data regarding adverse events associated with dry needling are lacking, with most literature based on patient or physician surveys and case reports
Pneumothorax from Needling: Understanding the Risk
Pneumothorax (collapsed lung) is the most frequently reported serious complication for both practices:
- A prospective study found that two out of nearly 230,000 patients reported pneumothorax after acupuncture treatment
- In Belgium, researchers documented four cases of pneumothorax after dry needling in one university hospital over just 15 months, with at least three different physiotherapists involved
- Even though the chances of pneumothorax are slim, patients must be informed of potential risks, including chest pain, tightness, fatigue, or shortness of breath during procedures involving the chest and shoulder areas
Why is Proper Training in Dry Needling Critical?
The lack of regulation in dry needling may lead to great variety in quality of care. When needles are inserted into the body, particularly near the thorax (chest area), understanding anatomy at a deep level is essential.
Licensed acupuncturists complete thousands of hours of rigorous, supervised training in needling technique, anatomy, physiology, and safety. This extensive preparation helps ensure practitioners can:
- Accurately assess anatomical landmarks
- Understand depth of needling relative to underlying structures
- Recognize and manage complications immediately
- Make informed clinical decisions about when needling is or isn’t appropriate
How to Choose Between Acupuncture and Dry Needling Providers
I want to be clear: many dry needling practitioners are skilled, conscientious healthcare providers who help their patients effectively. However, as patients, you deserve to know about the training differences when choosing a provider who will be inserting needles into your body.
When considering needle therapy, consider asking your provider:
- What is your specific training in needling techniques?
- How many hours of needling education have you completed?
- How many patients have you treated with this technique?
- What is your protocol for managing complications?
- Are you licensed or certified specifically in needling therapies?
Acupuncture vs. Dry Needling: Final Thoughts on Safety and Training
Whether you choose acupuncture or dry needling, your safety should always be the priority. The American Medical Association considers dry needling an invasive procedure and states that only practitioners with specialized training and licensing in safe needle use should perform it.
Licensed acupuncturists bring years of specialized education, extensive supervised clinical training, and ongoing professional oversight to their practice. This comprehensive preparation is specifically designed to ensure patient safety when performing the complex task of inserting needles into the human body.
If you’re experiencing pain or musculoskeletal issues, know that licensed acupuncturists are thoroughly trained to help. We’re here to provide safe, effective care backed by thousands of hours of specialized education in the art and science of needling therapy.
Have questions about acupuncture or wondering if it might be right for you? Feel free to reach out—I’m always happy to discuss how we can support your health and wellness goals.
Frequently Asked Questions on Comparing Licensed Acupuncturists to Dry Needling Practitioners
Is dry needling the same as acupuncture?
Yes — and no. Yes, dry needling uses the same type of needles and many of the same anatomical points that come from traditional acupuncture and Chinese medicine. Historically, needling of muscles and trigger points has long existed within the acupuncture tradition. No, dry needling as it’s practiced today is not acupuncture as a medical system. It was appropriated from Chinese medicine, renamed, and reframed within a Western musculoskeletal model that focuses on local tissue and trigger points rather than meridians, pattern diagnosis, or whole-body regulation.
How much training do dry needling practitioners receive compared to licensed acupuncturists?
Licensed acupuncturists in states like California complete over 3,000 hours of education and clinical training. In contrast, dry needling courses may require as few as 24 hours of instruction, with no national certification or oversight, leading to significant differences in experience and safety protocols.
Can dry needling cause serious side effects like a collapsed lung?
Yes. While rare, complications such as pneumothorax (collapsed lung) can occur, especially when needling is done near the chest. This underscores the importance of choosing a practitioner with in-depth anatomical training, like a licensed acupuncturist.
