CLINICIAN SERIES: Pneumothorax as a Complication of Dry Needling: What Clinicians Need to Know
Dry needling is a widely used technique among physical therapists to treat musculoskeletal pain by targeting myofascial trigger points. While typically safe when performed by trained practitioners, rare but serious complications like iatrogenic pneumothorax (collapsed lung) have been documented in the literature. Recent research has highlighted both individual case reports and broader surveys that show a need for awareness and caution, especially when needling near the thoracic region.
A 2024 case series published in ERJ Open Research detailed four young women who developed pneumothorax following dry needling around the neck and shoulder. All experienced symptoms such as chest pain and shortness of breath shortly after treatment, with imaging confirming lung collapse. Some required chest tube placement, while others were managed conservatively. This study underscores that although dry needling is minimally invasive, puncturing the pleura is a real risk in high-risk anatomical regions.
Beyond case studies, several large-scale surveys and prospective studies offer perspective on the true incidence of this complication:
What the Data Says: Incidence and Risk
While individual cases may raise concern, the broader data suggests that pneumothorax following dry needling is extremely rare, especially when proper training and technique are followed. Most large studies report either zero or extremely low incidence, even across thousands of treatments.
Here’s a summary of key studies:
Risk Factors and Prevention Strategies
The most common risk areas include:
Upper trapezius
Rhomboid/interscapular region
Thoracic paraspinals
Supraspinatus or scalene regions
Patients with low body fat or small frames may be at higher risk due to less muscle and tissue padding over the lungs.
To minimize the risk of pneumothorax:
Complete advanced training specific to dry needling (not acupuncture).
Always palpate and identify clear anatomical landmarks.
Use shorter needles or oblique angles when treating near thoracic structures.
Clearly explain risks during informed consent, especially for high-risk zones.
CONCLUSION:
Pneumothorax is rare but real. While most dry needling sessions are uneventful, clinicians must be aware of anatomical risks and exercise caution—especially in thoracic regions. Ongoing training, skill refinement, and patient communication are key to making dry needling a safe and effective tool in your practice
DISCLAIMER
This blog post is intended for general informational purposes only and should not be taken as medical advice, diagnosis, or treatment. It is not a substitute for a consultation with a licensed healthcare provider or physical therapist. Additionally, this content is not intended to serve as clinical training or educational material for therapists. Clinicians should always rely on their accredited continuing education courses, scope of practice, and professional judgment when performing any intervention, including dry needling. Reading this post does not establish a patient-provider or professional mentoring relationship with Local Point Physical Therapy or Dr. Christine Kornegay, DPT.