Who You See Matters: Acupuncture vs Dry Needling — What’s Different, What’s the Same, and Why Training (and Virginia Law) Protect Patients
- sarahalemilac
- 3 minutes ago
- 4 min read
A timely reminder: these things are rare — but real
This week, a high-profile athlete was hospitalized after a routine dry-needling session. Pittsburgh Steelers linebacker T.J. Watt underwent surgery for a partially collapsed lung (pneumothorax) following dry needling and is currently recovering. The incident was widely reported by major news outlets, including Reuters.
While cases like this are rare, they are real — and they highlight an important point in healthcare:👉 Who performs your treatment matters.
Pneumothorax following needling of the chest or upper back is a known but infrequent complication. Medical institutions like the Cleveland Clinic describe it as uncommon, yet peer-reviewed case reports confirm that it does occur and should be included in informed consent when needling higher-risk areas.
The takeaway isn’t fear — it’s education. Understanding your provider’s training, experience, and legal scope of practice is one of the most effective ways to reduce risk.
Acupuncture vs dry needling: how they overlap — and where they differ
What’s similar
Both acupuncture and dry needling use very thin, sterile needles inserted through the skin
Both can reduce pain, improve mobility, and support musculoskeletal healing
Both are often used alongside exercise, manual therapy, and lifestyle changes
From the outside, they may look the same — but how and why the needles are used differs significantly.
What’s different
Philosophy & scope of care
Acupuncture originates from Traditional Chinese Medicine (TCM) and is used to treat both local symptoms and underlying systemic imbalances. While acupuncture uses terminology like qi and meridians, it is still a medical system that works with anatomy, neurology, circulation, and connective tissue. Many modern acupuncturists also integrate biomedical assessment and diagnosis.
Dry needling is a Western biomedical technique focused on releasing myofascial trigger points and neuromuscular dysfunction. It is typically symptom-focused and localized to specific muscles.
Both approaches work with the body — they simply describe and interpret it through different clinical frameworks. Acupuncture’s distinguishing feature is its emphasis on identifying and treating the root cause, not just the site of pain.
Conditions treated
Acupuncture: pain conditions, headaches and migraines, insomnia, nausea, stress-related conditions, some women’s health concerns, and more
Dry needling: primarily neuromusculoskeletal and trigger-point-related pain
Training & regulation (the most important difference)
Licensed acupuncturists complete multi-year, standardized education programs followed by national board exams and state licensure.
Dry needling, by contrast, is typically taught as a short post-professional certification for clinicians who already hold another license (physical therapists, chiropractors, physicians). Required hours and oversight vary widely by state.
Training: real numbers patients should know
Licensed Acupuncturists (LAc)
To become licensed, acupuncturists must complete extensive graduate-level education and supervised clinical training — commonly thousands of hours across master’s and/or doctoral programs — followed by national board exams (NCCAOM) and state licensure.
This training includes anatomy, physiology, pathology, safety, and hands-on clinical internships before independent practice.
Virginia-specific regulations
Physicians, DOs, chiropractors, and podiatrists using acupuncture techniquesVirginia law allows these professionals to perform acupuncture-type modalities only after completing a minimum of 200 hours of acupuncture instruction, including at least 50 hours of supervised clinical experience.
Physical therapists performing dry needlingIn Virginia, dry needling is classified as an advanced post-professional skill. Physical therapists must complete specific dry-needling education that includes emergency preparedness, contraindications, complication management, and informed consent. Training requirements are skill-specific rather than standardized nationally, and commonly range from ~25–80 hours.
Title protection matters: Only individuals licensed as acupuncturists may legally call themselves a Licensed Acupuncturist in Virginia.
Important context: A weekend or short-term certification course is not equivalent to a multi-year graduate degree with board exams and supervised clinical training.
Safety, outcomes, and what patients experience
Immediate effects
Pain relief
Improved range of motion
Temporary soreness, bruising, or fatigue
Serious risks (rare, but real)
Infection
Bleeding
Organ puncture, including pneumothorax
Medical institutions emphasize that pneumothorax after needling the neck, shoulders, or chest is uncommon but documented, reinforcing the importance of proper training and risk awareness.
Long-term outcomes
Both acupuncture and dry needling can provide lasting improvement for musculoskeletal conditions when combined with appropriate rehabilitation. Acupuncture also has a broader evidence base across non-musculoskeletal conditions due to its wider scope of practice.
A quick patient checklist (Virginia)
Ask your provider:
How many hours of formal needling training have you completed?
Was your training supervised clinically?
Are you trained to recognize and manage complications like pneumothorax?
Do you needle near the chest or upper back, and what safeguards do you use?
Seek urgent medical care if you experience sudden chest pain or shortness of breath after needling.
A word about perspective — and my training
Although acupuncture and dry needling use different language, both are medical therapies applied to human anatomy and physiology. The difference lies in scope, depth, and philosophy.
Acupuncture is designed not only to treat symptoms, but to identify why they are occurring — addressing the root cause whenever possible.
As a practitioner, my training includes:
3,000 hours of graduate-level education from my master’s degree
1,000 additional hours during my doctoral training
Ongoing mentorship and supervised clinical experience
This depth of education is why I prioritize informed consent, anatomical safety (especially near the thorax and neck), and aligning each patient’s goals with the most appropriate form of care.
Bottom line
Needling therapies are generally safe when performed by well-trained clinicians — but rare complications can happen
Training, licensure, and regulation matter
Patients deserve transparency, education, and the ability to make informed healthcare decisions
When it comes to needling, the question isn’t just “Does it work?” — it’s “Who is doing it?”
