Dry needling
What it is, how it works, and what every patient should know before booking a session
In December 2025, Pittsburgh Steelers linebacker T.J. Watt underwent surgery to repair a partially collapsed lung, a pneumothorax, after a dry needling session at the Steelers’ practice facility. The story made national headlines and left a lot of patients asking a reasonable question: is this safe?
The short answer is yes, when performed by a practitioner with adequate training and experience. The longer answer is that “adequate training” varies enormously depending on who is holding the needle. That gap is worth understanding before you book a session.
What is dry needling?
Dry needling is a technique in which a thin, solid filiform needle, the same used in acupuncture, is inserted directly into muscle tissue to release trigger points, reduce pain, and restore normal muscle function. The term “dry” simply means no substance is injected. The needle itself is the therapeutic tool.
The targets are myofascial trigger points: the tight, tender knots in muscle tissue that refer pain to other areas of the body and restrict movement. You may know them as the spot in your neck that sends pain down your arm, or the tension in your calf that contributes to your plantar fasciitis. When a needle contacts an active trigger point, it often produces what practitioners call a local twitch response, a brief involuntary contraction of the muscle. That response is a sign the trigger point has been engaged and is beginning to release.
The technique has been used safely for decades. While the term “dry needling” is relatively new, the practice of myofascial needling is not. Its modern clinical roots trace directly to the work of Dr. Janet Travell and Dr. David Simons, whose collaboration produced the most comprehensive mapping of trigger points and their referred pain patterns ever published. Travell, who served as White House physician for President John F. Kennedy, began the work using injected anesthetics. Simons, an aerospace medicine physician and researcher, brought scientific rigor to the project, and together they authored the two-volume Myofascial Pain and Dysfunction: The Trigger Point Manual, which remains the definitive clinical reference in the field. The roadmap Travell and Simons created for understanding myofascial pain became the foundation for the needle-only technique we now call dry needling.
The deeper history most people don’t know
Much of the modern dry needling conversation overlooks the fact that Chinese medicine has been needling at the site of pain for well over two thousand years. The classical texts describe a category of points called ashi points, a term that translates roughly as “that’s it” or “that’s where it hurts.” These are not fixed, mapped locations on a meridian chart. They are points selected based on palpation, on where the practitioner’s hands find tension, restriction, or tenderness in the tissue. The concept appears in the Huangdi Neijing, the foundational text of Chinese medicine, and has been central to clinical practice ever since.
Ashi point needling is, in essence, the original trigger point therapy. The principle is the same: find where the body is holding, needle it, release it. Chinese medicine was doing this long before Travell and Simons mapped referred pain patterns in Western anatomical terms, and skilled acupuncturists have been integrating both traditions for decades.
Over time, a number of graduate-level acupuncture programs developed clinical frameworks that brought these two traditions together, combining Travell and Simons’ trigger point mapping with the ashi point tradition and rigorous acupuncture needling technique. These programs trained practitioners specifically in myofascial approaches, with extensive laboratory hours, supervised clinical practice, and the internalization of myofascial anatomy as a diagnostic skill set. It is this tradition I trained in.
Who performs dry needling, and does training matter?
In Maine and across most of the United States, dry needling is performed by licensed acupuncturists, physical therapists, chiropractors, and some physicians. What varies significantly, and what patients rarely think to ask about, is the depth and breadth of training behind the credential.
Licensed acupuncturists complete a graduate-level program of three to four years with a minimum of 2,000 hours of training, including extensive supervised clinical hours, laboratory practice, and in-depth study of anatomy, needling technique, and the management of adverse events. Needling is the entire foundation of the profession. For acupuncturists who trained specifically in myofascial and trigger point approaches, dry needling is not an add-on skill. It is central to how they were trained from day one.
Board-certified acupuncturists holding a Diplomate credential from the National Certification Board for Acupuncture and Herbal Medicine (NCBAHM), formerly the NCCAOM, have met the most rigorous national standards in the field.
Physical therapists who practice dry needling typically complete post-graduate certification courses. Many of these programs range from 30 to 50 hours to achieve some form of dry needling certification. Dry needling is one technique within a much broader PT scope of practice, and the prerequisite is a physical therapy degree, not needle-specific training.
This matters. As the American Academy of Medical Acupuncture, the premier North American organization of physician acupuncturists comprising MDs and DOs, states in their position paper on dry needling: the technique frequently involves needling close to sensitive structures like blood vessels, nerves, and organs such as the lungs. Adverse effects include bruising, hematoma, infection, nerve and vascular injuries, and pneumothorax. Practitioners must be competent to recognize and manage all possible adverse effects. An ill-trained practitioner could cause substantial medical injury or even death.
The AAMA further notes that dry needling has traditionally been performed by physician acupuncturists and licensed acupuncturists, who have advanced training in the technique and the management of potential adverse effects. This is not a statement from an acupuncture advocacy group. It is a statement from an organization of medical doctors.
What the T.J. Watt incident actually tells us
Watt’s pneumothorax, and the lesser-known 2013 case of Olympic skier Torin Yater-Wallace, who suffered the same injury and re-collapsed his lung after returning to competition too quickly, are not reasons to avoid dry needling. They are reminders that practitioner training matters.
Pneumothorax occurs when a needle penetrates too deeply or at an incorrect angle near the thorax, the upper back, chest wall, or neck, where the lungs sit close to the surface. It is not a random complication. It is almost always the result of a technical error: a miscalculation of depth, an incorrect needle angle, or a failure to recognize the anatomical risk of a particular region. A 2024 case series published in ERJ Open Research documented four patients who developed pneumothorax following dry needling around the shoulder, trapezius, and neck, all treated by physiotherapists in outpatient settings. The authors concluded that post-dry needling pneumothorax is not as rare as the literature has suggested, and that informed consent should explicitly mention it as a considerable risk of needling in those regions.
Procedural skill, the kind that lives in the hands rather than the head, requires a different kind of learning than coursework. It develops through repetition, feedback, and time. Fine manual dexterity, spatial anatomy, real-time tissue assessment: knowing what you are feeling as the needle moves through different layers of tissue, knowing when to stop. These are not skills that develop in a weekend course. They develop over years of supervised practice, repeated clinical exposure, and the gradual internalization of anatomical maps until the hands become diagnostic instruments in their own right.
The Steelers have not disclosed who performed Watt’s treatment or under what credentials. That detail matters. What we do know is that the upper back and thorax are among the highest-risk regions for needling complications, and that technical errors in those regions are strongly associated with insufficient anatomical training.
What conditions respond well to dry needling?
Myofascial needling has a well-established track record with musculoskeletal and pain conditions. Neck and shoulder pain, including rotator cuff issues and chronic tension, responds well. So does lower back pain and sciatica, hip and IT band tightness, and knee pain including patellar tendinopathy. Plantar fasciitis, Achilles tendinopathy, tennis and golfer’s elbow, jaw pain and TMJ dysfunction: these are conditions where myofascial restriction is often the primary driver, and where releasing that restriction produces meaningful change.
The work extends beyond isolated musculoskeletal complaints. Tension headaches and certain migraines have significant myofascial components, particularly in the neck, suboccipital muscles, and jaw. Post-surgical recovery, scar tissue release, and chronic overuse conditions in athletes are also areas where myofascial needling is consistently useful.
I have also used myofascial needling in clinical settings treating medically complex patients, including inpatient rehabilitation for spinal cord injury, brain trauma, and stroke. Patients recovering from these conditions often present with significant hypertonic musculature and spasticity. Skilled needling can be an important tool in supporting their rehabilitation. In those environments, where patient vulnerability is at its greatest, the margin for technical error is essentially zero.
What does a session feel like?
Most patients are surprised by how little they feel. The needle is far thinner than a hypodermic needle. Insertion is typically painless, or produces only a mild sensation.
When a trigger point is contacted, you may feel a brief muscle twitch, a dull ache, or a momentary sensation of pressure or warmth. This is the local twitch response. It passes within seconds. Some patients feel immediate relief after the session. Others notice mild soreness for a day or two, similar to the feeling after deep tissue work. That is a normal tissue response. It resolves.
Questions worth asking before you book
Regardless of a practitioner’s professional background, these are reasonable questions to ask: How long have you been performing dry needling or myofascial needling? What was your training, and how many hours did it involve? How many patients have you treated with this technique? What experience do you have with my specific condition? How do you approach needling in higher-risk regions like the neck and upper back?
A practitioner who is skilled and confident in their training will welcome these questions. A practitioner who is defensive about them is telling you something.
A note on results
Dry needling is not a one-session fix for most chronic conditions. Trigger points that have been present for months or years often require multiple sessions to fully resolve, and the movement patterns or postural habits that created them need to be addressed alongside the needling work. If you want to understand what progress looks like and how to track it, this is worth reading before your first appointment.
Many patients notice meaningful improvement within the first few sessions, sometimes immediately. If you are not experiencing any change after three to four treatments, that is worth discussing openly with your provider.
If you’re curious whether this is what your body needs, your first visit is where we find out.
Sharon Sherman, MSOM, Dipl. AHM (NCBAHM), L.OM., L.Ac., has practiced myofascial needling since 2001, including more than a decade treating patients recovering from spinal cord injury, brain trauma, and stroke at a major rehabilitation hospital in Philadelphia.