Dry Needling vs Acupuncture: What’s the Difference (and What Really Happened With T.J. Watt’s Injury?)
- Stella de Stefanis
- Dec 20, 2025
- 6 min read
Updated: 2 days ago
When it comes to therapeutic needling, two terms get used a lot - dry needling and acupuncture. Both involve very thin needles, but they are grounded in entirely different philosophies, techniques, and goals. Recent headlines about NFL star T.J. Watt suffering a partially collapsed lung following a dry needling session have left many people with questions: What is dry needling? How is it different from acupuncture? And how could a tiny needle cause such a serious injury?
In this article, we break it down in a clear way so you can understand these therapies and make informed choices about your care.
What Is Dry Needling?
Dry needling is a Western clinical technique used mainly by physical therapists, athletic trainers, and other musculoskeletal specialists. Practitioners insert solid, thin needles directly into myofascial trigger points - tight bands or knots in muscle that can contribute to pain, stiffness, and limited movement. The purpose isn’t to inject medicine (hence “dry”), but to release muscle tightness, improve blood flow, and decrease pain.
Dry needling has become especially common in sports medicine and rehabilitation settings because it can offer targeted relief for sore or overactive muscles when performed safely by trained providers.
What Is Acupuncture?
Acupuncture originates from Traditional Chinese Medicine (TCM) and dates back thousands of years. Instead of focusing solely on muscle trigger points, acupuncture targets specific acupoints along meridians, which are believed in TCM to be energetic pathways that influence the flow of Qi (vital energy).
Licensed acupuncturists study TCM theory, diagnostics (including pulse and tongue) and customized treatment plans that often address whole-body balance, not just localized pain. Acupuncture can be used for pain, but also for stress, digestion, sleep, immunity, and more - making it a holistic therapy.
The T.J. Watt Incident: What Happened?
In December 2025, Pittsburgh Steelers star linebacker T.J. Watt underwent a dry needling session at the team’s practice facility and later developed discomfort in his lung area.
His brother, J.J. Watt, confirmed that T.J. suffered a partially collapsed lung (pneumothorax) following the dry needling session and required surgery to repair and stabilize the lung. He was released from the hospital and is recovering, although the exact timeline for his return to play remains uncertain.
A pneumothorax happens when air enters the space between the lung and the chest wall - often because a needle or trauma punctured the lining around the lung. Although very rare, this is a known possible risk when inserting needles near the chest or upper back.
It’s important to note:
Dry needling is typically used for musculoskeletal pain, not directly on the lung itself.
Puncturing the pleural cavity (the space around the lung) is a rare complication, but it can occur if the needle is inserted too deeply or at the wrong angle in high-risk areas near the chest or upper back.
This case underscores why thorough training, anatomical knowledge, and professional judgment matter in needling therapies.
For a real-world perspective on how needling treatments are used - and how they’re viewed differently even among elite athletes - it’s worth checking out this ESPN article on T.J. Watt’s dry needling experience and the questions it raised in the sports world.
In that piece, reporters break down how Watt’s partially collapsed lung occurred during a dry needling session and explore why this uncommon complication drew significant attention among players, trainers, and fans alike. Interestingly, many NFL players continue to choose dry needling for muscle recovery and performance - and some even express a preference for acupuncture or other needling styles - underscoring that athletes weigh the benefits, risks, and individual comfort with different techniques when making choices about their care.
Safety & Training: What You Should Know
Both dry needling and acupuncture use extremely thin, sterile needles, but they are not risk-free. The most common mild effects include bruising, soreness, or minor bleeding at the insertion site. Serious adverse events like pneumothorax are very uncommon but are more likely if a provider lacks anatomical expertise.
Key safety considerations:
Provider credentials matter - make sure your clinician is properly trained and licensed.
Communication is essential - share your full medical history before treatment.
Be aware that needling near the torso or lungs carries higher risk and requires advanced anatomical precision.
It’s important to clarify that acupuncture is not limited to meridian-based points alone. Licensed acupuncturists are trained in trigger point needling as well, and this has long existed within Traditional Chinese Medicine under the concept of Ashi points. Ashi points are areas of tenderness, tightness, or pain that do not have a fixed location on a meridian - often described as “where it hurts.” Clinically, these points frequently correspond to what Western medicine identifies as myofascial trigger points. When appropriate, acupuncturists may needle Ashi points alongside classical acupuncture points to address both local muscle dysfunction and broader systemic patterns, allowing treatment to be both targeted and holistic.
Training & Education: Dry Needling Providers vs Licensed Acupuncturists in California
One of the biggest differences between dry needling practitioners and licensed acupuncturists lies in how much training and education they are required to complete before working with needles.
Dry Needling Training
Dry needling courses vary widely and are typically post-graduate continuing education rather than formal degree programs.
Many dry needling programs (for physical therapists, chiropractors, etc.) are short workshops ranging from about 24 to 100 hours of combined classroom and hands-on instruction. These are often completed over a few days or weekends and may not include comprehensive competency exams or supervised clinical experience.
Importantly, there is no nationally standardized curriculum or required minimum number of hours for dry needling certification, and supervision requirements vary by course provider.
California, in particular, does not allow physical therapists or similar clinicians to perform dry needling because state law interprets needling as part of acupuncture practice, which requires its own licensure.
This relatively short and variable training is focused primarily on needling mechanics for musculoskeletal trigger points, but it typically does not include deep training in clinical diagnosis, extensive anatomy, safety across diverse body systems, or broader medical and holistic context.
Licensed Acupuncturist Education in California
By contrast, becoming a licensed acupuncturist (L.Ac) in California requires far more extensive education and supervised clinical training:
Prospective acupuncturists must graduate from a California Acupuncture Board-approved professional program, which generally includes thousands of hours of combined coursework and clinical practice - structured as a master’s degree in acupuncture and Chinese medicine that takes about 3–4 years to complete.
State regulations mandate a minimum of at least 3,000 hours of theoretical and clinical training for acupuncture licensure, with programs also including deep study of anatomy, diagnosis, treatment planning, safety, public health, and acupuncture theory.
Within this training, students complete hundreds of hours of supervised clinical practice (often 800-1000+), learning to assess patients, diagnose using Eastern and Western methods, and safely perform needling in a wide range of conditions and body areas.
After completing educational requirements, graduates must also pass the California Acupuncture Licensing Examination (CALE), a rigorous state-specific board exam that tests knowledge of both acupuncture theory and clinical safety.
Once licensed, acupuncturists must complete continuing education regularly to maintain their license, ensuring they stay current on safety protocols, clinical developments, and professional standards.
In summary, a licensed acupuncturist in California completes a comprehensive, multi-year education and competency assessment, whereas dry needling training is often a short, workshop-style course with no unified national standard. This significant difference in depth, duration, and regulation reflects why state boards and professional bodies emphasize the distinct qualifications and scope of practice between these providers - and why needling procedures are tightly regulated under acupuncture law in California.
Final Thoughts
Dry needling and acupuncture both involve needles, but they are distinct therapies with different philosophies, goals, and techniques. While dry needling can be a powerful tool in a clinician’s toolbox for muscle pain relief, the T.J. Watt episode highlights the importance of qualified care and anatomical precision. Understanding these differences helps you make confident, educated choices about your health and well-being.
If you’re exploring needling therapies, talk with a licensed practitioner who can guide you based on your unique needs and safety profile.
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Medical Disclaimer: The information provided here is for educational purposes only and is not intended as medical advice. Each individual is unique, and acupuncture treatments are always tailored to the person’s specific needs. If you are experiencing a health concern, please consult a licensed healthcare professional to determine the most appropriate course of care.
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