What is Dry Needling?  

Dry needling is a technique used by qualified clinicians to treat myofascial trigger points – tight, overactive points / knots within muscles that can contribute to pain and restricted movement. A fine, sterile needle is inserted into the muscle to help reduce pain sensitivity and tension, improve blood flow, and normalise muscle activity. Slightly different than acupuncture, which is based on traditional Chinese medicine and aiming to improve energy flow (Qi) along meridians, dry needling is grounded in modern western medicine and evidence-based practice to relieve muscle tension and desensitise overactive muscles.  

Why thoracic dry needling safety requires special care  

The thoracic region contains vital structures including the lungs. Muscles such as the trapezius, rhomboids, and intercostals lie close to these structures. As a result, there is a small but important risk of complications such as pneumothorax (collapsed lung) if needling is performed incorrectly. This is why only appropriately trained clinicians should perform dry needling in this area. 

How Qualified Physiotherapists Approach Safe Needling  

Through my recent APA training, one of the key messages was that safe needling is not just about technique – it’s also about clinical reasoning and safety awareness. 

Physiotherapists follow several important safety principles when considering dry needling: 

1. Understanding of anatomical knowledge

A strong understanding of muscle layers, bones positioning, nerve innervation and other anatomical structures is essential. 

2. Controlled needle direction and depth

Needles are inserted with careful consideration of angle and depth to avoid deeper structures like the lungs and pleura. 

3. Appropriate positioning

Patient positioning (such as prone lying) helps optimise both access and safety. 

4. Individual assessment& Informed consent

Not every patient is suitable for dry needling. A thorough initial assessment and informed consent should always completed beforehand. 

5. Ongoing monitoring

Patients are monitored by the therapist during and after treatment to ensure safety and comfort.  

The Importance of Informed Consent and Patient Education 

Another key aspect of safe needling practice is ensuring that patients are fully informed before treatment begins. This includes discussing not only the potential benefits, but also the risks associated with needling in sensitive areas like the thorax area. Patients should understand what to expect during and after treatment, as well as what symptoms would warrant seeking medical attention. Clear communication also includes advising patients to remain still during needling and to avoid sudden movements such as deep breathing, coughing, or repositioning while needles are in place. This shared understanding helps reduce risk and ensures patients feel confident and informed throughout their needling treatment. 

Understanding Pneumothorax Risk and Early Recognition 

Although rare (0.01/10000 treatments), pneumothorax is the most significant complication associated with thoracic needling, and early recognition is essential. Symptoms may not always appear immediately and can develop over several hours following needling treatment. Patients may experience signs such as chest pain, shortness of breath, dry cough, dizziness, or increased respiratory rate. In more severe cases, changes such as reduced breath sounds or signs of respiratory distress may occur. While most cases are mild and resolve with appropriate medical management, some may require interventions such as oxygen therapy or drainage. This highlights why both clinician awareness and patient education are critical components of safe practice. 

Why Needle Angle and Depth Matter in the Thorax 

One of the most important concepts I took away from recent training is how significantly needle angle influences depth of penetration. Even when using the same needle length, a steeper angle (closer to perpendicular) can result in much deeper tissue penetration compared to a gentler angle. In the thoracic region, where structures such as the lungs sit relatively close to the surface, this becomes highly clinically relevant. Small changes in angle can mean the difference between staying within muscle tissue or reaching deeper, higher-risk structures. For this reason, guidelines suggested clinicians to use controlled angles, shorter needles where appropriate, and a clear understanding of underlying anatomy to ensure needling remains within safe limits. 

Applying Safety Principles in Clinical Practice 

Current recommendations for thoracic dry needling safety emphasise several practical strategies. These include using needling on one side or same side of body to reduce risk, selecting safer anatomical zones such as the region around the vertebrae, and applying oblique or angled techniques rather than perpendicular insertion where appropriate. Additionally, clinicians are encouraged to work within a proportion of the “safe depth” (often less than 70% of the estimated risk depth) and to adjust their approach based on individual patient characteristics like body size. Ultimately, safe practice relies on a combination of technical skill, anatomical understanding, patient education, and clinical awareness. 

A Holistic Physiotherapy Approach 

In physiotherapy, dry needling is not used in isolation. Dry needling will be more effective in reducing muscle pain and improving function when used as part of a broader physiotherapy treatment plan. Physiotherapists usually combine it with other treatments such as exercise therapy, manual therapy such as joint mobilisation or manipulation, activity modification and education. This approach helps address the root cause of the pain and supports long-term recovery rather than just temporary relief. 

Are you experiencing upper / mid-back pain?  

If you are experiencing upper or mid-back pain, a thorough physiotherapy assessment can help identify the best approach for your management. Our Physiotherapy team at Thriving Lives Co. are dry needling-trained and able to provide safe, evidence-based dry needling when appropriate.    

Justin So 
Physiotherapist 
Thriving Lives Co. 
Bungalow, Cairns