Pneumothorax Risk in Athletic Needling: What Professional Teams, Athletes, and Recovery Clinics Should Know

Recent discussions surrounding TJ Watt’s injury have brought increased attention to the topic of needling safety in elite athletes. While needling techniques are widely used across professional sports — including the NFL, UFC, MMA, MLB, NHL, and NCAA programs — these conversations present an important opportunity for education rather than speculation.

This article is intended to provide clear, respectful, and evidence-informed guidance for:

• Professional and collegiate teams

• Athletic trainers and medical staff

• Hiring managers and performance directors

• Elite and professional athletes

The focus is on risk awareness, credential evaluation, and appropriate provider selection — not criticism of any profession.

Understanding Pneumothorax in Sports Medicine

A pneumothorax occurs when air enters the pleural space between the lung and chest wall, potentially leading to partial or full lung collapse. In sports medicine settings, this complication is rare, but has been reported in association with procedures performed near the thoracic cavity, including:

• Upper rib cage and thoracic spine

• Shoulder girdle and axillary region

• Cervical and upper thoracic musculature

• Diaphragm and breathing mechanics

When needling is performed in these anatomically complex regions, depth control, anatomical variation awareness, and advanced training are critical.

Medical Disclaimer

This article is for educational purposes only and is not intended to diagnose, treat, or provide medical advice. Individual risk varies based on anatomy, health status, technique, and provider training. Athletes should consult with qualified healthcare professionals for individualized care. No medical procedure is entirely without risk, and outcomes cannot be guaranteed.

Dry Needling and Acupuncture: Same Instrument, Different Educational Pathways

Both dry needling and acupuncture utilize the same sterile, single-use solid filiform needle — commonly referred to as an acupuncture needle.

The difference lies not in the tool, but in the training pathway, scope of practice, and depth of anatomical education.

Dry Needling

Dry needling is typically performed by licensed Physical Therapists or Chiropractors who pursue post-graduate certification training hours after completing their primary professional degree.

These practitioners bring valuable strengths in:

• Orthopedics and biomechanics

• Rehabilitation and corrective exercise

• Injury assessment and functional movement

Dry needling education varies by state and program and is often completed through continuing education formats designed to complement existing clinical skills.

Important Credential & Licensing Notice (U.S.-Based Teams and Athletes)

Licensing requirements for acupuncture and needling vary significantly by state in the United States.

It is important for teams, facilities, and athletes to be aware that not all states require a professional license to perform needling.  In certain states — including, but not limited to, Alabama, North Dakota, Wyoming, Oklahoma, and others with limited or unregulated practice laws — individuals may legally perform needling or advertise acupuncture-related services without completing an accredited graduate program or holding a state-issued acupuncture license.

Licensed Acupuncture and Sports Medicine Acupuncture®

A licensed acupuncturist completes:

• 3.5–4 years of graduate-level education

• Comprehensive training in anatomy, physiology, point location, needle depth, and safety

• National board examinations and state licensure

Sports Medicine Acupuncture® is an advanced specialization layered on top of licensure, designed specifically for acupuncturists to get in-depth training of sports medicine and needling techniques to integrate medical practices.

Why Advanced Sports Medicine Acupuncture® Training Matters in Elite Sports

In professional sports — including football, combat sports, baseball, and hockey — athletes often require treatment in regions with higher anatomical risk due to:

• Muscle hypertrophy

• Lean body composition

• Prior injuries or surgeries

• High-force repetitive loading

Advanced Sports Medicine Acupuncture training includes:

• Cadaver-based anatomy laboratories

• Extensive supervised clinical hours beyond licensure

• Advanced depth-specific needling techniques

• Treatment of anatomically complex and nerve-dense regions

• Needling techniques for anatomically complex regions

This training supports safe and effective care in areas such as:

• Cervical spine and anterior neck

• Rib cage and thoracic spine

• Axillary region (armpit)

• Diaphragm and releasing techniques

• Groin and pelvic attachments

• Ankles and peripheral nerve pathways

• Facet joint needling

• And much more...

An Integrated Model for High-Performance Athletes

Sports Medicine Acupuncture® extends beyond traditional acupuncture and integrates:

• Orthopedic examinations

• Postural and biomechanical assessment

• Manual muscle testing

• Motor point and neuromuscular needling

• Myofascial release

• Corrective exercise

This makes it particularly well-suited for NFL, UFC, MMA, MLB, NHL, and high-level collegiate athletes, where precision, safety, and performance optimization are priorities.

Guidance for Teams, Agents, and Hiring Professionals

When evaluating providers for needling services, teams may consider asking:

• Is the provider licensed in their profession?

• What post-graduate training have they completed specific to needling?

• Do they have cadaver-based anatomy education?

• Have they completed extensive (300hours+) supervised needling hours?

• Are they trained to needle in high-risk anatomical regions?

• Do they integrate orthopedic assessment and rehabilitation principles?

These considerations support athlete safety while fostering collaboration across medical disciplines. In high-risk or anatomically complex cases, facilities may choose to reserve needling interventions for clinicians whose primary professional education and post-graduate training are centered on advanced needling anatomy and depth-specific technique.

A National Directory of Advanced Sports Medicine Acupuncture® Providers

Currently, there is one Sports Medicine Acupuncture® certification program offered in the United States (sought out by many around the world).If you're looking for a well-trained provider in your area, this directory includes all those licensed in this training. *note- many students may begin this program or do hours of this as CEU's but not complete the actual full program hours, or exams needed to get this certification program. Those listed in the directory below have all completed and passed this program.

👉 CSMA Practitioner Directoryhttps://sportsmedicineacupuncture.com/csma-practitioner-directory/

Practitioners listed have completed rigorous 300+ hours of post-graduate education focused on orthopedic assessment, neuromuscular needling, and athlete care.

Final Thoughts

Pneumothorax remains rare, but conversations around it underscore an important principle in elite sports medicine: The complexity of the anatomy being treated should match the depth of the provider’s training.

Sports Medicine Acupuncture® does not replace Physical Therapy, Chiropractic care, or Athletic Training — it complements them. When integrated thoughtfully, it supports safe recovery, performance longevity, and athlete confidence across professional and collegiate sports.

For Colorado-based teams and athletes:

Jackie Parra, L.Ac., is one of three practitioners in the state certified in Sports Medicine Acupuncture®. She provides both in-office care and home visits and has over eight years of experience working with professional athletes. Her background includes more than 400 hours of advanced post-graduate education and certifications in orthopedic assessment and sports medicine, in addition to her state acupuncture licensure.

Please contact her for questions and treatment. In Centennial, CO. Located behind the Broncos Training Facility.

www.eliteacu.com