MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

Dry needling is a therapy that is akin to acupuncture and trigger point therapy. It is claimed to be safe – but is this true?

Researchers from Ghent presented a series of 4 women aged 28 to 35 who were seen at the emergency department (ED) with post-dry needling pneumothorax between September 2022 and December 2023. None of the patients had any relevant medical history. All had been treated for a painful left shoulder, trapezius muscle or neck region in outpatient physiotherapist practices. At least three different physiotherapists were involved.

One patient presented to the ER on the same day as the dry needling procedure, the others presented the day after. All mentioned thoracic pain and dyspnoea. Clinical examination in all of these patients was unremarkable, as were their vital signs. Diagnosis was confirmed with ultrasound (US) and chest X-ray (CXR) in all patients. The latter exam showed left-sided apical pleural detachment with a median of 3.65 cm in expiration.

Two patients were managed conservatively. One patient (initial pneumothorax 2.5 cm) was discharged. The US two days later displayed a normally expanded lung. One patient with an initial apical size of 2.8 cm was admitted with 2 litres of oxygen through a nasal canula and discharged from the hospital the next day after US had shown no increase in size. Her control CXR 4 days later showed only minimal pleural detachment measuring 6 mm. The two other patients were treated with US guided needle aspiration. One patient with detachment initially being 4.5 cm showed decreased size of the pneumothorax immediately after aspiration. She was admitted to the respiratory medicine ward and discharged the next day. Control US and CXR after 1 week showed no more signs of pneumothorax. In the other patient, with detachment initially being 5.5 cm, needle aspiration resulted in complete deployment on US immediately after the procedure, but control CXR showed a totally collapsed lung 3 hours later. A small bore chest drain was placed but persistent air leakage was seen. Several trials of clamping the drain resulted in recurrent collapsing of the lung. After CT-scan had shown no structural deformities of the lung, suction was gradually reduced and the drain was successfully removed on the sixth day after placement. The patient was then discharged home. Control CXR 3 weeks later was normal.

The authors concluded that post-dry needling pneumothorax is, contrary to numbers cited in literature, not extremely rare. With rising popularity of the technique we expect complications to occur more often. Patients and referring doctors should be aware of this. In their informed consent practitioners should mention pneumothorax as a considerable risk of dry needling procedures in the neck, shoulder or chest region. 

The crucial question, in my view, is this: do the risks of dry-needling out weigh the risks of this form of therapy? Let’s have a look at some of the recent evidence that we discussed on this blog:

The evidence is clearly mixed and unconvincing. I am not sure whether it is strong enough to afford a positive risk/benefit balance. In other words: dry needling is a therapy that might best be avoided.

4 Responses to Pneumothorax after dry needling is not rare

  • Prof. Ernst. Your hypocrisy is palpable. Your title should read, “Physiotherapy care using dry needling causing pneumothorax is not rare.” Please be consistent with your titles, if a chiropractor et. al. was involved, I believe that you would have included the profession in your title.
    As a side note, Dr. Susan Ireaci was asked to provide some evidence as to the scientific validity of Physiotherapy. She has yet to provide even one reference. Perhaps you can?

    • Physiotherapy to a large extent is a big scam. At least in Germany.

      Under the umbrella word “Physiotherapie” all kinds of crap are sold. Physiotherapie is a recognized work and Physiotherapeut is a recognized title. But this does not mean that all they sell is really true.

      It is like with a kiosk selling a newspaper. One newspaper? Who can live from selling ONE newspaper? In older days newspaper boys would go in the streets and in cafes and restaurants, selling the just published new edition of the newspaper. It paid many of them their living. But if they sold TWO newspapers it was better. The more to sell the better. Kiosks are full of newspapers. And not only news papers! All kinds of candies. And cigarettes and beverage. The more the better. The more to sell the higher the income.

      The more to sell the higher the income. True for kiosks. True for physiotherapists. True for medical doctors. True for naturopaths. There even are special laws for medical doctors to offer crap. These poor people, one must support them. So let them sell crap. Look for the abbreviation “IGeL”:

      “Was sind Individuelle Gesundheitsleistungen (IGeL)?”
      https://www.verbraucherzentrale.de/wissen/gesundheit-pflege/aerzte-und-kliniken/was-sind-individuelle-gesundheitsleistungen-igel-11603

      We are safe no more. And nowhere. A country which allows crap to be sold to patients is doomed. We ARE doomed.

      Now, when even medical doctors are allowed to sell crap, why should the laws for less educated and less important people be more strict?

      We are all floating in midair. Better not get sick. You can buy newspapers, as many as you want. But better never get into the fangs of the healthcare exploitation system.

      That is the way it is.

  • GibletGiblet,
    Your ignorance is palpable, as is your logic.

    How about you providing some evidence, any real will do, for any validity for your form of witchcraft? Diversionary tactics won’t work, don’t work,, and are past the point of tedium.

    Physics work on injured Australian Rukes Footballers to get them back on to the paddock (real footy, not league thuggery), Players go back playing strapped up, massaged, and whatever else they do, BUT most can can continue to play.

    What does chiro offer, apart from comical theatrics? Sure, there are the stolen aspects of physio, but it isvstolen to try to legitimise the SCAM fraud.

    • Frank, in regard to the “real footie” that you refer to, is that the same as the “aerial ping pong”, that is played in states of Australia, especially Victoria, otherwise known as “Aussie Rules”.
      You will not find many chiropractors using the “shake, bake or fake”, that physios use. But you will find many physios doing post grad courses in “spinal manual therapy” that is not taught in the curriculum of the physio schools.
      Dr. Susan Ireaci was asked to provide some evidence as to the scientific validity of Physiotherapy. She has yet to provide even one reference. I asked this question of Prof. Ernst, as well. He has not provided an answer, perhaps you can?

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