Background: Pneumothorax is a very rare but serious complication associated with acupuncture and dry needling around the thoracic region. Physiotherapists and other health practitioners should be aware of the risks associated with needling in this region and should take care to minimize the possibility of an iatrogenic pneumothorax. Findings: An awareness of the signs and symptoms of a pneumothorax is necessary for practitioners using acupuncture and dry needling in the thoracic region. Understanding the normal anatomy and its variants can minimize risk associated with needling practices in this region. Various technique modifications are suggested so that the pleura or lungs are avoided while using acupuncture or dry needling in the thoracic region. Discussion/Conclusion: Acupuncture and dry needling in this region administered by well-trained physiotherapists and other health practitioners is very safe; however, to maximize safety therapists should consider the relevant anatomy and not practise using advanced acupuncture and dry needling techniques without adequate competency-based training.