The use of trigger point dry needling and intramuscular electrical stimulation for a subject with chronic low back pain: a case report

Abstract

Study design: Case Report.

Background and purpose: Myofascial trigger points (MTrPs) are widely accepted by clinicians and researchers as a primary source of regional neuromusculoskeletal pain. Trigger point dry needling (TrP-DN) is an invasive procedure that involves stimulation of MTrPs using an monofilament needle. The purpose of this case report is to report the outcomes of TrP-DN and intramuscular electrical stimulation (IES) as a primary treatment intervention in a subject with chronic low back pain.

Case description: The subject was a 30-year-old female, active duty military, who was referred to physical therapy for low back and right posterolateral hip pain. She noticed symptoms after suffering a lumbar flexion injury while picking up a barbell during weight training. Physical examination demonstrated findings that supported the diagnosis of lumbar segmental instability with a right hip stability dysfunction. Objective findings included a multi-segmental flexion movement pattern dysfunction and MTrPs in the right gluteus maximus and gluteus medius muscles with deep palpation. The subject was treated with TrP-DN and IES for a total of two visits. Bilateral L3 and L5 multifidus and right gluteus maximus and medius muscles were treated, along with implementing a home exercise program consisting of core stability exercises.

Outcomes: The subject reported no existing pain and disability on the Numerical Pain Rating Scale and Oswestry Disability Questionnaire and a large perceived change in recovery on the Global Rating of Change at final follow-up. Physical examination was normal, demonstrating no observed impairments or functional limitations, including normal multi-segmental flexion and no MTrPs with deep palpation.

Discussion: The subject was able to return to full military active duty without any physical limitations and resumed pre-injury activity levels, including the ability to resume all activities without pain. There is much promise regarding the use of TrP-DN with IES intervention for the treatment of lumbar and/or hip stability dysfunction. Future research is recommended to determine if TrP-DN intervention, with and without IES, is effective for other body regions and long-term subject outcomes.

Level of evidence: Level 4.

Keywords: Dry needling; intramuscular electrical stimulation; low back pain; myofasical trigger points.

Figures

Figure 1.

Multi‐segmental flexion (side view).

Figure 2.

Multi‐segmental flexion (front view).

Figure 3.

Lumbar Multifidus needle placements (L3 and L5).

Figure 4.

Needle placements for Gluteus Medius Gluteus Maximus.

Figure 5.

Needle placement for the Multifidi and the Gluteus Maximus/Medius.

Figure 6.

Intramuscular Electrical Stimulation Set‐up.

Figure 7.

Half Kneeling In‐line Balance.

Figure 8.

Quadruped Diagonals (i.e., Bird Dogs).

Figure 9.

Straight Leg Raise with Core Activation.

Figure 10.

Standing Single Leg Deadlift.

Figure 11.

Multi‐segmental flexion, post‐treatment (side view).

Figure 12.

Multi‐segmental flexion, post‐treatment (front view).