Ultrasound-Guided Dry Needling: A New Fascia-Based Approach for Low Back Pain Relief

What is it about?

Why is this study important? Low back pain is often linked to muscle and fascial dysfunction. While dry needling (DN) is widely used for myofascial pain relief, the role of the thoracolumbar fascia (TLF) remains underexplored. This study investigates how ultrasound (US) can improve the precision and effectiveness of DN, particularly by identifying fascial trigger points (TrPs) that contribute to pain and movement restrictions. What did we do? We studied 32 patients with myofascial low back pain and postural imbalance, applying an ultrasound-guided dry needling (DN-US) protocol: Muscle trigger points (TrPs) were identified and treated with DN. Fascial abnormalities (hypervascularity, hypomotility, adhesions, increased stiffness) were examined and needled separately. Post-treatment evaluation assessed pain reduction, mobility improvement, and structural changes in the fascia. What did we find? Pain relief and movement restoration occurred in all patients after muscle DN. In 24 patients, fascial trigger points were identified and successfully needled, particularly in the thoracolumbar fascia (TLF) and sacroiliac joint (SIJ). Needle grasp was stronger in fascia, but twitch responses (common in muscle DN) were not observed. Ultrasound showed a reduction in fascial stiffness and thickness after treatment, with hyperechoic layers decreasing from 5–10 mm to 2–4 mm. Patients receiving both muscle and fascia DN needed fewer sessions and showed better postural balance and mobility improvements.

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Why is it important?

Why does this matter? This study highlights the importance of including fascia in dry needling treatments. Ultrasound can help identify fascial dysfunctions that contribute to chronic low back pain and improve targeting for more effective, individualized therapy.

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