Myofascial Dry Needling Lower Back and Pelvis

Overview Neurovascular Anatomy of the Lower Back and Pelvis MDN of muscles in the Lower Back and Pelvis: Quadratus Lumborum Tensor Fascia Latae Gluteus Maximus Gluteus Medius Gluteus Minimus Piriformis Iliopsoas Pectineus

Nerves: Lumbar & Pelvis

Arteries: Lumbar & Pelvis

Anatomy

Quadratus Lumborum Travell, J. G., Simons, D. G., & Cummings, B. D. (1983)

Quadratus Lumborum Deep TrPs Patient in a side lying position A bolster or pillow may be placed under the iliac crest to aid palpation The TrPs should be directed perpendicularly along the frontal plane and in line with the transverse processes Whilst needling the upper TrP the needle should not be angled superiorly as it could penetrate the diaphragm and pleura

Quadratus Lumborum Superficial TrPs Patient in a prone or side lying position A bolster or pillow may be placed under the iliac crest to aid palpation The TrPs should be needled obliquely at a relatively shallow depth and directed towards the transverse processes to avoid penetrating the kidney

Tensor Fascia Latae Travell, J. G., Simons, D. G., & Cummings, B. D. (1983)

Tensor Fascia Latae MDN Patient in a supine position with the knee slightly flexed and resting on a pillow The muscle may be identified by asking the patient to internally rotate the hip The TrP is needled perpendicularly or obliquely in a cephalic direction

Gluteus Maximus Travell, J. G., Simons, D. G., & Cummings, B. D. (1983)

Gluteus Maximus MDN Patient in a side lying position with the hip slightly flexed to take up the slack The thigh may be rested on a pillow TrP 1 & 2 are needled perpendicularly or obliquely in a medial direction TrP 3 can be needled perpendicularly, or alternatively palpated and needled using a pincer grip

Gluteus Medius Travell, J. G., Simons, D. G., & Cummings, B. D. (1983)

Gluteus Medius MDN Patient in a side lying position The needles may be inserted obliquely or perpendicularly

Gluteus Minimus Travell, J. G., Simons, D. G., & Cummings, B. D. (1983)

Gluteus Minimus MDN Patient in a side lying position The needles may be inserted obliquely or perpendicularly When needling the posterior fibres, the needle must be directed in an oblique angle directed superiorly to avoid the sciatic nerve The greater sciatic notch may be palpated to establish the position of the sciatic nerve

Piriformis Travell, J. G., Simons, D. G., & Cummings, B. D. (1983)

Piriformis MDN Patient in a side lying position on the unaffected side with the affected hip in about 45° flexion and resting on the table The lateral TrP may be needled on an oblique or perpendicular angle Travell and Simons recommend that the medial TrP be needled using a bimanual approach (this may not be suitable for MST practitioners) in order to avoid the sciatic nerve

Iliopsoas TrPs in QL, rectus abdominis, rectus femoris, hamstring and gluteal muscles should be deactivated first Travell, J. G., Simons, D. G., & Cummings, B. D. (1983)

Iliopsoas MDN For the distal TrP, the patient is in a supine position with the hip abducted and externally rotated The location of the femoral artery must be identified before needling The TrP is identified (roughly at right angles from the ASIS and pubic tubercle) and needled on a slight oblique angle in a superior and lateral direction The iliacus TrP may be needled with great caution on the inside of the iliac crest The needle must travel close to the inner surface of the ilium to avoid penetrating the abdominal contents

Pectineus Travell, J. G., Simons, D. G., & Cummings, B. D. (1983)

Pectineus MDN The patient is in a supine position with the hip abducted and externally rotated The femoral artery is on the lateral side of the TrP, and must be identified before needling A finger is applied over the femoral artery to avoid puncturing it The TrP is needled obliquely in a superior and medial direction TrPs in adductor magnus should be deactivated first

Bibliography Travell, J. G., Simons, D. G., & Cummings, B. D. (1983). Myofascial pain and dysfunction : the trigger point manual (Vol. 2). Baltimore: Williams and Wilkins Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999). Travell & Simons' myofascial pain and dysfunction : the trigger point manual (2nd ed. Vol. 1). Baltimore: Williams & Wilkins Basmajian, J. V. (1982). Primary anatomy (8th ed.). Baltimore: Williams & Wilkins Deadman, P., Al-Khafaji, M., & Baker, K. (1998). A manual of acupuncture. Hove, East Sussex: Journal of Chinese Medicine Publications