1. Myofascial Dry Needling Lower Back and Pelvis

2. 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

3. Nerves: Lumbar & Pelvis

4. Arteries: Lumbar & Pelvis

5. Anatomy

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

7. 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

8. 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

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

10. 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

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

12. 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

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

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

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

16. 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

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

18. 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

19. 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)

20. 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

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

22. 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

23. 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