I had a 34 year old gentleman I was treating for a textbook L5 radiculopathy. He was responding beautifully to a combination of a Medrol dose pack, mechanical traction and an extension biased program. After 3 weeks his radicular symptoms were abolished and he was left with mild right lumbosacral pain that was resistant to further treatment. Honestly, at this point I was a bit stuck. Objectively, ROM testing was non-provocative, repeated movements did nothing, biomechanical assessment was unremarkable, neural testing was non-provocative and palpation only revealed bilateral multifidus atrophy at L5. Do I chalk it up to low level dural irritation I can’t provoke? What about very minor inflammation producing a chemically mediated pain I can’t provoke? Or, is it just the posterior annulus that remains painful? I could go on, but I think you see my paralysis by overanalysis.
My rationale for choosing dry needling in this case is as follows: We know that with discogenic pathology, there is inhibition and atrophy of the segmental multifidus. Typically, we choose dry needling for inhibition of musculature, but in some cases you can facilitate atrophied and inhibited musculature. In this case, he clearly had multifidus atrophy so I needled his multifidus bilaterally at L5 and S1 (for good measure). Remember, at this point, objectively things look great. He only had subjective complaints. Immediately following treatment he reported that his back felt tight and wasn’t sure if he felt any different. Three days later at his next appointment he came in and was very pleased to report that his pain quickly resolved after the dry needling treatment and he had been pain free since then.
Your thoughts? Let's discuss dry needling in more detail and practice the technique at our upcoming Dry Needling Upper Quadrant course, shall we?
–Gary Kearns, PT, COMT, FAAOMPT
NAIOMT Guest Faculty & Clinical Fellowship Instructor