Comparison of two angles of approach for trigger point dry needling of the lumbar multifidus in human donors (cadavers).

STUDY DESIGN: Descriptive comparison study.

OBJECTIVE: To assess the accuracy of two needle angle approaches for dry needling of the lumbar multifidus.

BACKGROUND: Low back pain is a leading cause of disability around the world; the lumbar multifidus plays a vital role in low back health. Manual therapy such as dry needling can improve pain mediation and motor control activation of the lumbar multifidus. Clinicians practicing dry needling at the lumbar multifidus typically use an inferomedial approach considered non-controversial. Clinicians practicing electromyography and nerve conduction studies commonly sample the lumbar multifidus in a directly posteroanterior approach that may provide another option for dry needling technique.

METHODS: Four human donors were used for a total of eight needle placements-four with an inferomedial orientation and four with a posteroanterior orientation. Each needle was placed from 1 to 1.5 cm lateral to the spinous process of L4 to the depth of the lumbar lamina. Each lower lumbar spine was then dissected to determine the structures that the needle traversed and the needle's final resting place.

RESULTS: All four inferomedial approach needles ended at the lamina of the vertebrae below. All four posterior-anterior approach needles ended in the lamina of the same level.

CONCLUSIONS: All eight needles traversed the lumbar multifidus and ended in the lumbar lamina with little possibility of the needle entering the subarachnoid space. Thus both the inferomedial and the posteroanterior angles of approach are efficacious for clinicians to use in dry needling of the lumbar mulifidus.