title: The use of trigger point dry needling and intramuscular electrical stimulation for a subject with chronic low back pain: a case report.
abstract: METHODS
  Case Report.
  
  
  OBJECTIVE
  Myofascial trigger points (MTrPs) are widely accepted by clinicians and researchers as a primary source of regional neuromusculoskeletal pain. Trigger point dry needling (TrP-DN) is an invasive procedure that involves stimulation of MTrPs using an monofilament needle. The purpose of this case report is to report the outcomes of TrP-DN and intramuscular electrical stimulation (IES) as a primary treatment intervention in a subject with chronic low back pain.
  
  
  METHODS
  The subject was a 30-year-old female, active duty military, who was referred to physical therapy for low back and right posterolateral hip pain. She noticed symptoms after suffering a lumbar flexion injury while picking up a barbell during weight training. Physical examination demonstrated findings that supported the diagnosis of lumbar segmental instability with a right hip stability dysfunction. Objective findings included a multi-segmental flexion movement pattern dysfunction and MTrPs in the right gluteus maximus and gluteus medius muscles with deep palpation. The subject was treated with TrP-DN and IES for a total of two visits. Bilateral L3 and L5 multifidus and right gluteus maximus and medius muscles were treated, along with implementing a home exercise program consisting of core stability exercises.
  
  
  RESULTS
  The subject reported no existing pain and disability on the Numerical Pain Rating Scale and Oswestry Disability Questionnaire and a large perceived change in recovery on the Global Rating of Change at final follow-up. Physical examination was normal, demonstrating no observed impairments or functional limitations, including normal multi-segmental flexion and no MTrPs with deep palpation.
  
  
  CONCLUSIONS
  The subject was able to return to full military active duty without any physical limitations and resumed pre-injury activity levels, including the ability to resume all activities without pain. There is much promise regarding the use of TrP-DN with IES intervention for the treatment of lumbar and/or hip stability dysfunction. Future research is recommended to determine if TrP-DN intervention, with and without IES, is effective for other body regions and long-term subject outcomes.
  
  
  METHODS
  Level 4.
authors.affiliation: Physical Therapist, Naval Special Warfare Group ONE, San Diego, CA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Rainey
keywords: Dry needling; intramuscular electrical stimulation; low back pain; myofasical trigger points