Low Back Pain (LBP) is the leading cause of disability and musculoskeletal morbidity worldwide. For the manual therapist, the lower back is a complex arena where bony structures, intervertebral discs, an intricate nervous system, and an extensive muscular envelope meet. While emphasis was previously placed on "passive" structures (such as disc herniations), modern research shows that the muscular component plays a decisive role in both the creation of pain and its rehabilitation. This is where Dry Needling enters as a tool that allows direct access to the deepest muscles of the spine.

 

The Forgotten Muscles: Multifidus and Quadratus Lumborum

In treating back pain, we often focus on the large, superficial muscles, but the key to spinal stability lies in the deep layer:

• Multifidus: A small but critical muscle that stabilizes each vertebra individually. Research shows that in individuals with chronic back pain, the multifidus undergoes atrophy and Fatty Infiltration very shortly after the onset of pain. Dry Needling allows us to "activate" this muscle in a way that is impossible through superficial manual contact.
• Quadratus Lumborum (QL): Known as the "Joker" of back pain. This muscle is responsible for the lateral stabilization of the spine and often becomes a focal point for active trigger points that radiate pain to the buttock and pelvis—frequently leading to misdiagnosis as a hip issue or disc herniation.

 

Treatment Mechanism: From Local Needling to Central Regulation

Dry Needling in the lumbar region operates on three levels:

1. Mechanical Release of Intramuscular Pressure: Needling the Erector Spinae and QL reduces the compressive load on vertebrae and discs by relaxing "protective tension" (Muscle Guarding).
2. Neural Impact: Needling affects the Dorsal Horn of the spinal cord, assisting in the alleviation of neuropathic pain (radiculopathy) by reducing local sensitization around nerve roots.
3. Improving Proprioception: The stimulus of the needle within the multifidus "awakens" the communication between the spine and the brain, which is vital for maintaining dynamic stability.

 

Want to learn how to needle the Multifidus safely? Register for our upcoming Dry Needling course

 

Research Evidence: Dry Needling vs. Conservative Treatments

A systematic review published in the Journal of Orthopaedic & Sports Physical Therapy (JOSPT) found that combining dry needling with strengthening exercises is significantly more effective at reducing pain than exercise alone. The research emphasizes that needling provides a "window of opportunity" where the patient can perform rehabilitation exercises (such as core recruitment) without inhibitory pain.

 

Safety in Spinal Needling

Needling in the lumbar region requires high-level skill. The therapist must be familiar with safe needling angles relative to the Lamina of the vertebra to prevent canal penetration or kidney injury. At Manual IL, we teach "Bone Touch" techniques that serve as a safe reference point, allowing for deep and effective needling without the fear of complications.

 

For details on the curriculum and the full syllabus of the Dry Needling course – Click Here

 

Summary: The Back as Part of a Kinematic Chain

Modern treatment of low back pain requires us to look beyond the MRI scan. Dry Needling allows us to treat the muscular and neural components of pain in a way that no other tool can achieve. When integrating needling into a work plan that includes differential diagnosis and movement exercises, we see high success rates even in "stubborn" chronic cases.