DRY NEEDLING UNDER ULTRASOUND GUIDANCE
DECREASE NEUROPATHIC COMPONENT AND
INCREASE LEVEL OF MOTION IN PATIENT WITH LOW BACK PAIN
R. Bubnov1, L. Kalika2.
1Clinical Hospital "Feofaniya", Ultasound; Institute of Microbiology and Virology, NAS of Ukraine , Kyiv, Ukraine
2New York Dynamic Neuromuscular Rehabilitation & Physical Therapy,
https://nydnrehab.com/, New York, USA.
The aim was to evaluate efficacy of dry needling under US
guidance for neuropathic pain treatment; and restoring joints
motility and muscle function in spine, pelvis and lower
We included 23 patients, 10 males and 13 females, (aged
18-55 years) with clinically diagnosed low back pain over 3
month with neuropathic component and reduced motility in
spine, pelvis and lower extremity. We conducted precise
physical tests and neuromuscular ultrasound using M-mode
and evaluated nerves and motion in intervetrebral spaces,
pelvis, intrinsic foot and leg muscles. Patients received DN
of MTrP under US guidance according to approach by R.
Bubnov (PMID:23088743) [2,3] . VAS (0-10) and Leeds
Assessment of Neuropathic Symptoms and Signs (LANSS)
scores were measured before, immediately after, 24 hours,
and 7 days after intervention.
1.Clinical definition zone of possible trigger point—pain syndrome with typical referred
pain pattern registration.
2.Trigger point palpation. Palpation of a hypersensitive bundle or nodule of the muscle
fiber of harder than normal consistency. Localization of a trigger point is based on the
sense of feel, assisted by patient expressions of pain, and by visual and palpable
observations of local twitch response 
3.Using precise physical tests, extensive neuromuscular ultrasound using M-mode to
evaluate muscle thickness, CSA and motion, different patterns of decreasing motility,
contractility (muscle contracted / rested thickness) in intervetebral spaces, pelvis, intrinsic
/extrinsic muscles in pelvis, gluteus region, foot and ankle, etc. .
4.When the affected muscle is detected, ultrasonography examination is performed for
myofascial trigger point visualization using gray-scale, Doppler, and sonoelastography [2-
5.After the visual identification of the trigger point, dry needling was performed— fine
(acupuncture 28-30G) needles were inserted into MTrP to elicit the LTR effect. The
needle was held in the tissue until complete disappearance of the LTR which could be
considered similar to the phenomenon of the ‘needle grasp,’ which has been attributed to
the muscle fibers contracting around the needle, and was held tightly in place to increase
the resistance to further move the inserted needle [2-4].
6.Ultrasound control after procedure [2-4].
7.Visual analog scale (VAS) scores (0–10) were recorded throughout the study period
before, immediately after, and 24 h after the procedure.
Our preliminary data demonstrated that DN under US guidance
effectively reduce myofascial pain, ameliorate symptoms of
neuropathy and local hypomotility. Further research needed for
development US patterns and study causation in the chain of
1.Simons DG, Travell JG, Simons LS. Travell and Simons‘ myofascial pain and dysfunction; the trigger point manual. 2 ed. Baltimore: Williams & Wilkins; 1999.
2.Bubnov R. V. The use of trigger point dry needling under ultrasound guidance for the treatment of myofascial pain (technological innovation and literature
review). Lik Sprava. 2010 Jul-Sep;(5-6):56-64.
3.Bubnov RV. Evidence-based pain management: is the concept of integrative medicine applicable? EPMA J. 2012;3(1):13. doi: 10.1186/1878-5085-3-13.
4.Bubnov R. Trigger Points Dry Needling Under Ultrasound Guidance for Low Back Pain Therapy. Comparative Study. Annals of the Rheumati c Diseases
5.R. V. Bubnov, L. Kalika, L. Babenko MULTILEVEL EVALUATION OF MOTION AND POSTURE PATTERNS IN LOWER EXTREMITY AND SPINE USING
DYNAMIC ULTRASOUND Annals of the Rheumatic Diseases 77(Suppl 2):1699. DOI: 10.1136/annrheumdis-2018-eular.3949
6.Bubnov R, Kalika L. WIP18-0393 DRY NEEDLING UNDER ULTRASOUND GUIDANCE FOR LOW BACK PAIN ALLEVIATE NEUROPATHIC COMPONENT
AND INCREASE MOTION IN SPINE, PELVIS AND LOWER EXTREMITY. Pain Pract. 2018; 18(S1):87.
7.Bubnov RV. Ultrasonography diagnosis of peripheral neuropathy. The initial experience. Ultrasound Med Biol. 2011;37(Suppl 1):S144-5.
8.Bubnov RV, Ostapenko NV: Ultrasound diagnosis for diabetic neuropathy - comparative study. EPMA J. 2016; 7(Suppl
Dry needling (DN) of myofascial trigger points (MTrP) under ultrasound (US) guidance is e ffective method
for treatment myofascial pain, and restoring postural imbalance. Crosslinks among TrPs , m ovement
patterns in spine, pelvis and e xtremity a nd n europathic pain in lo w bac k p ain patients have not been
The aim was to e valuate efficacy of dry needling under US guidance for neuropathic pain treatment; an d
restoring joints motility and muscle functi on in spine, pelvis and lower extremity.
Material and Method
We included 23 patients, 10 male s and 13 females, (aged 18-55 yea rs) with clinically diagnosed low back
pain over 3 month with neuropathic component an d red uced motility in spine, pelvis and lower extremity.
We conducted precise physical t ests and neuromuscular ultrasound using M -mode and evaluated nerves
and motion in intervetrebral spaces, pelvis, intrinsic foot a nd l eg muscl es. Patients received DN of MTrP
under US guidance according to approach by Bubnov [PMID:23088743]. VAS (0-10) and Leeds
Assessment of Neuropathic Symptoms and Signs (LANSS) scores were measured before, immediately
after, 24 hours, an d 7 days afte r int ervention.
After 7 days, VAS scores showed pain improvement from 7. 6 to 2.3; LANSS scores improved from 15 to 4.
US demonstrated improvement n erve st ructure, increasing m otility, contractility (muscle contracted / rested
thickness) on M-mode during functio nal test s a nd wal king in al l le vels.
Our preliminary data demonstrated that DN under US guidance effectively reduce myofascial pain,
ameliorate symptoms of ne uropathy and local hypomotility. Further research needed for development US
patterns and study causation i n c hain spasticity-contractility- motion-neuropathic pain.
low back pain; neuropathic pain; dry n eedling
Ultrasound detected sciatic neuropathy (left) vs normal
After 7 days, VAS scores showed pain improvement from
7.6 to 2.3; LANSS scores improved from 15 to 4. US
demonstrated improvement nerve structure, increasing
motility, contractility (muscle contracted / rested thickness)
on M-mode during functional tests and walking in all levels.
The case of low back pain and sciatica
Female 67 y.o. Diabetes M type 2, obesity
Complains during one month on low back pain and sciatic pain, moderate
Evalutation physical, ultrasound (grey scale, M-mode):
Hypomobility was detected in the thoracic, lumbar level, right sacroiliac joint
Ultrasound revealed neuropathy in the right side (sciatic pain) contrary to
the left side.
Trigger points detected in multifidus muscles – correlated with sites of
and areas of spasticity in qudratus lumborm, soleus, plantar muscles, etc.
Dry needling of multiple TrPs – 2 sessions (multifidus, pelvic, foot, plantar
Effect: Full recover. Recommendations given
Case - right knee pain (largely medial)
female 67 years
- trigger points in back (multifidus R/L; quadratus lumborum R);
sacroiliac joint (SIJ) hypomobility - L;
additional TrPs in hip adductors muscles - R.
Note: basic TrPS on the back, evoking knee pain;
and SIJ hypomobility and needling on the
controlateral site (L)