Dry Needling to the Multifidus Muscle in Subjects With Low Back Pain
Condition: Low Back Pain, Mechanical
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      To examine for differences in contraction thickness of the transversus abdominis muscle in
      symptomatic subjects with mechanical lower back pain following the application of dry
      needling to the lumbar multifidus muscles.
    

Detailed description: 
      Consenting subjects will be pre-screened for contraindications for dry needling and whether
      or not they meet the criteria for low back pain. Following acceptance and prior to
      intervention sessions, subjects will complete a pre-participation questionnaire. This will be
      used to check for any needle phobia or previous adverse reactions to needling in prospective
      subjects and analyze potential confounding variables within the subjects participating. Once
      consented and accepted into the study, subjects will be taught the deep corset contraction
      (DCC), which is the isolated co-contraction of bilateral transversus abdominis and the deep
      fibers of lumbar multifidus. Following DCC training, the subject will have a real-time
      ultrasound transducer applied to the lateral abdominal wall in order to image the three
      abdominal muscle layers external oblique, internal oblique and transversus abdominis. A
      relaxed state measure will be taken from the ultrasound image. Subjects will then perform the
      DCC and a second measure of the abdominal muscles will be taken. A percentage thickness
      change will be calculated. Prior to treatment, subjects will have been randomly assigned to
      one of 2 intervention ordered groups: 1) Dry needling: subjects will be placed prone and dry
      needling to the bilateral multifidus muscles will be performed. Subjects will sense light
      pressure and their skin will be penetrated by the needle. 2) Sham needling: subjects will be
      placed prone and the plastic tubes which house the needles for dry needling will be pressed
      into the bilateral multifidus muscles.Subjects will sense light pressure, but their skin will
      not be penetrated. All needling and sham needling interventions will be performed under
      "clean needle" conditions using appropriate skin preparation and use of clean protective
      gloves by the PI. The needles used will be single-use disposable acupuncture-style needles
      which come in a plastic tube for easy insertion. Dry needling techniques are techniques that
      many practicing therapists use for various musculoskeletal conditions, and are also taught by
      the PI as part of the requirements for the Doctor of Physical Therapy degree. For this study,
      all needling and sham needling interventions will be performed by the PI who has over 27
      years experience in such interventions. Immediately following the needling or sham needling,
      the real-time ultrasound will be reapplied to measure thickness of the abdominal muscles in
      the relaxed state and contracted state using the DCC, and percent changes will be calculated.
      Measurements will be collected by one of three independent researchers who will be blinded to
      the intervention. An average of 3 measurements will be used to calculate the percent
      thickness change after the treatment. In addition, the PI performing the needling will remain
      blinded to ultrasound measurements. Subjects will then be contacted by phone 48 hours as well
      as one week after the intervention was given in which they will verbally complete
      questionnaires regarding their degree of pain and level of disability.
    

Intervention name(s): Dry Needling; Sham Needling
Intervention type(s): Procedure; Procedure
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment