Sigh… Dry needling for persistent hip/QL pain?

Have been trying to shift right side lower back pain for what feels like 18months now if not longer. The daily routine of waking up sore then working through a battery of rehab exercises is getting a bit tedious and it’s really hard to tell if it’s making a difference.

I’ve been to see a variety of physios about it so if nothing else can be fairly confident it’s my quadratus lumborum being tight and over-active due to the usual lifestyle factors, too much sitting, underactive glutes etc.

Dry needling keeps coming up on Google as maybe being helpful, even if it just ‘de-tuned’ the muscle slightly so it didn’t keep taking over during my other exercises.

Anyone had it done for this reason? I’m sort of desperate enough to try it anyway…

I have similar back issues from Femoroacetabular impingement and general arthritis in the hip which means that I always put more pressure on the lower back, in particular those muscles.

Regular stretching, and moving around is the only thing that keeps on top of it.

Try all the potions / tech you like but thats trying to react to an issue rather than trying to stop it happening in the first place.

I have found sometimes that when its really bad, taking painkillers/anti inflammatory drugs for a period of time ie a week combined with lots of stretches does help calm it because I am not making it worse by feeling the discomfort.

Just keep moving around and plenty of stretching

Just out of interest, do you have any issues putting socks on, or sleeping on your side at night?

I have persistant hip and back issues too, I am sick of the physio exercises they never seem to improve enough that it goes away. However if I stop the exercises it definitely gets worse. So I’m resigning myself to its probably going to be this way forever more.

I’m currently trying acuptuncture, 2 sessions in, and all I can say is it f. hurts. Like to the point I’m not sure I can cope – turns out all my muscles are rock solid tight.

I had dry needling for something different, a verucca, many moons ago. Had a nerve block in the ankle and then the area was stabbed repeatedly. Once the nerve block wore off that really really hurt too. Not sure if they do the same thing for the hip. (it didn’t work by the way, what did was folic acid supplements!)

Ha, yeah, getting dressed is usually the first test of the day, I basically don’t bend at the hip properly 🙄

Sleeping on the side is fine though, I try to alternate and wedge a pillow between the legs. Changing position hurts but I suspect because it engages the sort QL which is already hypersensitive.

Femoroacetabular impingement and general arthritis in the hip

I think it’s purely muscular thankfully, range of motion and general mobility is OK, I think it’s the typical scenario of retraining glutes and hip musculature to do their job properly rather than dragging low back into it. The frustration is that the daily exercises often seem to aggravate it and I just wonder if forcing the QL to disengage a bit might help…

I had some done on my r piriformis a few months back – definitely made a difference at the fine level of relaxing the muscle, I could feel a difference stretching it afterwards.

Bigger picture it didn’t help much – I have a long term groin issue and there isn’t one obvious thing that is causing it, so it was more a let’s try this and see, as my piriformis was obviously tight.

So I’d definitely try a dry needling sesh – assuming a competent physio it won’t do any harm, it will definitely help the local muscle in question, and will hopefully help your back in general.

I had similar lower back pain on the left side that wasn’t going until I laid into it with my jigsaw massager a couple of times and now the tender area is dissappearing.

I originally bought one of those jigsaw massage attachments after seeing a post on here about something similair, and it was so good I bought a smaller Bosch 12V coordless jigsaw especially for it as the Dewalt was a bit bulky.

I often get ‘sore’ points appearing on my thighs, which the massager gets rid of, and last year I had a lot of issues with my right arm which the massager kept in check. (Now I have a gua sha scraping massage tool which has really helped fix the arm issues).

It has a ball attachment and a cone attachment and both of them are useful for different types of massage – with the cone for cross massage of muscles.

It is very powerful so a bit of a blunt tool and some care is needed – and dessicated coconut oil to lube the skin so as not to rip it.

The large amounts of power is good though as you can hammer the problem area and compare it to the good area on the opposite side of your body to help locate the issue. I did this with a knee issue which turned out to be problems at the back of the leg, which a physio failed to locate but reluctantly accepted was the issue when I pointed it out based on the tools ‘findings’.

Yeah, I get a bit of relief by leaning into a small massage ball, although as you say it does feel like a bit a of a ‘blunt’ instrument and I think also the QL tends to hide behind other muscles so I might just be tenderising my lats or something else to no good effect.

I’d hoped dry needling might be a bit more targeted although it does make me wondered just *how* skilled a practitioner you need to get the needles into the specific layer of muscle that’s causing the grief…

definitely made a difference at the fine level of relaxing the muscle, I could feel a difference stretching it afterwards.

I think that’s all I could hope for, if forcing QL to release a wee bit improved the quality and relevance of the other exercises I’m doing, as currently I’m always wondering how much benefit I’m getting vs. how much additional aggravation I’m causing…

I think it’s purely muscular thankfully, range of motion and general mobility is OK

I would have said mine is too. If I hadnt had a Labral Tear (and subsequent MRI) I wouldnt have though my hips were on there way out from a flexibility or movement perspective. Try scoring yourself on this for the funnies

Oxford Hip Score – Orthopaedic Scores

I went to see Wayne Peters with for physio. His exercises have done wonders for me, and he did some acupuncture on me. Completely freed up the muscles in my back, which then put the pressure back on my hip 🙁

I’ve had accupuncture for elbow forearm issues. Painter and was climbing loads just to clarify. I know it’s not a hip but for me the results were a miracle cure. The accupuncturist made me promise not to punch her before she started. It hurt a lot and I cried on the way home. Did the job though, this was after months of physio that had no effect.

I’ve suffered with chronic back pain also.

Strength traning has made a huge difference. Since start of year I’ve been trying to tie in some resistance days between the days I ride my bike; push/pull/legs (leg day is only some barebell back squats) . If I wasn’t riding I would have made much better progress. But my I don’t get back niggles, and my posture is so much better, on and off the bike.

Find it very hard to actually gain much muscle, but overall I feel much better for it. I think the mechanics of the body, the way you walk, and stand up etc all function better with some strength training.

I’ve had lower back issues relating to bulged discs at the bottom of my spine. Periodically I get muscle spasms that cripple me a bit.

I had physio last year so I know the exercises I can do to stretch it out and tend to do most of them almost daily. I find over time tension builds up and the stretching / strength if doesn’t sort that so I go for a sports massage every few months.

One of the sports masseuses does 45 mins of hard massage (brutal) then does 45 mins of needling. Just puts in needles in specific points and leaves them in for a while. I think it does help – not massively painful or anything (think they’re quite small) although sometimes it feels a bit funny.

Although I don’t particularly like the needles I think I feel more relaxed for longer than just a plain 60 mins sports massage.

I think the mechanics of the body, the way you walk, and stand up etc all function better with some strength training.

I think I agree, although my ‘general’ low back issues I think are caused by weak and fatigued low back muscles, which get particularly fatigued from cycling. I’m still oscillating between trying to relieve them by strengthening and engaging all the supporting muscles or going direct to source and trying to strengthen the specific low back muscles and lats. But yeah, the specific QL issue is a muscle function issue I’m sure.

Re: general low back pain though, the problem is how do you strengthen muscles which are perpetually fatigued from daily sitting and 5-6 hours riding a week? I have a horrible suspicion the solution is to give up riding for a 2-3 months to give the back a chance to recover and build up some endurance and strength. Shame I have a shiny new road frame coming in the post, I guess I could hang it on the wall as motivation for riding next year 🙄

Anyway, dry needling now booked, lets see how it goes.

Not on the NICE guidelines. Pretty much conclusively proven to be a ineffective treatment. My say job is spinal physio in the NHS. I generally avoid commenting on threads about msk pain because you know, work life separation.

it’s my quadratus lumborum being tight and over-active due to the usual lifestyle factors, too much sitting, underactive glutes etc.

Same here. Although mines my left side. Mine went into proper spasm, pulled a vertebra out of alignment etc. Physio releases the QL, but what’s made the difference to stop it tightening again is doing weighted hip thrusts in the gym to properly give my glutes a kicking and wake them up (glute bridges etc on my bedroom floor didn’t achieve a lot. Body weight+ on an olympic barbell made an almost immediate difference.)

I’m not sure you need to “give the muscles a rest”. If you get your glutes working properly, the QL will get a rest by default because the glutes are taking their share of the load.

As a side benefit, I’m feeling massively more punchy on the bike after only a month or so of work.

Good to hear! Yeah bodyweight squats and/or glute bridge feel good but my god it was a battle to find correct form for the glute bridge! It seems so difficult to prevent the QL taking over again, but once I finally got it it feels great. First squat of a set is the ‘test’ squat while I find form again, I usually feel the QL for the first one then get it under control.

Body weight+ on an olympic barbell

I’m not ready for 85kg on a 20kg barbell though!

Re: “giving muscles a rest”, I’m confusing matters by talking about ‘general’ low back pain in the same thread (hey, it’s my thread, I’ll hijack if I want to 😎). The reference to resting my low back muscles is the little erectors at the base of the spine which always get sore and cranky after any sort of committed bike ride, presumably because they’re held in tension for 1-5hrs and don’t have the capacity for it. I don’t want to start throwing deadlifts and good mornings at them when they’re in this state of crankiness hence thinking I needed a month or two off bike so they can recover before I start hitting them harder and building them up.

Maybe don’t stop riding, but cut down to something like twice a week, and then some weight training on 3 or 4 of the days your aren’t riding (I never weight train and ride on the same day).

I bet after a few weeks you’ll start to notice feeling better overall.

Barbell squats are great, and quite easy. I started light and am steady increasing. Only up to 65kg now. I need to give deadlifts a go. I have to admit I am wary of deadlifts after being living with chronic back pain. But squats don’t seem to have the same percieved risk (to me).

Also, bent over barbell rows really work, all of the back including the erectors, but start with light weights!

Like I said, I do a pretty basic push day (chest, shoulders and tricepts), pull day (arms and back) and a leg day (squats). And days between them are club rides etc. After leg day is a good day to have a proper rest day!

Also sitting. A a long term sufferer I know what you mean. My back gets cranky if I’m ill/have a cold and don’t do much for a week apart from lots of sitting around. I try and get up and walk around the office every 30 mins, any excuse just to change position.

It really is the hip thrusts that make the difference. I do dead lifts and RDLs as well, but adding the HTs into my circuit is the one that suddenly woke up my glutes and really dampened down my QL problems. I think its one of those very muscle specific excercises and its also remarkably easy to end up moving big numbers. I’ve not done them for a few years, but first session – started at 60kg, ended up at 90 and it felt fairly easy. (I weigh 65kg)

I have a horrible suspicion the solution is to give up riding for a 2-3 months to give the back a chance to recover and build up some endurance and strength

This is what I did, I pretty much stopped riding in Nov, and started again in Easter. It has got me out of the worst of it, but it hasn’t gone away and I still have bad days.

Going to try hip thrusts as I find bridges do nothing, even single leg ones.

I find when I do lunges my knees try to bend inwards and not work in a vertical line. i presume this is one of the naughty muscles trying to take over instead of using the glutes. It takes a lot of concentration to make sure its vertical. Would the QL do that?

Knees inward is glute medius I think, crab walks are your friend and really hit the glutes as well!

Edit: saw this video last night, good guide to crab walk. Am still not a fan of single leg glute bridge though…

Alternatively (my theory, not a trained physio) I think my adductors are weak and thus fatigue quickly and get tight. This causes imbalances etc. but would also potentially pull the femur into the midline. I’m going to work some lateral lunges and/or Copenhagen planks back into my routine.

Feeling generally a bit better this morning for doing some gentle low back extensions over a gym ball. I think the actual movement as much as anything got the low back muscles to relax a little bit 🙄