Case Study: Occupational Hip and Low Back Pain

Our Patient

Our patient was a 55 year-old male employee of the Metropolitan Transportation Authority (MTA). The patient’s job required heavy manual labor. He came to us complaining of hip and low back pain.

The Challenge

The patient’s job did not allow ample recovery time for standard physical therapy and injury rehabilitation to provide significant relief.

Exam and Diagnosis

Our exam revealed multiple myofascial trigger points and areas of fascia densification that were affecting the patient’s low back and hip region.

Trigger points were identified in the following areas:

  • Shoulder rotator muscles
  • Serratus posterior inferior
  • Quadratus lumborum
  • Thoracolumbar fascia
  • Multifidus muscles
  • Lower thoracic region
  • Right sacroiliac joint (SIJ)


Fascia abnormalities were detected in the thoracolumbar region, which we suspected were the primary source of the patient’s hip pain.

Our Treatment Approach

We approached the patient’s condition with a targeted treatment regimen using ultrasound-guided dry needling to deactivate trigger points. This technique involved the precise insertion of dry needles into specific trigger points under ultrasound guidance. To address multiple fascia densifications, we used Stecco fascia manipulation and various shockwaves.

Final Results

Our combined approach of ultrasound-guided dry needling, fascia manipulation and shockwave therapy proved to be highly effective. The patient reported significant pain relief, improved mobility, and significant improvements in posture.


This case report demonstrates that a successful combination of fascia manipulation and ultrasound-guided dry needling is a valuable therapeutic option for managing pain and mobility issues. Our results suggest the potential for broader applications of dry needling in the treatment of various musculoskeletal conditions.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

Buy now 3D Gait
Payment Success
Request Telehealth Request Telehealth Request in office visit Book now