Myofascial Pain Syndrome as a Cause of Acute Radicular Pain: A Case Study

Document Type : Case reports or series


1 M.D. Assistant professor, Physical Medicine and Rehabilitation Specialist, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 M.D. Assistant professor, Physical Medicine and Rehabilitation Specialist, Imam Khomeini hospital, Tehran University of Medical Sciences, Tehran, Iran


Background: Low back pain is a common disease among young people causing pain, disability, and loss of many valuable working days. Low back pain can have various causes, one of which, usually disregarded, is the myofascial pain syndrome, which is caused by trigger points in the muscles and which leads to occasionally acute low back pain with radicular patterns. Timely and correct diagnosis of the cause of low back pain can help greatly in opting for the appropriate medical plan.
Case Presentation: The patient is a 34-year-old man suffering from chronic low back pain for the last four years. He had been afflicted by acute radicular pain in his left leg because of intense physical activity the day before seeking treatment. In the examinations conducted, the patient’s straight leg raise (SLR) test result was positive at 20 degrees, his left leg’s Achilles reflex was absent, and he could not stand on his left toes. Through palpation of the gluteal area, several trigger points were palpated and discovered in the gluteus muscles, especially gluteus medius and piriformis. Conservative treatment including resting, medicine, and physiotherapy was initiated, which improved the patient’s conditions to some extent Subsequently, a dry needling process was conducted for the gluteal region trigger points. After the sixth session of dry needling, the patient improved significantly, his SLR test was negative, and he returned to his normal work.
Conclusion: Attending to various causes of low back pain with a radicular pattern, including myofascial pain syndrome, can help greatly in selecting an appropriate treatment plan. In the cases where low back pain is accompanied by active trigger points in muscles, dry needling and injection can help avoid invasive and expensive treatments.


1.            Zhang YG, Guo TM, Guo X, Wu SX. Clinical diagnosis for discogenic low back pain. Int J Biol Sci. 2009;5(7):647-58.
2.            Karas R, McIntosh G, Hall H, Wilson L, Melles T. The relationship between nonorganic signs and centralization of symptoms in the prediction of return to work for patients with low back pain. Phys Ther. 1997 Apr;77(4):354-60; discussion 61-9.
3.            Flax HJ. Myofascial pain syndromes--the great mimicker. Bol Asoc Med P R. 1995 Oct-Dec;87(10-12):167-70.
4.            Lauder TD. Musculoskeletal disorders that frequently mimic radiculopathy. Phys Med Rehabil Clin N Am. 2002 Aug;13(3):469-85.
5.            Travell J, Simons, D. General issues. In: Lippincott Williams editor. Myfascial pain and dysfunction the Trigger Point Manual,. Philadelphia: Lippincott Williams & Wilkins. Copyright. ; 1993.
6.            Han SC, Harrison P. Myofascial pain syndrome and trigger-point management. Reg Anesth. 1997 Jan-Feb;22(1):89-101.
7.            Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician. 2002 Feb 15;65(4):653-60.
8.            Adelmanesh F, Jalali A, Shooshtari SM, Raissi GR, Ketabchi SM, Shir Y. Is There an Association Between Lumbosacral Radiculopathy and Painful Gluteal Trigger Points?: A Cross-sectional Study. Am J Phys Med Rehabil. 2015 Mar 12.
9.            Saeidian SR, Pipelzadeh MR, Rasras S, Zeinali M. Effect of trigger point injection on lumbosacral radiculopathy source. Anesth Pain Med. 2014 Oct;4(4):e15500.
10.          Rainey CE. The use of trigger point dry needling and intramuscular electrical stimulation for a subject with chronic low back pain: a case report. Int J Sports Phys Ther. 2013 Apr;8(2):145-61.
11.          Itoh K, Katsumi Y, Hirota S, Kitakoji H. Effects of trigger point acupuncture on chronic low back pain in elderly patients--a sham-controlled randomised trial. Acupunct Med. 2006 Mar;24(1):5-12.