Abstract
Introduction Ultrasound is currently a powerful and valuable tool for assessment purposes and
for the performance of invasive procedures during physical therapy treatments, to
the extent that this technology is becoming essential for many of these techniques.
The evolution undergone by ultrasound-guided techniques in our profession derives
in the need to research the importance of the combined use of these two powerful tools.
Aims To demonstrate the importance of ultrasound guidance for the treatment of the quadratus
lumborum muscle and adjacent structures.
Material and Methods 20 volunteer subjects were evaluated (seven women and 13 men) aged 22 to 54 years
who were asymptomatic. Four freehand approaches were performed (two freehand approaches,
one approach on acupuncture point V52 and one approach described by Travell and Simons)
and two ultrasound-guided approaches (in prone and in side lying). Each approach was
performed twice by the same physical therapist. The freehand approaches were performed
by two physical therapists with over five years' experience in invasive physical therapy
techniques. The assessment and post-intervention measurements were performed by another
physical therapist with over five years' experience in ultrasound assessment and invasive
physical therapy techniques. Ultrasound-guided approaches were performed by a physical
therapist with over five years' experience in invasive techniques and ultrasound assessment.
The data were analyzed with SPSS statistical software for Windows.
Results Statistically significant differences were found between the freehand approaches
and ultrasound guided approaches regarding the ability to reach the objective/target
tissue (17.5% hit ratios compared to 100%), obtaining a mean distance in the failed
attempts of 0.5165cm (0.11-1.61cm). In 70% of the freehand approaches the needle was
found in the iliocostal muscle. Overall, during the freehand approaches, and without
considering the learning effect, the percentages of hits on the target decreased (from
17.5% to 11.25%) and the percentage needle placements on the iliocostal increased
(from 70% to 75%).
Conclusions During physical therapy procedures of the quadratus lumborum muscle and peripheral
structures ultrasound-guided approaches are essential to reach the target tissue effectively
and with safety.
