Effective Pain Relief and Functional Improvements with Dry Needling for Obturator Internus Injury: A Case Report

Case Diagnosis: A 36-year-old female sustained an obturator internus injury presenting as sharp sacral and coccyx pain, difficulty transitioning from sitting to standing, and an antalgic gait with decreased cadence following a fall on her buttocks while descending stairs.

Case Description or Program Description: The patient reported severe pain and moderate disability, scoring 7/10 on the numeric pain rating scale (NPRS), 28% on the Pelvic Girdle Questionnaire (PGQ), and 32% on the Oswestry Low back Pain Disability Questionnaire (OLBD-Q). Examination revealed point tenderness and increased referred coccyx pain upon palpation of the right obturator internus, while the left side was unremarkable. Dry Needling (DN) was performed with two needle insertions into the right obturator internus belly near its origin within the obturator canal.

Setting: An outpatient rehabilitation center where the patient was assessed for pelvic pain.

Assessment/Results: Following the DN treatment, the patient's NPRS score decreased to 0/10, surpassing the minimal clinically important difference (MCID) of a 30% change. Functional outcomes also showed improvement, with her OLBD-Q score dropping to 2% (30% improvement), and her PGQ total score decreasing to 2% (26% improvement), both exceeding clinically meaningful thresholds. The patient tolerated the DN well without adverse effects.

Discussion (relevance): This case highlights the potential efficacy of DN as a treatment for managing musculoskeletal pain resulting from an obturator internus injury. Prior literature focuses on conservative treatments, with limited reports on DN targeting this muscle. The observed immediate pain relief and functional improvements suggest DN may be a promising intervention. Expanding research in this area could help refine clinical approaches to musculoskeletal pain.

Conclusions: DN demonstrated notable benefits in reducing pain and improving function in a patient with an obturator internus injury. These findings support the potential role of DN as an alternative or complementary intervention for musculoskeletal conditions. Further research is needed to explore its long-term effectiveness and broader clinical applicability.