A Multi-Point Ultrasound-Guided Fascia Hydrorelease Protocol for Fascia-Derived Low Back Pain: A Clinical Protocol

Background/Objectives: Non-specific low back pain (LBP) is multifactorial, and psychosocial factors are often important. Densified fascial tissues of the thoracolumbar and lumbogluteal fascial system, seen as “stacking fascia,” may represent one under-recognized and treatable peripheral source; routine imaging assesses the disc, vertebra and nerve root but not these tissues [1]. The release points presented are representative examples, not an exhaustive list. The objective is to present a standardized, multi-point ultrasound-guided fascia hydrorelease (US-FHR) protocol for the fascia-derived component of LBP, identified by the Fascial Pain Syndrome (FPS) criteria [2] and a stacking-fascia appearance on ultrasound, after exclusion of red-flag disease and clear radiculopathy. Methods: A Protocol Development Framework (narrative synthesis of anatomy, neurophysiology and the authors’ clinical experience; no new prospective dataset) was used to define diagnosis/evaluation, the US-FHR procedure and a region-based multi-point protocol. Results: Fifteen release points, ordered from the lower thoracic to the sacroiliac region, cover the thoracic paraspinal/latissimus–TLF continuity, serratus posterior inferior, diaphragm–quadratus lumborum interface at Th12, lumbar interfascial triangle, quadratus lumborum, psoas major at L2, lumbar plexus, posterior midline ligaments, thoracolumbar fascia, multifidus and peri-facet fascia, iliolumbar ligament, ligamentum flavum/flavum–facet point, superior cluneal nerve, gluteus medius and superior gluteal artery, and posterior sacroiliac ligament. Each point is described by anatomical rationale, referred-pain pattern, technique concept and safety, with a representative ultrasound still. Conclusions: The protocol describes a peripheral component of LBP that may be identifiable and treatable, and is offered as the methodological basis for a planned prospective study distinct from the single-site TLF pilot NCT06818175 [3].