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To use ultrasound (US) imaging to determine the validity and reliability of needle placement of two dry needling (DN) protocols for the lumbar multifidus (LM) in individuals with a high body mass index (BMI). Twenty-one participants with a BMI higher than 25 kg/m 2  completed the study. A US scanner was used to determine the location of needle placement after a 100 mm long needle was inserted in the LM at L4 and L5 following two DN protocols for the deep LM muscle. US images were saved and viewed 6 months later to determine the intra-tester reliability. The probability of reaching the deep LM muscle was high (85–95%) at L4 and L5. Although the needle reached a bony landmark 85–100% of the time, it only reached the vertebra lamina as intended 70–75% of the time. The intra-tester reliability of needle placements based on analysis of real-time and recorded US images was poor-to-moderate. Although the bony drop may not indicate that the needle has reached the vertebra lamina as the protocol intended, reaching a bony drop is still meaningful as it coincided with reaching the LM in the majority of participants.

Validity and reliability of dry needle placement in the deep lumbar multifidus muscle using ultrasound imaging: an in-vivo study