A Comparative Clinical Evaluation of Ultrasound-guided Acupotomy Combined with Extracorporeal Shock Wave Therapy for Nonspecific Low Back Pain

Summary

This study evaluates a structured protocol for ultrasound-guided acupotomy combined with extracorporeal shock wave therapy for nonspecific low back pain, focusing on pain relief and improvement in lumbar function.

Abstract

Nonspecific low back pain (NLBP) is a prevalent condition associated with pain and functional limitation. This study evaluated the therapeutic efficacy and procedural feasibility of ultrasound-guided acupotomy combined with extracorporeal shock wave therapy (ESWT) compared with monotherapy approaches for NLBP. A total of 90 patients with NLBP were randomly allocated to three groups (n = 30 each). In the acupotomy group, trigger points within the lumbar erector spinae muscles were identified by palpation and treated using acupotomy. In the shock wave group, ESWT was applied to painful areas using an energy density of 0.10–0.20 mJ/mm² at a frequency of 10 Hz. In the combined group, ESWT and acupotomy were performed sequentially under ultrasound guidance. Clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores before treatment and at a 2-month follow-up. Therapeutic efficacy was additionally assessed in accordance with the Traditional Chinese Medicine Syndrome Diagnosis and Efficacy Standard. Baseline scores were comparable among groups (p > 0.05). After treatment, the combined group demonstrated significantly lower VAS and ODI scores, higher JOA scores, and a higher overall effective rate (93.33%) compared with the monotherapy groups (p < 0.05). This study presents a structured protocol for combining ultrasound-guided acupotomy with ESWT for NLBP and demonstrates improved short-term clinical outcomes compared with monotherapy.

Introduction

Nonspecific low back pain (NLBP) is a general term used to describe a type of low back pain in which no clear pathological or anatomical changes can be identified upon diagnosis, and for which there is no definitive clinical cause or objective test findings. If symptoms have persisted for three months or longer, the condition is diagnosed as chronic nonspecific low back pain¹. Although most patients with NLBP present with acute and self-limited symptoms, NLBP is often persistent and difficult to treat because of its multifactorial causes². Approximately 7.3% of the global population is affected by NLBP, and nearly 500 mi....

Protocol

This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the Second Affiliated Hospital of Qiqihar Medical University (No. [2024]92). Written informed consent was obtained from all participants. The research tools used in this protocol are listed in the Table of Materials.

1. Study participants

A total of 90 patients with NLBP admitted to the Second Affiliated Hospital of Qiqihar Medical University between January 2025 and November 2025 were enrolled in this randomized controlled trial and allocated to three groups (n = 30 ....

Results

A total of 90 patients were enrolled in this study and randomly allocated to three groups, with 30 participants in each group. The flowchart of patient enrolment and allocation is shown in Figure 1.

In the acupotomy group, there were 18 men and 12 women, with a mean age of 47.73 ± 8.68 years. In the shock wave group, there were 16 men and 14 women, with a mean age of 47.70 ± 10.51 years. In the combined group, there were 15 men and 15 women, with a mean age of 47........

Discussion

Nonspecific low back pain (NLBP) is a common musculoskeletal condition characterized by pain and functional limitation without clear nerve root involvement or identifiable spinal pathology¹⁸. This study evaluated the therapeutic efficacy and procedural feasibility of ultrasound-guided acupotomy combined with extracorporeal shock wave therapy (ESWT) for patients with NLBP. The results demonstrated that the combined treatment group showed greater improvements in pain and lumbar function scores after.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Acupotomy needle	Jiangsu Huayou Medical Devices Co., Ltd., Suqian, China	0.40 mm × 50 mm	Used for soft tissue release during acupotomy.
Extracorporeal shock wave therapy device	Zimmer MedizinSysteme GmbH, Tuttlingen, Germany	enPuls Version 2.0	Used to deliver extracorporeal shock wave therapy (ESWT).
G*Power software	Heinrich Heine University Düsseldorf, Düsseldorf, Germany	NA	Used for a priori sample size estimation and statistical power analysis.
Portable color Doppler ultrasound system	Shenzhen Huasheng Medical Technology Co., Ltd., Shenzhen, China	Clover 60	Used for ultrasound guidance during acupotomy and treatment-site visualization.
SPSS Statistics	IBM Corp., Armonk, NY, USA	SPSS Statistics Version 26.0	Used for statistical analysis of study data.