Patient Position: Prone on fluoroscopy table.

Indications: Myofascial pain in muscle groups secondary to areas of ischemia in those muscles as a result of reflex muscle and vascular spasm. This is often secondary to prolonged imbalance in posture from chronic low back pain.

Needle Size: 22-gauge, 88-mm Quincke spinal needle.

Medication/Volume: 0.25 to 0.5% bupivacaine, 10 mL per muscle group. Decrease the dose by 20% if more than one group is injected.

Anatomic Landmarks: Piriformis injection: The muscle attached proximally to the anterior border of the sacrum and distally to the superior border of the greater trochanter of the femur. Under fluoroscopy in the anteroposterior view, identify the greater trochanter, the head of the femur, and the neck of the femur.

Quadratus lumborum injection: The muscle is attached superiorly to the inferior border of the 12th rib and inferiorly to the internal lip of the iliac crest. Under fluoroscopy in the anteroposterior view, identify the iliac crest in the lumbar back.

Psoas muscle injection: The proximal attachment is the sides of T12-L5 vertebrae, and the distal attachment is the lesser trochanter of the femur. Under fluoroscopy in the anteroposterior view, identify the L3 vertebral body and transverse process.