Hi everyone,

I am co-treating a patient with another PT who comes to us for increased urgency for bowel movements with sitting and radicular sx into LLE. She has had various surgical intervention recommendations including fusion, L hip replacement, laminectomy, and arthroscopic surgery to her low back. She wishes to explore skilled therapy intervention to address symptoms including radicular pain down the left leg on the lateral aspect of her thigh. She has point tenderness on left piriformis and gluteus medius/ minimus. She reports poor positional tolerance requiring her to change positions every few minutes along with intermittent urge to pass a bowel movement when sitting. She does remember a fall in 2020 that did not result in any known fractures or significant immediate symptoms. She is concerned this incident could of set off her cascade of symptoms/ tissue damage. She did have an operation for an inguinal and femoral hernia in February 2025. Sitting recreates burning sensation and radicular symptoms that are down the L leg that stop at the knee. She did not tolerate extension biased spinal movement and they actually increased her sx. 

My question is, are there any contraindications or red flags for dry needling due to her urgency of bowel movements with sitting. I'm uncomfortable needling her spine, sacral or hip regions due to symptoms and recent inguinal/femoral hernia repair. 

What are your thoughts?

I appreciate the help,

Maxine