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

Background and Objectives: Non-specific low back pain (LBP) is multifactorial. Fascia of the thoracolumbar and lumbogluteal system showing stacking fascia—a layered, hyperechoic ultrasound appearance—may be an under-recognized peripheral source; routine imaging assesses the disc, vertebra, and nerve root but not these tissues. The objective is to describe a multi-point ultrasound-guided fascia hydrorelease (US-FHR) protocol, based on our clinical experience, for LBP in which involvement of the fascia is suspected from the history, the physical findings, and stacking fascia on ultrasound, after excluding red flags and clear radiculopathy. Methods: Narrative synthesis of targeted literature searches and our clinical experience; no formal consensus process or new prospective dataset. Results: Fourteen release points are described with rationale, technique, safety notes, and an ultrasound still. Conclusions: The diagnostic steps and their correspondences with the release points are based largely on our clinical experience and have not been validated. US-FHR is proposed not as a stand-alone treatment but as one element of multimodal care, in which the period of pain relief is used to resume active exercise. It is offered as the basis for prospective validation studies, distinct from the single-site thoracolumbar fascia (TLF) pilot NCT06818175.