Complete Resolution of Low Back Pain Following Cesarean-Section Scar Injection with Trigger Point Injections: A Case Report
Availability
On-Demand
Release on Dec 22, 2025 12:00 AM Central Standard Time
Expires on Dec 31, 2026
Cost
Member: $0.00
Non-Member: Not Eligible
Student/Resident/Fellow: $0.00
Life Member: $0.00
Company: Not Eligible
Exhibitor: Not Eligible
Credit Offered
0.5 1B AOA; 1 AMA Credit
0.5 Non-Physician Credit

This free CME activity is exclusively available to members of the American College of Osteopathic Obstetricians and Gynecologists

Complete Resolution of Low Back Pain Following Cesarean-Section Scar Injection with Trigger Point Injections: A Case Report

0.5 AOA Category 1-B credits, 0.5 AMA PRA Category 1 Credits™

Release Date: December 22, 2025

Expiration Date: December 31, 2026


Background

Chronic low back pain (LBP) after cesarean section (C-section) often receives treatment focused on lumbar and gluteal musculature, while abdominal wall scar-related myofascial pain receives less attention. This case report describes a 53-year-old woman with refractory bilateral LBP and gluteal pain following three C-sections. Examination identified taut bands and tender regions along the C-section scar overlying the transversus abdominis, reproducing her symptoms with referred pain. A single trigger point injection (TPI) using 0.5% ropivacaine diluted with normal saline into the scar-associated trigger points produced immediate and sustained pain resolution through seven months, without adverse effects.

Learning Objectives

  • Identify clinical features suggesting cesarean section (C-section) scar related myofascial pain syndrome (MPS), including trigger points within transversus abdominis scar tissue and referred pain patterns contributing to chronic low back pain and gluteal pain.
  • Select an appropriate evaluation and initial management approach for refractory post C-section low back pain when exam localizes pain to the abdominal wall scar, including targeted palpation of the scar to reproduce symptoms and consideration of trigger point injection (TPI) into taut transversus abdominis regions using local anesthetic as described in the case protocol.

Faculty

Taylor Carmichael

Taylor Carmichael

Rowan-Virtua School of Osteopathic Medicine, MS-3

Taylor Carmichael is a third-year medical student at Rowan-Virtua School of Osteopathic Medicine. Her research focuses on clinical outcomes in sports medicine and women's health, with an emphasis on optimizing recovery and health outcomes. She is particularly interested in improving patient outcomes through data-driven clinical decision making. Following medical school, she plans to pursue residency training in general surgery with the goal of advancing evidence-based approaches to patient care.

Alexander King, D.O.

Alexander King, D.O.

Associate Professor of Osteopathic Manipulative Medicine

Originally from northern Virginia, Alexander King D.O. earned his Osteopathic medical degree at the Philadelphia College of Osteopathic Medicine in 2017, followed by a residency and board certification in Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine (NMM/OMM). During his PGY2 year, he completed the Helms Medical Institute (HMI) medical acupuncture fellowship. Dr. King is currently an Associate Professor of OMM, ONMM3 Residency Director, OMM2 Course Director, and Neuromusculoskeletal Institute Medical Site Director at Rowan-Virtua School of Osteopathic Medicine.

Disclosures

ACOOG requires each planner and presenter to identify all conflicts of interest, and mitigates risk of bias using a series of strategies for relevant conflicts. Unless otherwise noted below, the ACOOG, ACOOG staff and planners for this activity have no relevant financial relationships to disclose.

Ms. Carmichael and Dr. King have no relevant financial relationships with ineligible companies to disclose.

CME Accreditation

The American College of Osteopathic Obstetricians and Gynecologists is accredited by the American Osteopathic Association to provide osteopathic continuing medical education for physicians.

The American College of Osteopathic Obstetricians and Gynecologists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CME Credit Designation

The American College of Osteopathic Obstetricians and Gynecologists designates this program for a maximum of 0.5 AOA Category 1-B credits and will report CME and specialty credits commensurate with the extent of the physician’s participation in this activity.

The American College of Osteopathic Obstetricians and Gynecologists designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credits™.

Physicians should only claim credit commensurate with the extent of their participation in the activity.

ACOG Cognate Credit(s)

The American College of Osteopathic Obstetricians and Gynecologists designates this activity for Category 1 College Cognate Credits. Maximum Cognates are equal to the number of maximum AMA PRA Category 1 CreditsTM . A reciprocity agreement with the AMA exists that allows AMA PRA Category 1 CreditsTM to be equivalent to ACOG Cognate Credits.

NPs, PAs & CNMs

The American Academy of Nurse Practitioners Certification Board (AANPCB) recognizes activities approved for Category 1-A credit through the American Osteopathic Association and Category 1 AMA PRA Category 1 Credits™ as providing advanced practice CE content hours for applicants seeking renewal through continuing education credit.

The National Commission on Certification of Physician Assistants (NCCPA) recognizes activities approved for Category 1-A credit through the American Osteopathic Association and AMA PRA Category 1 Credits™ as Regular Category 1 CME for national certification maintenance.

The Certificate Maintenance Program of the American Midwifery Certification Board accepts AMA PRA Category 1 Credits™ to satisfy its contact hours requirement.

All NPs, PAs, CNMs and other health professionals participating in this activity will receive a certificate of completion commensurate with the extent of their participation in the activity. ACOOG strongly recommends all non-physician health professionals check with their certification/licensing organizations to confirm credit reciprocity.

Additional Information

System Requirements

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Requirements for Successful Completion

Participants must complete the pre-test, read the text-based content, pass the post-test (70% or greater), complete the activity evaluation, and claim credit.

Commercial Support

This activity is not commercially supported.

Disclaimer

This activity is for educational purposes only, offered by ACOOG. Physicians must rely on their medical knowledge, experience, and patient relationships for clinical decisions.

Use of Artificial Intelligence

ChatGPT and Google Gemini aided in the editorial review of the front matter and drafting assessment questions.

Grievances

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Data Use

Data collected as part of this activity may be analyzed as part of educational research to study the effectiveness of educational interventions on health care, population health, health care providers and others, or to identify additional needs and gaps for future interventions.

Refunds

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