Another hidden source of lower back pain is irritation of the superior cluneal nerve, coming from dysfunction at the thoraco-lumbar junction. I have been working with the Maigne syndrome concept for at least 3 months, as of December 2011. It has made me see the integration of the thoraco-lumbar and the lower back and pelvis more clearly. If this concept is new to you, read my article first. Since writing the article, I have been observing my patients. Here are some thoughts. First, it is so wonderful to have a clear indicator. In this case, the clear indicator- Maigne’s gluteal point- is the hot spot, the knot, about 7-8 cm lateral to the midline, just below the iliac crest. If you don’t get rid of this knot, you have not succeeded.
A sixty-something-year-old male comes in with thoracic stiffness and lower back pain. The lower back pain would occur on various motions. He had previously been quite active, living on 3 acres and taking care of his property. He had been involved in a vehicle accident, rear ended, several months previous. His previous chiropractic care and massage had seemed to make him worse rather than better, he would spasm the day after the treatments. The key findings on exam included stiff hips, he couldn’t internally rotate beyond 10 degrees on both sides. He was very rigid throughout the thoracic spine. It was hard to elicit tenderness in the thoracic spine, as his muscles were so tight. His lumbar motion was fairly normal, with some pain at the extremes of motion.
We could do better. We meaning all of the therapists trying to help all of our patients. The world of hands on care is very subjective, and we are the seven blind men looking at the elephant. We tend to see and touch through our own limited training, and our current passions. I would like to see us have a bigger view, and see the patterns more clearly. I would like us to engage our patients, and teach each of them what they can do to help themselves.