I see often older men wearing belts who solemnly come in with nerve-like pain level at low back and flank level. I tell them I can treat this – but they are going to laugh – because what is a good portion of the pain is cluneal nerves crushed by the waistband as it crosses the wing of the hip ilium. Muscles become tight, facets and sacroiliac pulled out of alignment, iliac crest starts to rub on ribs, and the pains go down hill from there. Lack of sleep and low resultant testosterone make it worse. Treating the pain is now a mess because you have to work ribs out of pelvis and deal with Quadratus lumborum spasms. These tissues also get tenderized by chronic back pains and need treatment in their own right.
- belt-wearing people – often older men – have seen maybe 7 cases +
- Chronic somewhat Neuropathic level back pain
- Point sensitivity in middle of waistband impression
- Response to repeated D5W sugar water injections + work on Quadratus lumborum + gluteal muscles
Injection analogous to dextrose injections of low back nerves for recalcitrant back pains:
Prolotherapy for recalcitrant lumbago.
Australas Musculoskeletal Med 2008;13(5):18-20.
Injected subjects an average of 6.2 times (2-16) over an average of 8.3 weeks (1 – 1+ weeks) in tender skin nerve tracts:
Results were not obvious in first couple session but were down 50% by 4 injections and much better with 6+.
Results are breathtaking for just injecting sugar water.
I have found the quadratus lumborum muscle is often very spastic and painful. Surprisingly, injecting the skin nerve tracts will relieve the QL spasm half the time.
If you pinch flank (assuming you can because bottom rib might end up on hip crest) – if you dig in, you can grab it tight.
Quadratus lumborum band is only about a finger’s breath in thickness and the more anterior of the back muscles:
What will surprise you and the patient is that it will be much more tender on the front side palpated. I pinch it with both hands and shake it back and forth at least 120 times to see if it can be shook out. One of four cases ( a woman with a small muscle) could be shook out.
It is used by chiropractors to thump joints, but if I press my thumb hard onto the deep quadratus lumborum over L3 or lower, and thump hard while pressing 60-80 times, suprisingly, the quadratus will often come out. Patients are often amazed how much pain relief occurs.
The Chinese call L3 deep QL the Third Lumbar Transverse Process Syndrome, and knife area with acutomy or inject botulinum into it with significant effects on low back pain.
If the muscle does not come out then I inject it laterally – put one finger on either side of strip and inject in between.
If the ribs are below the iliac crest then the QL is felt below the anterior superior iliac spine in the pelvis just below the anterior rib edge and will be very tender there. I will inject there and inject down from just above ilaic crest into it.
After that is almost a magical technique where you stretch muscle after it was contracted and then relaxed:
Lay with bad side up.
Put a latex gloved hand (good traction) just above iliac crest and tell patient to hike iliac crest up against your hand.
After about 15 seconds request patient to RELAX the muscle and thrust down towards toes with hand on iliac crest brim laterally.
Repeat 3 times and knuckle area about iliac crest. You will get a profound relaxation of QL if you have previously softened it up with shaking, activator and maybe injections. The relief of back pain is immediate and amazing if you are dealing with just muscle back pains.
- If the ribs have been rubbing in the pelvis then the rib and iliac crest edges will be painful, and only a cortisone shot to areas seems effective.
- With cluneal nerve tenderized, the spinal segment from which the pains arise from will be in spasm and their facets sore.
- I will inject the paraspinous muscles and work the facets, though J. Maigne who defined this syndrome would inject facets with local and steroid.
- All that muscle spasm can cause lower facets and sacroiliac joint to rotate and necessitate work on them.
- In severe form, the whole region can spasm with piriformis spasm, gluteus medius tendonopathy, and gluteal muscle triggers become issues too.
I hope to have shown you how one problem can blossom into multiple issues all requiring treatments.
I am amazed how much relief can quickly be achieved, and how simple the problem really is.