By Salin Perayotyucol/Webb, R.AC, R.TCM.P
James was a patient who came in specifically for lower back pain. He was a 65 year old truck driver. He said he suffered from back pain for many years. Pain was more on the right side of lower back and ran down to the right side of his leg above the right knee.
I noticed that when he walked into my office, his right leg was shorter and his right hip was elevated. His right shoulder was also dropped down. His right knee was higher than the left. Examination showed local tenderness on L4 vertebrae. With manual muscle tests I found that his left iliac crest was lower in reference to the right iliac crest by observing hand placement and positiveTrendelenburg test as the right iliac crest rises (right gluteus medius weakness ). I inserted the needles on acupuncture points on Pigen , 1 cun inferior to Pigen, Yao Yan, GB29, GB30, BL54 and Jian Kua, Additionally I add sensitive points of the gluteus medius and gluteus minimus muscles. These points are found inferior to the iliac crest over the board area of the iliac fossa, superior to GB29 and Jian Kua. After the generation of needling sensation, I retained the needles for 30 minutes . After the needles were removed, the patient felt a pain relief instantly and he slept well that night. The next day, he indicated the pain was much better by 40% and we continued with the treatment two time a week for 2 months with exercise. A follow-up in three months showed the patient resumed regular activities without any pain. I also recommended him to strengthen his weak muscles and stretch his tight muscles by performing a series of exercises:
|Hip Hiking (right side)||Quadratus Lumborum (QL)
|Dropped Hip (left side)||Hip Abductors
Tensor Fasciae Latae
Note: Hip hiking is caused by tense QL, Hip flexors, and Hip Adductors so we need to stretch them. Consequently, adductor muscle antagonists (abductors) will become lengthened and possibly even weaker, so we need to strengthen the abductors. Dropped Hip is caused by weaken QL, Hip Flexors, and the adductors, so we need to strengthen them. However, we need to stretch the abductors and tensor fasciae latae which are tight.