Low Back/Hip

Question 1

Pain can develop from a lifting and twisting mechanism or insidiously (without known cause). Pain can be severe, often worse with lumbar flexion, prolong sitting or standing (all increase pressure on disc) and bearing down (trying to move bowels, cough, sneeze). Sore, achy, dull back pain can present and/or dermatome and affected nerve root radiculopathy. LBP can be absent and dermatome and affected nerve root pain can be present instead.

Answer 1

Disc Syndromes

Question 2

Special Tests for disc syndromes

Answer 2

Slump Test

Straight Leg Raise

Question 3

Local stagnation of Qi and Blood in Du Mai. Deficiency in the discs and possibly supporting
musculature can relate to LV Blood Deficiency, Kidney Yin/Yang/Jing Deficiency

Answer 3

Diagnosis of Disc Syndromes

Question 4

Disperse stagnation, regulate local circulation of Qi and Blood,
Local: Huatuojiaji points4 of the effected levels as well as above and below those levels, BL25, BL23
Distal: BL40, BL58 (Ah Shi), SI3 + BL62 Use Yaotongxue in acute pain case
Other points: GB34, KD3, BL54, BL37, BL58

Answer 4

Points and treatment principle for Disc Syndromes

Question 5

Pain tends to be located over the joint and ligaments at BL28 through to BL30 and can radiate into the buttocks. Pain presents with the act of sitting and standing,

Remember, myofascial trigger points in the quadratus lumborum, piriformis and gluteus medius can refer pain here. Be sure to rule out referred pain. Pathology with the SI ligaments will inhibit firing of the glute medius and will need to be addressed with treatment

Answer 5

SI Joint/Ligament pathology

Question 6

Special Tests used for SI Joint/Ligament Pathology

Answer 6

Gillet Test
Gapping Test
Approximation Test

Question 7

Diagnosis of SI joint/ligament pathology

Answer 7

LV/SP Blood Deficiency, Q/B Stagnation

Question 8

Local: BL28, BL30
Distal: BL58, BL59, SP6
GB41, TW5
Needle SI Joint along BL28 to BL29 Needle Glute Medius IZ

Answer 8

Treatment points for SI joint/ligament pathology

Question 9

Acute Pain lasts

Answer 9

3-4 weeks

Question 10

Subacute Pain lasts

Answer 10

12 weeks

Question 11

Chronic Pain lasts

Answer 11

longer than 3 weeks

Question 12

Mechanism usually involves decelerating (eccentric phase) the lower limb such as in running. Pain can occur at the distal musculo-tendinous junction, in the muscle belly or at the origin at the ischial tuberosity. Patients will often report they heard a snap followed by pain. Bruising can be significant. Special Testing: RROM, AROM, not so much with PROM unless stretching the muscle.

Answer 12

Hamstring Strain

Question 13

History of SP or LV Blood Deficiency, Q/B stagnation of the BL or LV meridian

Answer 13

Diagnosis of Hamstring Strain

Question 14

Acute hamstring strain tx

Answer 14

Gentle Tuina to reduce edema and scar tissue malformation Internal or external herbs to treat the injury

Question 15

Injury at medial hamstring musculo-tendinous junctions LV8, LV9

Injury at bicep femoris musculo-tendinous junctions BL38, BL39 Ah shi in muscle belly

Injury at its origin at the ischial tuberosity
Tuina performed transversely against muscle fibers at site of injury to “break up” scar tissue adhesions
Sliding cups over site of adhesion
Ah shi into site of strain
BL58
Gentle stretching (depends on stage of injury)

Answer 15

Chronic Hamstring Strain

Question 16

Pain in buttock, can radiate to the hip, the coccyx, down the back of the thigh (sciatica). Restricted hip abduction and internal rotation due to pain. + SLR if performed with internal rotation of the hip, “pins and needles” in calf or foot can be present if sciatic nerve is impinged. Must differentiate between nerve impingement (pins and needles) and myofascial pain (dull, achy, sore).

Answer 16

Piriformis Syndrome

Question 17

Special Testing for Piriformis Syndrome

Answer 17

PROM hip abduction and lateral rotation

Question 18

a symptom rather than a diagnosis of what is producing pain, numbness, tingling or weakness. This symptom can include myofascial, nerve root or sciatic nerve pain which radiates from the low back or buttock inferiorly, past the knee. The pain can radiate all the way to the foot.

Answer 18

Sciatica

Question 19

Sciatica can be caused by a number of things…

Answer 19

a. Lumbar disc herniation (KD DEF)
b. Piriformis syndrome (LV/SP Blood DEF/Stagnation)
c. Sacro-iliac strain (LV Blood Deficiency)
d. Intraspinal tumor (Phlegm generally)

Question 20

Local: Huatuojiaji of effected levels with lumbar disc herniation
GB30, BL54, BL53 and piriformis syndrome points if piriformis is the cause.
Distal BL40, BL58, BL57, GB34, GB40, BL60

Answer 20

Treatment for Sciatica

Question 21

Pain can be referred to the lower back along the inner BL line to the Huatuojiaji points or to the anterior portion of the thigh. Worse when lying supine with the legs straight.

Answer 21

Ilipopsoas injury

Question 22

Local: ST31, BL23, Huatuojiaji points of the lumbar vertebrae Distal: LV8
Illiacus needling
Hip flexor stretching with hip extensor strengthening exercise

Answer 22

Iliopsoas injury

Question 23

Pain is mostly found over the groin and anterior portion of the hip but can also refer to the, buttock, inner thigh or knee. Worse on waking, toothache like pain. Reduction in hip Internal rotation and/or internal rotation with pain. Pain is sharp at times with residual soreness post activity.

Answer 23

Osteoarthritis

Question 24

irritating structures (boney, bursitis) but some patients report the snapping without pain.
an be a result of many causes. Patients will think the hip is subluxing (popping out of the joint
then quickly popping back in) but this is highly unlikely.
Pain can be sharp especially if the friction is
External snapping: A tensioned IT-band (TFL) or glute maximus tendon riding over the greater
trochanter of the femur. The snapping or popping, which tends to be felt more laterally, can occur during
hip flexion and extension especially if the hip is medially rotated. Trochanteric bursitis would be made
worse as a result or be caused by this.
Internal snapping: Can be caused most commonly by the tendon of the iliopsoas slipping over the bony
ridge of the lesser trochanter or anterior acetabulum. The iliofemoral ligament riding over the femoral
head can also cause this internal snapping. The degree in which the snapping is felt is when the patient
moves the hip from extension into flexion at around 45 of flexion. This snapping is sometimes
accompanied by pain.
Intra-articular snapping: Patients between the ages of 20-40 would complain of sharp pain in the groin
and anterior thigh, especially with weight bearing pivoting movements. This is a result of degeneration or
trauma to the joint resulting in loose bodies or acetabulum tears.

Answer 24

Snapping Hip Syndrome