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October 29, 2004

More On Low Back Case Study

In my three-part case study about a client's low back pain, I'm writing again as a follow-up to that case. More work has been done focusing on a pain pattern above the right illium that wrapped around toward to front of the body. This area was exquisitely sore, luckily with no electrical sensation, so I chose to gently coax the tightness out of that area. I also followed-up with heat and deep work in the gluteals and lumbar region.

Today, I focused on pain that centers around the greater trochanter of the right hip. The pain wakes the client up in the night forcing them to turn from a right side-lying position to their back for relief. The gluteal muscles and deep hip rotators exhibited little pain upon palpation, however, the right gluteal muscles continue to jump and spasm (without pain) when pressure is applied.

I palpated the hamstring attachments at the ishial tuberosity--no pain until I hit #37 (from Bonnie Pruden's Pain Erasure); then the pain jumped to an eight on the pain scale. I followed a tension line down the posterior aspect of vastus lateralis to another common hot-spot in the lateral calf muscle, also an eight on the pain scale. Then the client reminded me about a numb spot that sometimes tingles which had developed on the heel of the right foot about two years previous. I immediately considered nerve damage.

Studying the anatomy of the leg, I've found that numbness in the heel indicates a possible sciatic nerve condition. The heel is innervated by the the tibial branch of the sciatic nerve; vastus lateralis is innervated by the muscular branches of the femoral nerve. This gives clues as to the origin of possible nerve impingement.

I proceeded to work from the ankle up the leg using cross fiber friction. As the muscles softened the pain reduced in severity. The numbness had not abated by the end of the session, but I'm anxious to hear if tingling returned to the area with a little time. I suggested the client do some gentle hamstring stretches by doing heel drops as long as they were not painful.

Posted by linda at October 29, 2004 9:45 PM

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