left sided abdominal pain

[bernard]

Hi Somasimplers,

I found this statement on another forum, can our clinical reasonning skill resolves the poor guy case?

Here is his case =>

I have been suffering for years with pain on the left side of my abdomen about an inch to the left, and an inch below the belly button. Recently it has become really really painful and like sharp spasms. Reduced by holding in abdomen, sitting down, pushing leg out to the left. Also helped by preventive taping / strapping or a corset

Had every medical test possible only result possible signs of diverticulitis

Anyone any ideas how I can move forward or if not good techmiques for reducing the pain

[Diane]

Hi Bernard,
How about this? I found it while researching abs.
Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES): A Commonly Overlooked Cause of Abdominal Pain

You can read all about it at: http://xnet.kp.org/permanentejournal/sum02/acnes.html
Cheers,
Diane

[rolf]

Hi all!

If there are active triggerpoints in the rectus abd. i always try to deactive them , by needeling this points.
What if this person do sit ups,does it hurt?
:wink: :wink: :wink:
RIN

[rolf]

Hi all!
just forgot to ask about this persons breathing pattern!?
:roll:
RIN

[bernard]

Hi Rin,

The huge difficulty, there, is to provide some findings without any chance to get mores clues.
The patient brought his case on PPA and is waiting since two weeks.

Hmmm I think his breathing is quite away from abdominal! Simple extrapolations of my brain, but he is suffering for years? I think that pain disengaged the abdominal breathing?

[bernard]

I had some news from Jon about our asking =>

Bernard

Thanks I have no idea about my breathing pattern, certainly sit ups or adjusting my position in bed is very painful. Supporting legs with a pillow is better. The ACNES thing seems very relevant

Any thought?

[BB]

I would be interested to learn some more info about his movement,

My thoughts thus far would be to look at his recruitment pattern of his abs...does he do everything by using his rectus and little with his obliques....does he have splayed ribs when he tries to contract his abs....does he or has he in the past done lots of sit-ups?

I would also want to look at his hip movement....does his femur head glide forward when he tries to flex his hip....does his femur rotate internally when he extends his knee....is he trying to use his psoas (another struture consistent with his area of pain) too much or too little?

My thoughts are that he is probably rectus dominant, and may of developed the nerve entrapment and scar tissue as a result and like has been said likely does not relax or breath well. Also, he may have developed an imbalance between the long movers of the hip (dominant) and the stabilizers (being overpowered) having abnormal movement in the hip and therefore the lumbopelvic areas.

Cory

[Diane]

Hi there,
If indeed this guy has an entrapment of some long cutaneous nerve exit point, I think it should be cleared first, (through hands-on, not injection!) before any analysis of movement pattern begins, as it will be affecting said movment pattern.

In my mind, it is unlikely that any movement pattern "caused" this possible entrapment..motion of any kind is lotion.. even 'faulty' recruitment. It is more likely I think, that any faulty or asymmetric movement pattern is as a result of the entrapment, not a cause of it.

Entrapments of cutaneous nerves occur (in my experience) as a result of static postures, not active ones, eg: always sleeping on the same side ( typical in those who share beds with spouses..they unwittingly sacrifice their body comfort for the sake of a relationship.. :? )
..or those who sit, usually on one butt-cheek more than the other for hours at a time, or wear a wallet in their back pocket that shortens one side of the trunk habitually, that sort of thing.
Cheers,
Diane

[rolf]

Hi Bernard

My advice is simple!Deactivate the active triggerpoints in the rectus abd,NOT by injection but by dryneedeling,and streching in prone (McKenzie hyperextension for lumbar pain problems,.lieng on your elbows ,looking up to get a max strech of the rectus abd)If this muscle is "short" in this possition let him,use acupressure at this tp and streching at home 3-5 times aday.
I like the entrapment theory,but what have come first ,the hen or the egg.
A muscle spasm is able to give a nerve entrapment.
RIN :wink: :wink: :wink:

[emad]

Hi all ;

how are you ?
glad to discuss with you :D :D :idea:

a good topic really .
i will try to catch you :arrow:

i liked the idea Cory has presented regarding movement pattern.

Diane ;

clear that sleeping in bed with partners could compress nerves , i have met before a case of drop wrist ,and ulnar nerve compression just because the one of them lieing on the other s arm with head , i think usually that head is huge, yes of course may be a factor.

cheers
emad

[BB]

Hi Diane,

What about repetitive use injuries/pain? Those commonly involve entrapment issues especially in the upper extremities.

I agree that static postures are very important, and might be key in this case (maybe he sits in slumped posture all day?), but I think the "all of the above" answer is usually most accurate. The fun thing for us is prioritizing which is the most involved factors to know how to best help/advise.

Cory

[Diane]

Hi BB, Rolf,
I think sitting is a repetitive strain injury!
Also lying on one side all the time isa repetitive strain injury.
Any apparently static position we are in is still "movment"...even if we aren't using our arms and legs and moving around, we are always in motion. A person sitting for hours on end with their thighs horizontal, is still using their body.. to breathe with if nothing else. So I think you are right..
:wink:
Diane