Low Front Pain

[christophb]

Finally, the diagnosis I have been waiting to give the attention it deserves... Low Front Pain (LFP).

Seriously though, I'm having a bit of trouble with a patient. His symptoms started about a year ago after a week of aggressive backcountry skiing and he has been in PT since July. I inherited him when the primary PT wasn't making any headway. I'm afraid I'm having no luck either.

His main complaint is stiffness in hips and bilateral groin and "low front pain". I initially tried simple contact which completely eliminated symptoms after the first session. However, they returned the next day and I haven't been able to replicate the results since. I've tried DNM with mixed success (TL junction stuff worked well temporarily). Teaching him how to do ideomotion was about a one long month event and even now I'm not sure he is doing is right. I swear this guy has no interoceptive awareness; proprioception seems to be OK though.

Interestingly though his chronic problem of "sciatica" which limited driving to about 30 minutes comfortably has suddenly vanished, so I think ideomotion did something but the symptoms that brought him in are still present.

I'm thinking iliohypogastric nerve but haven't been able to influence his nervous system in a significant way to help this. Any thoughts or suggestions?

Chris

[Diane]

Hi Chris,
"Low front pain" (LFP?) is common; just yesterday I treated a woman pregnant with for a third time, due in a few months, for low front pain. She hadn't experienced low front pain in either of her other pregnancies - she saw me during pregnancy 2 for low back pain.

This time the embryo must have implanted in a new spot. She is getting unilateral varicose veins. Her main complaint was a feeling of pressure/swelling across the front of her pelvis. She found it uncomfortable to lie in sidelying even with a pillow. She was greatly relieved with DNM to the inguinal nerves, all of them, both sides, legs over bolster. Following treatment she could lie comfortably in sidely with no pillow again. And yes, I treated her midback too, just to make sure, once she could sidely comfortably..

Great diagnosis. :D

[christophb]

And yes, I treated her midback too[

Any DNM wisdom for this?

Chris

[Diane]

And yes, I treated her midback too
Any DNM wisdom for this?

Origin of iliohypogastric nerves.. they get stretched around a pregnant belly wall.

[christophb]

Sorry, I wasn't as clear as I should have been. This is where I tried to work on my fellow as well. I wasn't successful. Any veteran hints for how to work this area?

[Diane]

Any veteran hints for how to work this area? Slowly. Longitudinally along the spine. Perpendiculary across the spine. Any way that works. Use your hands and feel for the best way for him. Sidelying is the most comfortable position for the patient usually.

[Luke Rickards]

Chris,

I've got a guy with the same problem. Onset 4 ya after a compression fracture of L1 and L2.

[christophb]

My guy definitely has a hard time moving in low-mid back. Ideomotion was initially successful until, I think, he started trying to do it. When he does ideomotion all the movement seems to come from the hips/pelvis. He does not feel any of the characteristics of correction though I think he’s getting them because I can feel the heat, but again he feels nothing. Maybe the combo of DNM/SC can help direct him with a lot of repetition and time. I've tried a few jt mobs in the area to get a bit deeper/"louder" input to the system but that did nothing.

[Diane]

Hmmm. If you widen the perspective, what else has he got? What (possible sinister problems) have been medically ruled out?

Any time something doesn't respond to simple things like what we do, I get a bit nervous.

[christophb]

I thought about that also. He has been worked up in that area with everything coming back negative, but you never know.

[Jason Silvernail]

Chris you and Diane are thinking what I'm thinking.
Maybe it's visceral and not mechanical. So much stuff can start off in the abdomen. How old is he? CA history? Smoking? Considered AAA?

Has his primary care person worked him up appropriately?

[Diane]

Chris you and Diane are thinking what I'm thinking.
Maybe it's visceral and not mechanical. So much stuff can start off in the abdomen. How old is he? CA history? Smoking? Considered AAA?
Actually, I wasn't thinking visceral.. I would expect medical people to have thought of/ruled out viscera by now. I was thinking about possible cauda equina syndrome (mild) or some other weird stuff that could be going on inside the spinal column maybe, around where the cord ends, about T12/L1, or a tad lower..
(Jason, love the little orthopaedically impaired hedgehog avatar.. :))

[ginger]

my advice would be to turn off protective responses at t12/L1/2 and observe the almost immediate effect likely to occur at the groin by restoring a non irritated nerve root state. By using Cm for about four to five minutes at each facet joint , this can be easily accomplished. If you are unsure about CM there is plenty to read If you have an interest in aquiring a very valuable manual therapy tool, best place to begin would be at the RE site. In cases like you have described , I find the first treatment would enable both patient and therapist to prove , as it were , ther relationship between T12/L1/2 and the pain/dysfunction. This is by far the most likelt outcome where no immediate trauma had been involved.
Cheers

[bernard]

Ginger, you're so... facet-ious. :clap2:

[ginger]

Bernard, oui vous avez raison.

[bobmfrptx]

Origin of iliohypogastric nerves.. they get stretched around a pregnant belly wall.

I have seen the same client thru both of her pregnancys as well and she presented with deep inguinal pain on the right. Sidelying left felt best. Treating the whole system with manual techniques afforded relief ranging from 24 hours to a week or more. Symptoms always returned.
Is this the result of the dynamic nature of pregnancy? What would you suggest for home program. I have shown her husband how to lightly stretch the mid back in all directions, but she states it doesnt work well when he does it.
thanks for your thoughts
bob

[Diane]

You could follow the course of the nerve from its origin to where it disseminates. It can be hung up anywhere along its course and pain could be signalled anywhere along it, or elsewhere too. Maybe it's hung up on the left, and the brain is projecting pain to the right. There are treatment suggestions for this nerve and many others, in the DNM forum.

[Jon Newman]

It can be hung up anywhere along its course and pain could be signalled anywhere along it, or elsewhere too.

Maybe nociception instead of pain?

[Diane]

Maybe nociception instead of pain? Not if the brain is generating then projecting it.