A man in his late 40s came to see us for a pain in the left buttock, being referred to us by another acupuncturist.
His pain began about 6 months earlier after a fall when cross-country skiing. He fell on his buttocks and had severe back pain that lasted several weeks and spread to the left buttock.
At the time of the first appointment, the pain was on the left hip and buttock and radiated to the lower back. This pain woke him at night if he turned in his bed. It was worse in the morning upon waking up, but faded after being active for a moment. It was also worse when he remained seated for a long time and he could feel a sharp pain if he coughed or laughed. This pain that had persisted for 6 months prevented him from doing physical activity, which caused him a lot of frustration and made him impatient and irritable. A few osteopathy and massage therapy treatments provided only minor relief.
The patient had a history of recurrent sciatica including a major episode 7 years prior, after a wrong movement at the gym. He had then seriously injured himself and felt a sharp pain, numbness and a loss of sensation in his right leg as well as the loss of the patellar reflex. MRI revealed disk herniation at the L4-L5 level. The neurosurgeon did not want to operate and the physiatrist recommended rehabilitation exercises. His situation had improved a lot since then, but he still felt some numbness in his right leg and regularly experienced pain in the right buttock upon waking up.
The other health problems of his medical history are irrelevant to the pain for which he came. On examination, what stood out most was that the patient had no strength to abduct (or open the legs) the left hip. This lack of strength is typical of an inhibition of the gluteus medius muscle (and potentially the gluteus minimus).
The gluteus medius muscle is very important not only for hip abduction but also, and most importantly, for stabilization of the pelvis. When walking or running, when the weight of the body is held on one leg, the gluteus medius stabilizes the pelvis. When the gluteus medius does not do its stabilization work we can observe the Trendelenburg gait. The video below illustrates this problem.
A weakness or inhibition of the contraction of the gluteus medius can be caused by several factors. Including sitting for too long, especially with crossed legs, sleeping on the side without cushion between the knees (the muscle is then elongated for an extended period of time), an injury or imbalances in the muscle chains. When the gluteus medius does not do its stabilization work, other muscles will have to compensate to try to maintain the stability of the pelvis. These are often the quadratus lumborum and the tensor fascia lata. In clinic, one often sees a weakness of the gluteus medius in cases of lumbar pain and / or pain in the lower limb. It is therefore important not to neglect evaluating its proper function.
To come back to our patient, resisted abduction of the hip revealed that the gluteus medius muscle was very weak. It was therefore essential to restore its proper function, and this was my priority during our first treatment. Restoring the function of an inhibited muscle can be easily and quickly done with acupuncture. A few needles, some electrical stimulation and tuina massage were sufficient to restore normal function of the gluteus medius muscle. When we tested the strength of the abduction of the hip at the end of the treatment, it was completely normal. The patient also reported an improvement of about 80% in pain and ease of movement immediately after getting up from the treatment table.
At follow-up, a week later, the patient said that he felt very good. He could walk a lot, feeling more stable and upright. He felt a slight pinch in his lower back and calf on the left side, but said he had an improvement of more than 80%. For this second treatment, he asked that we treat, in addition to his leg and buttock, his neck pain and tension. These tensions and pains were on the same meridian (or muscle chain) that we had treated during the previous treatment (Zu Shao Yang meridian or Thomas Myers’ lateral line), so it was a good idea to work on both problems simultaneously. After this treatment, the patient having attained more than 80% reduction of its symptoms, we did not book any other appointment. Knowing that once the blockages are removed, the body continues to heal and balance itself, it was suggested that the patient make an appointment if the pain returned or if another health problem warranted new treatments.
If you want to make an appointment to treat your pain or if you want to learn more about what acupuncture can do for you or your loved ones, contact us.