Ischialgie for 10 years
A 61-year-old woman consulted me about "Ischias complaints." She has had pain at the back of the left leg almost daily for 10 years. The pain was triggered by everyday movements, for example, she stated that she only has to bend down three times after a ball she throws at her dog while walking, then she has such a strong iscia and back pain that she can hardly stand upright. She has undergon therapeutic treatment several times with her complaints - without success. Imaging procedures have not been carried out. She is a slim sporty woman who goes out with the dog three times a day for an hour. She has a part-time job with a change of job.
There were not many abnormalities in the osteopathic diagnosis. There were no dysfunctions of the vertebral joints, no visceral findings or other movement restrictions. My patient was actually in a very good general condition. When asked where this leg pain began, she pointed to a point above the pelvic crest on the left.
In March 2016, a case report by Yoichi Aota about the pinning of Nn. clunii mediales during its passage through the Ligg. sacroiliacalia posteriora appeared in the World Journal of Othopedics. The Nervi clunium are branches of the spinal cord nerves that are responsible for the sensitive innervation of the gluteal region (Regio glutealis). They are available as upper, middle and lower gluteal nerves. The Nn. clunii superiores come from segments L1-3, the Nn. clunii mediales et inferiores from segments S1-3. In his article, he describes that it is possible to trap the superior branches where they pierce the fascia thoracolumbalis and pull it over the pelvic crest, just as a pinching of the media branches can occur where they run under or through the Ligg. sacroiliacalia posteriora. In the case described, a surgical exposure of the nerves was carried out, which led to freedom from pain in the patient.
I have this case in mind when patients have unexplained lumboischialgia. The upper Nn. clunii on the left were very sensitive to my patient's palpation, the palpation caused a strong local pain. I treated these nerves with fascial techniques. After the treatment, she no longer had any pain, which is already a good sign and justifies the treatment approach. 14 days later, she came to the second treatment and had hardly any lumbar or leg pain in the meantime. This was not the first case in my practice in which the Nn. clunii are the cause of lumboischialgia. The far-reaching radiances of the pain cannot be explained by the anatomy. It is an empirical phenomenon that should receive professional attention.