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MAIGNES SYNDROME (really should be MAIGNE'S)Common SymptomsMaignes Syndrome causes pain in the low back, buttock, groin, side of hip. [Maignes Syndrome or Maigne's Syndrome? My apologies to language boffs. Search engines on the web do not like the ubiquitous little apostrophe!]
A 'syndrome' simply means a collection of seemingly unrelated signs and symptoms: Buttock, low back pain, groin pain, lateral hip pain may all be mimicked by this condition. A bit of science, sorry hey!The area between the low back and the midback (where you can see the last rib in the picture below, same area as the wording for Latissimus Dorsi muscle) is called the thoraco-lumbar region.The thoraco-lumbar junction syndrome, also known as MAIGNES SYNDROME, has been thought to be responsible for up to 40 percent of common low back pain. This percentage is subjectively based upon Dr. Maigne's personal statistical study of 500 cases.
I increasingly begin treatment of low back pain with thoraco-lumbar adjusting. Neurologically, the nerves T-12 and L-1 nerve roots innervate the superior buttocks. One branch innervates the trochanteric region (side of the hip). Thus, lumbar pain, buttock, groin and lateral hip pain may in fact be a referred pain from the thoraco-lumbar region. Only a careful and thorough examination can clearly distinguish between hip pain, sacro-iliac joint pain, low lumbar and Maigne’s syndrome. Commonly, Sacro-iliac joint fixations may be associated with Maigne’s syndrome. Clinically, one is faced with a chicken and egg situation. Do the pelvic conditions cause the thoraco-lumbar fixations? Or do the thoraco-lumbar fixations/ subluxations cause the Sacro-iliac syndromes and lumbar pain? Mostly, your chiropractor will pay careful attention to both areas of the spine and pelvis.
TREATMENTLumbar and buttock pain coming from the thoraco-lumbar region, Maignes Syndrome, is a notoriously difficult region to adjust. Thus you should be patient with your doctor. You may not immediately hear loud clicks, and dramatic relief of pain. Common chiropractic adjustment techniques for this low back pain may include a prone straight bilateral transverse adjustment, a hyper extension technique (sitting or standing), a lumbar roll, McManis traction, an activator technique, and others.Do you enjoy light reading? Chiropractor Bernard Preston writes excellent books about chiropractic and life. Described as "Gems, both funny and healthful, from the life and work of a Chiropractor" you will love these books.
Another less commonly known technique for this lumbar pain is the supine hyperextension techique. Using a standard adjusting table, the pelvic section is raised to perhaps 45 degrees. The patients sits on the pelvic section with his hands behind his neck. The doctor places his hand behind the back at the fixated segment, flexes the torso slightly, and then makes the corrective adjustment in an anterior to posterior direction. Active trigger points will often be found in the quadratus lumborum muscles, adding to the low back pain, and may be addressed by a variety of techniques. Hip hike, and pelvic tilt exercises (especially with the hands under the involved segments) are useful, as would alternating ice and heat treatment help with the lumbar pain. FROM THE COAL FACE'Doctor, I have a pain here on the side of my buttock. I've been to my doctor, two physios, and another Chiropractor. I am despairing. It's getting worse. It keeps waking me throughout the night.''We had better start with a good examination, Mrs P. Would you slip your down to your underwear, please.' The examination was unremarkable in many respects. All the neurological and orthopaedic tests were negative. The previous practitioners had successfully treated the lumbar spine and the pelvis. But the pain remained. A raw, gnawing pain. X-rays didn't show much of interest, but indeed a moderate curve with the apex at the thoraco lumbar junction, where we found a massive fixation. It was solid as concrete. I don't diagnose it as Maignes Syndrome until the buttock pain has been cleared by the thoraco-lumbar adjustment. Early in my career, I had the good fortune, to walk passed an elderly chiropractor giving a colleague an adjustment at a chiropractic congress. I had never seen the technique before. Or since, for that matter, but I use it every day. I call it the FIST EXTENSION, simply because I know of no other name. I've only cracked two ribs in nearly thirty years in practice. One of them was using this technique! But it's fixed hundreds of Maigne's syndrome sufferers. Fortunately, a large bouquet of flowers, and a humble letter of apology saved my bacon. I suppose in America I would have had the pants sued off me, and those hundreds of people would still be suffering because I would be too afraid to use it! The cost of low back pain is becoming a massive burden to society, not least of which because the enormous insurance premiums doctors have to pay. If this little understood Maignes syndrome makes up 40% of low back pain ...then no wonder we are making little progress. (personally I think 40% is over the top. That was Dr Maigne's opinion) But also because of lost time at work. If you are interested, read on:
The economic burden of LBP
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