By Whitfield Reaves After years of experience, I have come to believe there is nothing more complex to differentiate, diagnose, and treat than low back pain. Western orthopedic evaluation does a great job when there is a disc herniation with a protrusion or fragment lodged on a spinal nerve root. Anything else, in my opinion, is either art or guesswork.
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I see many patients who have been to numerous physicians, each diagnosing a different cause of pain. Unfortunately, TCM diagnosis is no better. I gave up on treatment based upon the meridian (jing-luo) perspective years ago when Bladder meridian points such as Bl 23, Bl 25, Bl 40 and Bl 60 gave my patients inadequate results. And from an internal organ viewpoint, I have never found treating the Kidney, which controls the lower back, to be clinically reliable. Back pain is a complicated and comprehensive condition, and it is not the purpose of this article to articulate on the subject. However, I would like to discuss how acupuncture treatment to the quadratus lumborum (QL) muscle is important to consider in any treatment plan for lumbar, sacral, and gluteal pain.
While this muscle might not be the entire cause of pain - other points, treatments, and techniques may be necessary - the simple techniques that follow benefit many patients and may serve as an important protocol for acupuncture treatment. The following is a brief summary of the pain due to quadratus lumborum dysfunction: Common patient complaints • Acute back pain and spasm • Patient may report the spine feels 'locked up' • Pain is often one-sided • Pain may radiate towards the gluteal region • Some patients may have chronic QL dysfunction. Clinical Features • Pain upon palpation at the superior attachment of the quadratus lumborum in the region of the extraordinary point Pi gen, about 3.5 cun lateral to the first lumbar vertebrae. • Elevated pelvis on the side of pain • Lumbar region may be slightly flexed laterally to the side of pain (antalgic position) • Acute injury often accompanied by lifting and twisting movements • Always differentiate referral pain from lumbar nerve root, as well as consider how the disc or facet joint may contribute.
