Acupuncture – The lumbar and gluteal regions

Needling sites:

– Paraspinal muscles
– Lumbar vertebrae
– Sacroiliac joint (sij)
– Quadratus lumborum
– Gluteal muscles
– Greater trochanter of femur

Radiation (wide and variable):
– Back, buttocks, legs
– Abdomen, genitals

Indications:
– lumbago
– sciatica
– groin pain
– hip pain

Low back pain and sciatica

Acupuncture can be useful in the treatment of these disorders. As usual, the best results are obtained in Type A and Type B pain. The fact that a patient has had previous surgery to the back is not an argument against trying acupuncture.
Examination of the back includes the usual assessment of gait, posture, range of movement, and straight- leg raising (a less useful test than is sometimes claimed). Next, a careful search for TPs is carried out. The patient’s position for examination and treatment is important. It might seem that the obvious position is prone, but this is often unsatisfactory because it causes the vertebral spines to be forced together and relaxes the muscles more than is desirable for detecting TPs; moreover, some patients find the position uncomfortable. If it is used, it is often a good idea to put a pillow under the patient’s abdomen to straighten the spine a little.

A better position is generally the right or left lateral – the “recovery position”. Again, it may be desirable to place a pillow under the patient’s flank to straighten the spine. The painful side is placed uppermost, or if the pain is bilateral the patient is turned over.

Another possibility is to ask the patient to sit sideways on the couch, facing away from you. It is easy to insert the needles in this position but TPs are often harder to detect.

The common sites for TPs in the back are listed above. In many cases a long (50 mm) needle is required, and even this may not always reach deep enough. The lumbar vertebrae may be needled periosteally, the needle being inserted just to the side of the midline and passed towards the midline until the bone is reached. This is seldom painful and indeed many patients cannot feel it at all. Another site is the region of the sacroiliac joint. The groove between the sacrum and the ilium can be felt in most people and the needle can be passed slightly laterally so as to enter this gap. (It is not generally necessary to be too accurate about where the needle point arrives, since this is an example of regional acupuncture.)

The gluteal muscles, especially gluteus medius, seem to be particularly important in acupuncture for sciatica. There are often active TPs here, although quite firm pressure is needed to elicit them. They should be needled as accurately as possible, and teh chi should be elicited if possible. The needling can be painful, and it is important to gauge the patient’s response accurately. The commonest site of tenderness is over the middle of gluteus medius, but some patients are tender mainly along the crest of the ilium.

Some patients have, not so much discrete TPs, as a more generalized area of tenderness over the lower back. In such cases more or less random needling, not necessarily very deeply, may be used (B23 to B28). Other sites that may be tried in patients who fail to respond to the above treatments are the anterior abdominal wall, the anterior superior iliac spines, Lr 3, and various tender areas in the lower limbs:

The Hip Joint

Osteoarthritis of the hip responds fairly well to acupuncture (about a third to a half of patients). Relief may last 8 weeks or more. The site to needle is the greater trochanter of the femur at the point where it is most superficial.

What you have in your mind?