REMEMBER THE DTM FLOW…
1. Identify provocative movement
2. Consider involved neurology for potential neuropathic component
3. Assess for neural sensitivity
4. Apply treatment to improve mechanical interface of the involved neuro
5. Re-test provocative movement
6. Apply homecare and perform regularly until sensitivity to movement normalizes
Common Diagnosis
- Lumbalgia
- Chronic low back pain
- Nonspecific low back pain
- Sacroiliac (SI) joint syndrome
- Disc herniation
- Maigne’s syndrome
- Thoracolumbar syndrome
Target Neurology
- Superior cluneal nerves
- Medial cluneal nerves
- Subcostal nerve
- Ilioinguinal nerve
One could nearly make a practice out of treating the cluneal nerves in chronic back pain. In our clinic, we usually consider that presentation as a sequela to an original threat from a bulging disc. We think the resultant adaptation of the lumbodorsal fascia and spinal erectors to unload sensitized nerve roots might be the driving process here. Your results may vary. 🙂
At any rate, consider upstream process at the disc/facet/nerve root in the assessment. Per the sacroiliac joint (SIJ), pain in the area of the SIJ should always be evaluated according to Laslett’s work which has the best science to support it. We regularly see patients with pain in this area that have been receiving “SI joint adjustments” for years who are not positive on Laslett evaluation and respond quickly to DTM targeting the cluneal neurology.
A review of Maigne’s (AKA, thoracolumbar) syndrome is worthwhile and consideration of segmental involvement of the T12-L3 region may prove helpful.
