Have you ever experienced pain at the top of the buttock and or low back pain? You might have been experiencing a condition called "Thoracolumbar Syndrome"
The thoracolumbar region is where our mid back (thoracic spine) meets our low back (lumbar spine). This area is what we call a “transitional zone” within the spine which means a large amount of forces need to be absorbed and distributed around this area. We particularly see high loading through this area in activities that require spinal extension. This is due to the fact that the thoracic region above has limited extension and our low back and pelvic region with our hips flexed experiences similar limitations, thus we overextend at the T/L junction. The vertebral segments involved within this section of the spine span from T12-L2 and the joints that connect our vertebrae are called facet joints The structures causing the symptoms are actually the facet joints between T12-L2, most commonly T12-L1 facet.
The irritated or inflamed facet joints usually will lead to irritated spinal nerves at the same levels T12-L1. These levels contain three main nerve groups:
- Subcostal (T12)
- Iliohypogastric (L1)
- Cluneal Nerves (L1-3)
In most cases we see the irritation and referral pain from these groups of nerves called the Cluneal nerves which tend to refer to the back top of our gluteal region. In other cases, we may also see irritation of subcostal and iliohypogastric nerves which can get referral pain to the outside of our hip and down into the thigh and around the groin. Symptpms may range from altered sensation, hypersensitivity to deep aching over the associated areas.
Patient who may be more susceptible to this condition typically will have more repetitive loading through the T/L region. Some examples include:
- Football players
- Hockey players
- Desk workers(sustained load)
In conclusion, if you have ever had low back and or hip/gluteal pain and found that symptoms returned shortly after treatment the issue may actually be originating at the thoracolumbar region and not the low back or gluteals. A combination of needling, soft tissue and adjustments to the associated areas tend to be the best for correcting the dysfunction. Coupled with specific thoracic, lumbar and hip mobility and strengthening.
By Braeden Melmer - Chiropractor - Neurohealth Chiropractic