Over the years I've had many patients with chronic lower back and buttock pain. It's actually really common.
The pain you get from lower back and butt pain is a deep ache - hard to ignore and difficult to live with.
There's one guy in particular that I remember (let's call him Dave.) Now I'm going to tell you Dave's story because it illustrates a very important principle about chronic pain and trigger points.
Dave came to me after he'd had many investigations done.
You name it, he'd done it.
He'd had MRI's of his lower back and buttock. The spine specialist was looking for damaged structures which could cause his pain -
except there were none.
Then he'd been to see an orthopedic surgeon. Dave had gone to physios, an osteopath and a chiropractor. He'd even had an acupuncture treatment from a traditional Chinese acupuncturist.
Now this is where the story gets interesting.
What the acupuncturist had done was used the traditional route. That meant a couple of needles in Dave's back, one or two points in the buttock and then a few leg points.
The pain relief Dave had from this particular treatment was minimal and temporary.
When I saw Dave, the first thing I did was a detailed check of all the muscles in the buttock and lower back. Dave's gluteus maximus, medius and piriformis were a mass of highly active trigger points.
In these circumstances, I find that treating one or two points is not enough.
What Dave needed was to have the whole series of points treated - with pinpoint precision. So in the first session, I began the treatment - and the method I used to treat the triggers was dry needling.
Now, while dry needling uses acupuncture needles, and while many acupuncture points and trigger points are in similar locations, the approach is quite different.
I used my hands and Dave's feedback to find the active trigger points. In this case, accuracy is vital. A needle that's not correctly placed simply isn't effective.
And the wonderful thing about dry needling is that you can get accuracy - pinpoint accuracy.
Even for triggers inches deep in the muscle.
There were 10 individual points to treat in the first session. I carefully introduced the needles and then left them in for 15 mintues with no stimulation of the needles.
After that, I applied heat and specific stretches for each muscle. Then Dave and I had a discussion about what could have caused his triggers in the first place.
The second session was a week later. By this stage some of the active triggers had already disappeared - there were just 6 points to treat.
By the third treatment, I knew which points were the primary points. The primary points are the ones that tend to drive the other points and create the problem in the first place.
Dave's primaries turned out to be two points in the gluteus medius and one in the piriformis.
By the fourth treatment, there were no more triggers to treat. The pain that had plagued Dave for months just dissipated and went away.
A good story - but what's the point?
The core of the story is this - without dry needling, I don't know if this treatment would have been nearly as successful.
When someone has a mass of trigger points in very deep muscles (like Dave's piriformus and gluteus medius) the key is getting to those specific triggers in the muscles.
You need to be absolutely specific for the treatment to be really effective. And in this case the triggers were 3 inches below the surface of Dave's skin.
While getting in there with an elbow can work, in this case, it wouldn't be my first choice of treatment for accuracy.
Not by a long shot.
And I see many people over the course of a year who have similar stories - unexplained back, abdominal and buttock pain. No one has been able to help them, and thus far they have no obvious cause for their pain.
For many of these people, the problem is deep muscle triggers - a cluster of them. And these are best treated with dry needling.
An important point though - after each treatment I used heat and stretches. And then I taught Dave how to find and treat his own trigger points if they should ever come back.
I taught him how do ischemic releases on his trigger points, and then how to do neuromuscular stretches - an powerful technique to help prevent triggers from coming back.
Then we discussed underlying causes.
It turns out Dave is a keen amateur cyclist. And his triggers were been created by cycling with a seat that was set wrong and a bike that didn't suit his physique. So we looked at ways for Dave to set up his bike so that he wasn't creating active trigger points whenever he went for a long cycling trip.
But in the first instance, dry needling his deep seated triggers was what switched them off. Now, I use dry needling a lot in my practice. But this is only part of the story - and there certainly are risks involved in doing needling.
So tomorrow I'm going to send you an email about a particular group of people for whom dry needling is super effective - but only if you use it the right way. Used in the wrong way, dry needling can seriously backfire.