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Iliocostalis syndrome

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Iliocostalis syndrome - August 24, 2007 9:21:20 AM   
JSPT

 

Posts: 284
Joined: April 19, 2005
From: Michigan
Status: offline 		Any ideas on how to treat this on a 72 y/o female with DDD?  Symptoms are on R side around lateral quadratus area and near oblique insertion on iliac crest.
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RE: Iliocostalis syndrome - August 24, 2007 10:15:51 AM   
proud

 

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Joined: March 22, 2006
Status: offline 		How did you dx iliocostalis? Any reliable/valid provocations tests for that?

Just curious.

(in reply to JSPT)
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RE: Iliocostalis syndrome - August 24, 2007 12:46:50 PM   
Alex Brenner PT MPT OCS

 

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From: Kentucky
Status: offline 		Iliocostalis syndrome a.k.a. non specific low back pain?

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RE: Iliocostalis syndrome - August 24, 2007 8:39:09 PM   
plhunter

 

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Joined: March 5, 2006
Status: offline 		Well, we usually treat pt's with LB pain with teaching them how to contract and isolate (the best they can) the TrA and then add movement with the contraction, heel slides, single knee to chest, bridging, sciatic nerve releases, sitting on a therapeutic ball peforming heel raises, toe raises, static sitting with a WBOS/NBOS eyes open/closed for 30 secs. at a time, hamstring stretching.   Coupled with ultrasound, IFC with MHP or soft tissue manipulation.   

Peggy 

(in reply to Alex Brenner PT MPT OCS)
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RE: Iliocostalis syndrome - August 24, 2007 9:25:46 PM   
proud

 

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quote:

ORIGINAL: plhunter

Well, we usually treat pt's with LB pain with teaching them how to contract and isolate (the best they can) the TrA and then add movement with the contraction, heel slides, single knee to chest, bridging, sciatic nerve releases, sitting on a therapeutic ball peforming heel raises, toe raises, static sitting with a WBOS/NBOS eyes open/closed for 30 secs. at a time, hamstring stretching.   Coupled with ultrasound, IFC with MHP or soft tissue manipulation.   

Peggy 


The cornucopia approach. Hit it with everthing...stabilization, manipulation, neural tissue tx and some modalities for good measure. Nothing wrong with that I suppose.

I say sort out the underlying problem as best you can and select the Tx based on that. Outcomes proven to be improved that way.  So needless to say, I still don't understand the title of this question( iliocostalis syndrome). What is that?




(in reply to plhunter)
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RE: Iliocostalis syndrome - August 26, 2007 4:27:34 PM   
JSPT

 

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Joined: April 19, 2005
From: Michigan
Status: offline 		Yeah, I know it sounds like non-specific LBP.  Here is a non-peer reviewed link to the syndrome:

http://www.caringmedical.com/conditions/Iliocostalis_Syndrome.htm

The lady has pain along the superior R iliac crest and the lateral side of the R QL which increases during R sidebending.  The physiatrist who referred her was thinking it was oblique enthesopathy.

She has minimal disc height and is have a fusion of at least 2 lower lumbar levels in about a month.  I'm just trying to settle the symptoms down until the surgery. 

Treatment of US in L sidelying to the R QL, x-friction to the QL and iliacus, and ionto over the apex of the R iliac crest has decreased symptoms about 50% since I originally posted. 

(in reply to proud)
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RE: Iliocostalis syndrome - August 27, 2007 9:04:19 AM   
ginger

 

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From: Melbourne Victoria
Status: offline 		replace iliocostalis syndrome with NFI as another bizarre medical euphemism for I don't know. The  mention of the doctor thinking this L4 pain problem was another 'enthesis' of muscle, would be hilarious if it wasn't so common and so absurd. A further axample of doctor driven pahological arguments in favour of surgery. This woman would benefit from a good pair of hands .

(in reply to JSPT)
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RE: Iliocostalis syndrome - August 28, 2007 9:27:03 PM   
plhunter

 

Posts: 42
Joined: March 5, 2006
Status: offline 		The cornucopia approach. Hit it with everthing...stabilization, manipulation, neural tissue tx and some modalities for good measure. Nothing wrong with that I suppose.

I say sort out the underlying problem as best you can and select the Tx based on that. Outcomes proven to be improved that way.  So needless to say, I still don't understand the title of this question( iliocostalis syndrome). What is that?

My suggestions were not a cornucopia approach, it's usually called a "core strengthening program".  Also, before you critize a plan: A: Come up with one of your own and B: Find out what  iliocostalis syndrome means.

Peggy

(in reply to ginger)
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RE: Iliocostalis syndrome - August 28, 2007 10:53:34 PM   
plhunter

 

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RE: Iliocostalis syndrome - August 29, 2007 6:12:26 AM   
JSPT

 

Posts: 284
Joined: April 19, 2005
From: Michigan
Status: offline 		So is the consensus that this woman can't possibly have lower ribs which are rubbing on the soft tissue near the iliac crest?  That the quadratus attachments can't possibly be irritated due to this? 

I already said that she is having back surgery, so I'm well aware that this needs to and is being addressed. 

Consequently, I have been ultrasounding the QL in sidelying, providing deep massage of the QL and musculature superior to the iliac crest, and have done ionto over the superior iliac crest for 4 visits.  I have only treated the R side; the L side has the same symptoms, but about 50% less pain.

She reported yesterday that the R side is about 80% better, and I plan to take the same approach on the L side. 

So again, iliocostalis syndrome (simply meaning irritation between the lower ribs and iliac crest) can't possibly be an actual clinical diagnosis?

I could care less about the name of the cluster of symptoms; I only mentioned it because I had never heard the term before.  I was just looking for some help treating whatever was causing that cluster of symptoms.  I am not a proponent nor a paid spokesperson for iliocostalis syndrome. 

< Message edited by JSPT -- August 29, 2007 6:16:23 AM >

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RE: Iliocostalis syndrome - August 29, 2007 7:15:03 AM   
proud

 

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Joined: March 22, 2006
Status: offline 		Peggy,

(a): As stated, with the information originally provided:

"Any ideas on how to treat this on a 72 y/o female with DDD?  Symptoms are on R side around lateral quadratus area and near oblique insertion on iliac crest."
 
I asked how this apparent provisional diagnosis was concluded. There is nothing in there that would allow me, or anyone else for that matter to provide "ideas" of how to treat something that likely does not exist( as Ginger indicated).
 
(b): I did look up "iliocostalis syndrome". And no...I do not think it is an actual diagnosis. However, if I investgated all the more likely causes for right sided LBP and it came up inconclusive...I might look for something more obscure like irritable QL.
 
And I will add a (c): You said this is "core strengthening". Okay...but what made you conclude this patient required stabilization? What information led you to that conclusion?
 
And you stated:
 
"Well, we usually treat pt's with LB pain with teaching them how to contract and isolate (the best they can) the TrA and then add movement with the contraction,..."
 
So are you saying every patient with LBP you see improves on a stabilization program?  That is your approach with ALL LBP patients? If so, that would be akin to a medical doctor taking every chest pain patient that comes to his/her office and prescribing nitro without determining, in line with the evidence, who would benefit from nitro and who would not. Sort of like spinal stabilization in rehab. We as a profession need to develop more sensitive/reliable/valid tests to determine what approach should be used. Otherwise, we are just another bunch of "treaters" throwing blind punches in a ring in hopes of hitting something. 
 
Stabilization/manipulation/US/IFC for everyone? Sounds like cornucopia to me. And outcomes using that concept have been shown time and time again to be no better than massage, chiro, voodoo...you name it.
 
Looking forward to your response Peggy

< Message edited by proud -- August 29, 2007 11:54:32 AM >

(in reply to JSPT)
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RE: Iliocostalis syndrome - August 29, 2007 11:53:09 PM   
plhunter

 

Posts: 42
Joined: March 5, 2006
Status: offline 		Proud,
First off my orginial entry was a suggestion, it was not intended to be the only suggestion.   I actually treat a lot of patients that are recovering from or are going to have spinal surgery and yes, most of them do very well with a core strengthening program, and no it is not the only approach to take.     Obviously, it is difficult without seeing the patient to know what course to take and it sounds as if JSPT has done a good job.   I actually agree with most of your comments, and as I said before my comments were just a suggestion.  

Peggy

(in reply to proud)
Post #: 12
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