Test A
1. Patient stands up, places each arm, straight and relaxed, at the corresponding side of the body. Straighten both legs and close heels together. Without worsening the back pain, ask the patient to incline the trunk of the body backwards which allows the lumbar spine to produce a slight forward curvature or be on the point of curving as such.
2. The examiner should position itself behind the patient, facing the back of the patient. Place one hand on top of the outside normal side shoulder, place the other hand on top of problem side hip
3. The examiner presses the pelvis, using the hand on top of problem side hip，to prevent any movement, then uses the other hand to push the normal side to the problem side。This causes the whole spine ,alongside with the skull, to be bended towards the problem side。Note that when doing this, the bending should be made completely by the examiner, not by the patient. This is to prevent some affected deep muscle to contract, when the soft tissue outside the spinal cord is damaged, which can cause stretching pain on skeletal muscle attachment area，hence causing false positive pain. Furthermore, patients should keep their knees straightened, their heels should not leave the floor. Rising of the heels may cause the pelvis on the corresponding side to rise also, which can affect the accuracy of the test.
4. When the spinal cord is bended to the patient’s limit, ask the patient if there is painful or conductible pain to leg, as well as any sign of numbness。Also, ask the patient to point out the precise position of the correct location of lower back pain using the tip of index finger, in order to decide which Vertebral space is affected.
5. The examiner switches sides and help patients bend the spinal cord towards the non-affected side then asks if there is any sign on the affected side.
Above test can produce the following clinical results.
1. when the spinal cord has been bended to limit to the affected side, patients complains that there is deep pain or conductible pain to bottom or leg and in some cases there is also numbness in leg。These are positive results, hence the diagnosis may be that there is soft tissue damage within the spinal cord. If the test result is negative, such damage would be unlikely, but it is still necessary to use Test B and Test C to be absolutely certain on the diagnosis.
2. when the spinal cord has been bended to the limit to the non-affected side, the deep pain on problem side and leg trouble can disappear. During which, patients who have pain on the affected side, because of back muscle at the affected side over stretching, can be diagnosed as having lower back soft tissue damage outside the spinal cord on the affected side. Then it is required to do further test on Test B in order to make a clear and precise diagnosis. The reason being is that tender points is a very important piece of diagnostic evidence for any soft tissue damage outside the spinal cord. If doing this test(bending spinal cord to the non-affected side) doesn’t produce any pain on the affected side, the above possibility would be quite unlikely or that the damage is so slight that it has not yet produced any symptoms, although it is still necessary to test tenderness point to be absolutely certain.
3. In some clinical cases, when the bending towards the affected side has reached its limit, there is only conductible pain in the hip and lower limbs(on the affected side) but no deep pain of lower back on the affected side. These pain may be caused solely by primary soft tissue damage of the hips, but it is unsafe to exclude the possibility of conductible caused by soft tissue damage inside the spinal cord. Therefore, it is necessary to use Test B and Test C for an accurate diagnosis. If the two tests both produce positive results, this conductible pain of the hips and lower limbs should be diagnosed as the conductible pain caused by soft tissue damage inside the spinal cord. If the two tests both produce negative results, the pain should be diagnosed as conductible pain caused by primary soft tissue damage of the hips.
Test B
The patient lies prone on a hard bed, with upper limbs straight, relaxed and placed at either side of the body. Let the patient relax all the muscles in the body, the examiner find the deep tender points by thumb press at the lower back of complaint, i.e. L3-S1 (Problem side) and deep muscle 。First do the following test:
1. Pain test of spinal extension posture:—The examiner straightens the thumb vertically and uses the tip of the thumb press at tender point with reasonable force. Ask the patient: is there any pain, conductible pain or lower limb numbness present? Then the examiner stops pressing, but let the thumb remain on the skin at the tender point without losing contact with the skin in any way, which is to ensure any further thumb press is at the precise location, hen do the following tests.
2. Pain test of spinal over-extension posture:–Prepare a cylindrical pillow which has a diameter of at least 30cm after pressing it hard. Cushion the pillow directly under the patients chest, allowing the spine to extend further more. The examiner uses the thumb in (1), which has not yet been moved from the original position on the skin, to deeply press at the original tender point with the same degree of pressure or force, then ask the patient: is there pain, conductible pain or numbness in the lower limbs present? Comparing to the previous test, is there any changes to the degree of pain, more, less or no change? Stop deeply press，but with the thumb still remaining on the skin at that precise point, and do the following tests.
3. Pain test of spinal over-bending posture :—Slide the pillow downwards to the belly, so that it is directly underneath the point which is slightly beneath the belly button.. This way the spine is over- bending forward. The examiner deeply the original tender point using the same thumb at exactly the same point, ask the patient: is there pain, conductible pain or numbness of the lower limbs? Comparing to the previous two tests, is there any changes to the degree of pain, more, less or no change? This test should be repeated twice.
clinical meaning
From the above three tests, there can be the following clinical results.
1. in the spinal extension posture , pressing a certain point at deep muscle L3-S1 causes obvious painful. However, this pain can be caused by soft tissue damage either inside or outside the spinal cord, hence it confers no significant meaning on the diagnosis.
2. Comparing to pain of spinal extension posture, no matter there is soft tissue damage outside or inside the spinal cord, the pain of spinal over-extension posture produces more severe pain more easily, hence it has no actual diagnostic significance either. Doing pain test of spinal extension posture is to decide the precise location of tender point，based on which the pain test of spinal over-extension posture and pain test of spinal over-bending posture can be done. If there is no pain of spinal extension posture , then the other two tests would be unnecessary.
3. comparison between pain test of spinal over-extension posture and pain test of spinal over-bending posture.
(1) If pain test of spinal over-bending posture causes the deep pain，conductible pain or numbness of the lower limbs, which have been developed from spinal over-extension posture, to disappear completely or nearly completely, then in the former case, it may be diagnosed as soft tissue damage inside the spinal cord. In the latter case, even though there is residual tender point , with consideration of the fact that long period for which the soft tissue inside spinal cord has been damage, may progress onto slight damage to deep muscle outside the spinal cord, it is still appropriate to view it as mix lower back pain caused by soft tissue damage inside the spinal cord.
(2) If the initial pain is only lessened by a small degree, there is the possibility of mix lower back pain caused by soft tissue damage inside and outside the spinal cord.. Here Test A and Test C in combination with examination of tender points，to make a clear diagnosis.
(3) If the initial pain has not changed at all, then the possibility of damage inside the spinal cord can be eliminated. Damage outside the spinal cord can be considered, but the examiner still needs to use the other tests to produce the final diagnosis.
Test C
1. The patient is asked to lie in a prone position on a hard bed, relax all muscles.
2. The examiner uses one hand to lift up the ankle on the affected side, making a 110°angle at the knee joint.popliteal soft tissue should be relaxed in this position. The examiner uses the index finger tip of the other hand to find the tibial nerves at centre of popliteal area， then strum lightly in a horizontal motion. Ask the patient: is there any discomfort at some parts, pain or conductible numbness at the back of the calf? Do the same procedures at the |popliteal on the non-affected side, because strumming non-affected nerves would not produce any symptoms.
clinical significance
When strumming nerve, if there is any partly discomfort, pain or other stimulation, even if the extent is slight, it would be the positive result of this test. Strumming should be light and skilful, DO NOT press nerve hard! DO NOT press joint cavity at the back of popliteal ，which is to prevent the production of any false positives.
So how to know acupuncture works for this patient or not?
Test A Positive ,Test B Positive,Test C Positive ——–Acupuncture doesn’t work
Test C Positive Test A Positive Test B Negative ———-Acupuncture doesn’t work
Test C Positive Test B Positive Test A Negative ————Acupuncture doesn’t work
Test C Negative Test A Positive Test B Positive——–Acupuncture works
If only one Test Positive ,others Negative ——–Acupuncture may works
All of Test are Negative ———–Acupuncture works
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This 58-year-old female patient presented in February 2008, with severe pain of her lower back, right buttock, leg, and foot.The patient’s pain began in February 2007, when she slipped on a cleaning in her home,after that,she has been many different treatment including phsiotherapy,osteopathy,chiropracitc,etc,but nothing worked,She also received hydrocodone bitartrate/acetaminophen, which provided minor relief but caused nausea.She described the pain as “cramping, burning, radiating, and squeezing.” She said the pain was constant, with an intense ache in her lower back. Pain radiated hot across her hip and buttock, down the posterolateral aspect of her leg to the sole and top of her foot.She was unable to work because of intolerable pain. On physical examination, it was noted that flexion, extension and lateral movements of the spine were all completely normal. However, on palpation of the L4,L5 facet joint there was extreme tenderness, on the right more than the left, examination also showed decreased ankle reflex on the right side. After presentation at my clinic the patient enrolled in zak acupuncture,after first time treatment,patient was with little result. She carried on treatment and received deep and intensive acupuncture in lower back area for approximately 2 months,almost 10 acupuncture sessions in which she had a lot of thick needles put over the tender facet joints,and some regional acupuncture points. On the eleventh session, it was difficult to elicit the previous area of tenderness and the patient felt that the pain had completely resolved.
Z, male, 46 years old, because of low back pain and sciatica had undergone surgery, then gradually feeling the left knee pain, abdominal pain calf, Calcaneus pain at the bottom, not the heel, the need to take sharp position have in the hospital for diagnosis: calcaneal spur, a variety of treatment ineffective. Clinical examination: Before the bottom of the left knee pain, popliteal pain, abdominal pain, legs pain, standing, calcaneal pain, tenderness sharp left patella, Calcaneus tenderness at the bottom, when the tip of the patella pressure, and leads to pain , the pain can disappear at the bottom of the foot, if not oppression patella, Calcaneus pain at the bottom of the re-emergence. Diagnosis: left patella fat pad damage pain, and Calcaneus pain at the bottom. Treatment: zak acupuncture After several cycles of treatment, the patient’s symptoms disappeared Discussion: patella fat pad damage, or outside ankle after the bottom of the soft tissue damage caused by high pain can be caused to the low conduction Calcaneus pain at the bottom. Similarly, such as occurred in the back of neck and shoulder. . .
