Flank Pain and Maigne’s Syndrome
Probably one of the most common areas of low back pain that we see is into the flank, and top of the glutes. There are several culprits, but one that is not talked about often is called “Maigne’s Syndrome”.
Sometimes this area is just mechanical, meaning that the glutes are weak and the low back is compensating. However, sometimes it is a referral pattern from the nerve that exits your upper lumbar vertebra.
It is also called “thoracolumbar junction syndrome” and as the name suggests, the source is at the junction where the last thoracic vertebra meets with the first lumbar vertebra. Not all vertebrae are created equal, and the shape of the joints vary. The joints that tend to create problems are called “facet joints”.
The orientation of these joints vary depending on where you are in the spine. In the picture above, you can see that the highlighted area shows a joint surface that is inclined. In the lumbar region, the facet is more straight up and down:
Because of this transition in orientation, the junction of T12 and L1 are more susceptible to irritation. Lumbar vertebrae don’t handle rotation or twisting well because of the orientation of the facet joint. Athletes that participate in highly rotational sports such as golf, baseball, or hockey may be more susceptible to Maigne’s syndrome. Maigne’s syndrome is almost always one sided, perhaps because athletes are always twisting in only one direction.
The nerve that exits this area innervates the flank, the lateral hip, and the groin. The classic presentation of Maigne’s syndrome will follow this distribution:
Facet joint injections can be effective, however the first line of defense is to try physical therapy. There are techniques to gap the joints and reduce local inflammation. There may be imbalances in the musculature of the back contributing to the syndrome that can be corrected.