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Treatment of the Back Mouse
To treat back mouse, iliac pain crest syndrome, or episacral lipomas, I adhere to following treatment protocol:
Do not apply deep direct pressure. This may aggravate the herniation. Deep pressure may and should be applied to the surrounding paraspinal and hip musculature (as much as client comfort will allow), but avoid direct pressure on the lipoma. Since it is a fascial problem, I apply a fascial stretch to only the thoraco-dorsal fascia. I apply trigger point therapy to the surrounding musculature, electronic acupuncture, and a sports massage to the low back, excluding the lipoma itself.
Do not stretch or twist the low back. Many clients feel they should stretch or twist the low back. It is through an inherent fascial weakness, or faulty biomechanics that this problem evolved and when the client puts additional pressure on the fibrous capsule, the inflammation may worsen. I do recommend stretching, but only when the back pain improves above a 50 percent level. When stretching the hamstrings, I always have the client standing with the leg elevated on something of waist height.
Do not exercise. Exercise tends to only aggravate the problem until the client improves above the 50 percent pain level. Many clients aggravate the back mouse while doing some kind of exercise. They have the misconception that painful soft tissue requires exercise so they tend to overexert themselves. As they improve, some mild exercise should be added. I recommend tai chi, qigong or swimming as the best initial exercises for someone with a back mouse.
Apply ice. Since the back mouse results in inflammation, ice will tend to sedate the nerves and cool the heat. After a treatment, I tell the client to go home and apply ice for a few minutes at a time. As he/she improves, I tell him/her to start using heat as long as he/she does not fall asleep on the heating pad. They can also use a hot water bottle for heat therapy where you don’t have to worry about falling asleep.
Avoid lying on a hard surface. Some clients have heard that to treat back pain they should lie on a hard surface. Although, this may be true for some conditions, it is not true for the back mouse. The pressure on the capsule may aggravate the condition and cause additional inflammation.
Avoid prolonged sitting/driving. Prolonged sitting and/or prolonged driving tends to aggravate the condition by direct compression of the lipoma and deconditioning of the low back. The hamstrings tend to stiffen and the abdominal muscles weaken. This will cause the low back musculature to tighten, further putting pressure on the fascia. If the client must spend hours in traffic, a low back support pillow or rolled-up towel is helpful.