Maignes syndrome is essentially when the joints/tissues at the junction between the thoracic spine and lumbar spine are gunky / have inflammatory chemicals building up around them after they got overloaded past their capacity for one reason or another. When there is dysfunction at these transitional joints, it can cause referred pain to the low back, hip, abdominal, and/or groin area. This is due to the nerve pathways from those joints - the brain sends "help me" signals not to the source itself, but along the nerve pathway, hence "referred pain"

These referred pain areas are why this syndrome is often missed / misdiagnosed. Too many times no one looks/assesses outside of the area of main complaint.

Full evaluation from a clinician familiar with Maignes/Thorocolumbar Syndrome is the quickest way to get on track. It's actually very simple - If the junctional joints reproduce symptoms during joint play evaluation, that's "positive"

The even better news is, with some manual mobilizations in the area and targeted strengthening and mobility, this is a fairly straight forward rehab!

Here’s a case example from someone I treated:

This won't be everything and I've gotta be careful with HIPAA, but this will be plenty to get a good idea of one way it may present and then how I tackled day 1 treatment.

Patient arrived with main complaint of left (L) sided low back pain (LBP) that came on after a heavy deadlift day. Upon detailed questioning about pain location/patterns, I find out patient does have some on/off groin pain as well (immediately mentally add Maignes as a hypothesis due to this). No pain down past gluteal fold on the L. No pain on R side or up into mid back on either side. Further history gathered including several years of inactivity after being a collegiate athlete and then recent completion of the gym's on-ramp program to get back into lifting and working out safely. During this time of getting back into the gym, patient has also been dialing in nutrition and sleep to the recommended levels, but does have a high stress job and main stress reliever is the gym, which pain is currently preventing.
States feeling some of the L LBP off/on while getting back into training, but never more than 24hrs. This time, felt some the day before the 5RM deadlift day, but it really flared up during deadlifts and remained agitated for 48hrs & the day after, it "hurt to move to do anything like bend over to pick something up or turn to look behind me."

(Sound familiar to anyone so far??)

Ok…this next bit with all the underlined stuff is my assessment findings…you may find it helpful to read through, but it’s admittedly more for the other practitioners who read this and would be interested in eval presentation and actual measurements. If you just wanna know the treatment, jump down to below that!)

Average pain with daily activities since recent onset: 7/10
Aggravating factors: getting up from bed, lifting from ground (currently 50% DL can increase it to 7/10. On "bad days", donning pants will cause same level), first 400m running ("eases up a bit after that") - all cause immediate increase to 7+/10 pain
Easing factors: gentle movement. Time it takes to come back to baseline "usually 15 min, but this time it's 48 hrs and still only down to a 4/10"

(Main hypotheses at this point in no particular order: Maignes, intraarticular hip issue, flexion derangement)

Main objective findings were as follows:
Range of motion (ROM) of the low back: all normal, including flexion (so not likely a derangement). Pain only with L SB and quadrant.
Hip ROM: normal, including quadrants (mentally throw out intraarticular hip hypothesis)
Strength testing: normal except L hip flexor and hip abduction (3+/5. 2/10 symptom reproduction)
Sorensen test looking at low back endurance: 34"
Thoracic rotation via lumbar lockout: normal R, 15 deg L
Palpation of hip structures: nothing significant
Joint play: insignificant through lumbar spine until I get up to T8/9 - as soon as I put solid pressure on L side there, immediate reproduction of L LBP and mild groin pain.

*** Maignes confirmed as primary issue

I wanna take a second to note that the “impaired” findings above, such as the strength limitations and the low back endurance being less than a minute don’t necessarily tell me if there’s any true weakness on board just yet. These findings can be very much caused by pain inhibition versus true weakness. (As you’ll see in a second, it was definitely pain inhibition here)

Ok, treatment time!

Did a couple quick manipulations at that junctional site to get stuff moving again (without getting too clinical, when you get a manip, that gapping of the joint suddenly creates lower pressure in the area which causes fluid to rush in, and then it’ll flow back out right after….think of it like a quick flush of any inflammatory chemicals that are chillin and gunking up the area). We followed that up immediately with some exercises:

4 rounds for quality:
X10 ea side weighted psoas march
X5 bent over rows with 5" negative
X2 thoracic CARS (instructed pt to avoid sharp pain and how to "move around" that range)

Patient had an immediate decrease in pain from 7/10 to 4/10 after the first session and then down to 2/10 after session 2 (and they were able to get back to deadlifting without pain!!)…saw them for a total of 6 sessions with a lot of focus on making them & that area more resilient to decrease the likelihood of this coming back.

Here’s a video compilation of those manips and what those exercises look like, though there are videos linked in the workout above so you can get a better look at them.

https://www.youtube.com/shorts/UrGILCVl48k (Sorry, y’all…tried several times to embed the video, but it wasn’t cooperating)

I’m sure there are questions after reading this, so let me know! Drop them in the comments or email me at [email protected]

Much love fam,

Megan