Maigne syndrome and osteopathy

Also known as thoracolumbar junction syndrome, Maigne syndrome owes its name to the man who discovered it: Dr. Robert Maigne.

Maigne's syndrome corresponds to the irritation of the roots of the nerves that emerge from the thoracic-lumbar area, that is to say between the twelfth and last thoracic (T12) and first lumbar (L1).

The pain felt is unilateral and is projected pain, that is to say that the patient feels the pain in a different place of the problem:

• No pain in general at the T12-L1 hinge
• Low back pain (89% of cases): Even if the problem is on the vertebrae higher up, the patient feels pain in the lower lumbar and very often in the back of the pelvis on the sacroiliac joints (between the sacrum and the iliac bone)
• False external hip pain (5%): This is the consequence of irritation of the lateral perforating branch of the skin, which results in pain in one of the hips at the level of the greater trochanter (upper part of the outer edge of the thigh). Palpation of this area is painful.
• False anterior hip pain Pain in the lower visceral area but also in the pelvis (testicular, urinary, gynecological, pelvic pain, etc.) but also pain in one of the pubic branches.
  • In 3% of cases, the pain is due to irritation of the anterior ilioinguinal branch (inguinal pain). 
  • And in 3% to irritation of the genitofemoral nerve (pain in the groin fold) 

The diagnosis is made according to the symptomatology but also specific tests:

• Thoracolumbar hinge blockage: The manual therapist (doctor, physiotherapist or osteopath, etc.) will test the mobility of the thoracic and lumbar spine. A blockage at the level of T12-L1 can be suggestive provided that it correlates with the symptoms and the rest of the tests. 
• Reproduction of symptoms: Another test consists of compressing the thoraco-lumbar area and seeing if this reproduces and/or increases the patient's pain.
• The ridge point: This is a precise point located 8 centimeters from the midline (vertical line representing the middle of the body) on the iliac crest.
• Cellulalgia: The pinch-and-roll maneuver on the lower abdomen or the upper-internal part of the thigh reveals the presence of cellulalgia, i.e., a thickened and lumpy area of skin that is especially painful during this maneuver.

The causes are still unclear but it seems that the following factors are favourable

• Poor posture, especially from sitting too long
• Stress
• Paradoxical breathing
• Joint blockage of the thoracolumbar area

• Anti-inflammatory (short term)
• Analgesics
• Infiltrations in rare cases
• Physiotherapy
• Osteopathy

The osteopath will first of all test the different parts of the body and confirm if there is a blockage in the thoracolumbar region. This area is systematically tested by all osteopaths, whatever the reason for your consultation, because it corresponds to a hinge zone in the spine, a zone of change of curvature between the lumbar lordosis (arched part) and the lumbar kyphosis (slightly arched part).

The osteopath will obviously remove the blockage in this area using specific painless techniques. But he will also treat the repercussions that this blockage may have caused. The goal of osteopathic treatment is to restore balance to the body so that it can function optimally.

Finally, your practitioner also has a counseling role. He will explain your dysfunctional pattern and the reasons for your complaint. He will also give you adapted exercises, simple and easy to reproduce at home in order to limit the risk of recurrence.

Marie Messager
Osteopath in Versailles
78000 - Yvelines