Case Note 4 - Part 3, Simon Crittenden, Right Sidedness of the Condition and the Second Cardinal Sign

 

A summary of my recent history since the back injury in 2016 and how it relates to gradual deteriorating leg function. In understanding this interpretation of events, one must become familiar with the Three Cardinal Signs of Short Right Leg Syndrome. In particular, the Second Cardinal Sign. It is not merely a slight anatomical postural misalignment...it is a significant rigidity throughout the right hip most individuals and practitioners are not aware of. It becomes evident when tractioning the legs of a subject. Wooden like, unmoving, no give and solid throughout the right hip from the QL's in the lumbar region down through SIJ, hip joint and musculature of the adductors. The opposite side will move freely. This is not unusual and common in SRLS cases. Subjects will not be aware of this rigidity as they are able to ambulate just fine, albeit with certain restrictions and tightness they may only be aware of if they are a devoted Yoga practitioner. This degree of tightness through the region is able to severely block energy flow through the meridian channels. With this in mind, please read the following story of my condition since 2016 to the present.....

 

One decade ago Master Duncan Tao (14th generation Dao Yin Chi Gong Therapist) said to me, “Your right kidney is weak. Left kidney is strong.” I experienced symptoms of Kidney Yin deficiency during my teenage years. I have been receiving TCM medical treatment for a Kidney Yin deficiency all my adult life. In recent years it has entered a more acute phase.

 

I will spare you the detailed explanation of the catastrophic back injury I suffered in June 2016 compounding the effects of Short Right Leg Syndrome on my condition. From that moment leg function began to progressively deteriorate. Consequent instability issues in the left knee prevented me from continuing athletic cycling activity. Knee joints became painful. Fluid retention in feet and ankles problematic. TCM, Chiropractic and Thai Massage therapy and walking was beneficial but did not change the status quo…leg function continued to deteriorate gradually. The condition was so acute in latter stages I twice considered retiring and buying a mobility scooter to get to the supermarket. 

 

On 18 March 2020 I experienced sudden onset of pain in both Bladder and Kidney channels of the right leg. Accompanied by tightening and thickening through calf and hamstring. This tightness damaging tendons behind the knee resulting in pain and severely restricted ROM and inflammation in the joint. A horrific fungal infection struck both feet. I received TCM acupuncture and herbal treatment weekly for the following nine months. Herbal treatment for the condition is ongoing.

 

I was walking so badly and stiff legged on the hilly terrain where I live, it aggravated old back injuries and a mild disk bulge resulted in October 2020. Quickly remediated with rehab exercise and a course of Thymosin Beta 4 peptides but niggles persisted in the lumbar-sacral region. For the first time I considered I had cause to use a heel lift to adjust a minor leg length difference. My right leg is approximately 12mm shorter than my left. 

 

When a 5mm rubber heel lift was inserted under the right foot on 28 January 2021 it began to turn around. I could breathe into my feet from the second day and instability in the left knee began to resolve. I no longer needed to do rehab exercises for the lower back by day five. The thoracic spine went through three days of blissful release at the one month mark…increasing rotation through the spine. Inexplicably improved digestive power and vitality at three months. The rheumatic like pain left my knees entirely at six months. Asymmetrical torsion through the neck and cranium released at ten months.

 

Yet the thickening, tightening and pain through the right leg that commenced March 2020 persisted. Fluid retention in the feet and ankles persisted. This had been assessed by two TCM doctors as a Kidney related issue causing pain through the Bladder meridian. It was on the right side. The Chi Gong Master had told me years ago I have a weak right kidney. It was not hard to eventually consider the sidedness effects of Short Right Leg Syndrome might be part of the story. 

 

Might it be the Second Cardinal Sign, rigidity through the right hip readily palpable when tractioning the leg, is responsible for the Bladder and Kidney meridian pain and associated symptoms in the right leg? Energy/Qi flow through the pelvis to the six TCM meridian channels in the lower limbs is inhibited by the postural distortion in the pelvis causing rigidity and tightness through the soft tissue. It might be this minor postural anomaly at the pelvis from a leg length difference is responsible for the Kidney deficiency experienced for most of my life and the reportedly weakened right Kidney.

 

I was assured by the TCM doctor the Kidney pulse was good or, at least, improved as much as can be expected considering my age. I had been consuming buckets of TCM herbal medication for two years. He doubted right Kidney weakness was responsible for the right leg symptoms. Nevertheless, I decided to try stimulating the right Kidney. Stopping all herbal medication and began an acupressure, hands on massage approach to stimulate the Kidney by placing my hand directly on the small of the back on the right side. Palm on the QL’s and lower ribs, forefinger resting across the top of the Iliac Crest and merely holding. This is a most fundamental technique of constant steady pressure for a prolonged period which will release fascial tightness.

 

The first sign of change was the foot became warm at the beginning of the Kidney meridian in the sole of the foot. Then the entire foot became warm, the leg softened and pain in calf and hamstring ceased. This occurred in the first attempt. I did not time it precisely but it was in the order of 20 or 30 minutes duration to achieve this result. I repeated it on the left side too. This procedure was carried out morning and night. Morning sessions were followed by acupuncture to K1, K3, BL60. The constant pain in the right leg has been completely relieved. Thickening and tightening is still present at times but to a much lesser extent. It required three weeks of this treatment before tendon injury in the posterior knee improved, restoring ROM and enabling limp free gait. The treatment continues daily.

 

Improving this treatment, the thumb is conveniently in position to apply pressure directly into the spine at the small of the back on BL23. Doing so, a sensation down the Bladder meridian in the leg is clearly evident. This point is known for benefiting Kidney function and I am not surprised because it is ideally located to release tightness in the lower back caused by Short Right Leg Syndrome. 

 

Examining the path of the Bladder meridian through the lower back and pelvis you will see it travels down either side of the spine, two channels on both left and right sides. At the lower back one of each pair dives to wrap several times around the Kidney, then travels downward along the side of the sacrum, returning upward and out across the Iliac Crest to the lateral aspect of the hip before travelling down the posterior of the leg. The second more lateral channel moves directly down the leg. Both passing adjacent to the Femoro-Acetabular joint, through the Biceps Femoris tendon insertion to the back of the knee and then around the lateral aspect of the heel before joining the beginning of the Kidney meridian in the sole of the foot.

 

The significance of this in relation to Short Right Leg Syndrome is the Second Cardinal Sign of SRLS is rigidity through the right hip. Tractioning the leg of a SRLS case typically demonstrates a wooden-ness through the entire right hip region. Whereas the left side has a softness and movement clearly evident to both client and therapist. Mild disk bulging may be present through the right lumbar region with tenderness and tightness in the QL’s. The right SIJ is frequently stuck and manipulative therapists attempt to mobilise it. Soft tissue about the Femoro-Acetabular joint will be rigid, Adductor Magnus will be in spasm. Right Adductors in the groin are always tight needing stretching, whereas those of the left are loose. This degree of tightness and rigidity blocks energetic flow. In a case where the right kidney is weak and this wooden-ness is present through the right hip, energy/Qi flow to the lower limb is compromised. It is as though the Bladder meridian is strangled in its circuitous passage through the right lumbro-sacral region. Where energetic flow is blocked for any reason, thickening, tightening and pain results. I was experiencing this in the Bladder meridian through the hamstring, calf and heel. Releasing tightness and clearing the blockage at the lower back region on the right side and stimulating the right Kidney rapidly relieved the condition.

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Described above is treatment commenced January 2022. While immediate reduction in pain through the Bladder meridian in the right lower limb was remarkable and a considerable relief, I would judge that overall it was a 90% improvement. In particular, Kidney symptoms I had been treated for much of my life by TCM practitioners were not much changed and nagging tightness through the Biceps Femoris insertion to the knee continued. Noting a muscular spasm still present at the right hip, In November 2022 I began exploring with Deep Tissue treatment about the Iliac Crest. High degrees of pain and gristle like tissue was present. Following the Iliac Crest to the anterio-lateral aspect revealed an activation point particularly effective in the distal region of the Bladder meridian. It required four days to clear the majority of tightness and pain along the Iliac Crest. Both left and right sides were treated. 

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Notably, apart from improved leg/knee function, health and vitality also changed for the better. The ever present dry mouth symptoms from Kidney yin deficiency is no longer present. Energy levels are elevated. The need for afternoon siesta's gone. Workload is no longer daunting. For the first time in 43 years of consulting TCM practitioners I am told my pulse is "Normal". I have never been told that before.

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It would seem the vast amount of acupuncture and herbal treatment for Kidney yin deficiency for symptoms afflicting me since later teenage years was not treating the cause. Yes, bolstering an ever present Kidney deficiency but not eliminating the cause which was a minor postural anomaly affecting the pelvis caused by a structural leg length discrepancy.

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