This is an article from 2004 published in the Dynamic Chiropractic magazine by David Bond entitled Chiropractic treatment of the back mouse. This is the second article about this subject, the first one was published in 2000 and was entitled Low back pain and episacral lipomas. Both are free on line.
Bond is a chiropractor from California, U. S. In an article from 2000 (published in the same magazine as this article) he already presented a nice and extended bibliographical review about the entity we called back mouse or mice and a case of a male patient suffering from episacral lipoma or back mouse. In that article he admits that there are no previous studies from a chiropractic point of view about the treatment of the back mouse.
In this article he provides some figures to illustrate his paper. He provides many interesting references (thanks to Bond’s two free papers in the internet, we were able to find the first medical references when we got intrigued by the intriguing nodules).
Bond presents a CASE STUDY of a 50-year-old FEMALE.
Chiropractic treatment of the back mouse
By David Bond
Bond starts the paper with a clear sentence:
“The episacral lipoma or back mouse has been shown through many medical studies to be a SIGNIFICANT CAUSE OF ACUTE AND CHRONIC LOW back pain”.
He describes it as: a tumor-like nodule occurring mainly over the sacroiliac region, the nodules are located in certain specific area, can be bilateral or unilateral. On palpation they can be asymptomatic or tender, reproducing the complaint pain, which can be local or radiate usually to the limb.
Presentation: Because of the general lack of awareness on the topic by the medical profession, typically patients presenting back mice have run the gamut of treatment protocol, they may have seen many specialists and have been subjected to many examinations and diagnostic tests usually with negative results. The only objective is usually finding the TENDER NODULE on the sacral region.
Epidemiology: it seems it is more common in women, particularly in moderately obese women.
Physiopathology: it has been described to be a kind of subfascial fat herniation through tears or foramina of the thoracodorsal fascia. This fatty tissue can become swollen within the capsule referring low back pain that can radiate to the limb. The swelling has been related to edema.
Other terms to designate the back mouse are: episacral lipoma, iliac crest pain syndrome, multifidus triangle syndrome or subfascial fat herniation.
About the treatment of the back mouse: studies suggested that local injection could give temporary relief and surgical removal, a permanent cure.
Bond’s CASE STUDY: a 50-year-old female
A 50-year-old woman went to Bond’s office after a motor-vehicle accident 4 months before. She experienced immediate neck and low back pain. She had been treated with medication, chiropractic manipulation and physiotherapy, without improvement with regard to her low back pain.
Symptoms: she presented right-sided low back pain radiating to the right lower limb to the foot.
Exploration: radiographs revealed NO abnormalities. MRI revealed some signs of LEFT disc herniation L5-S1, neuronal foraminal and canal stenosis.
The patient was offered a surgical option that she refused because the surgeon gave no explanation why the pain was in the opposite side of the disc herniation.
Then the patient was released as having reached “the maximum improvement”.
Bond’s examination: Lumbar range of motion within normal limits, pain noted upon flexion and extension. On palpation, the presence of MULTIPLE LARGE, PROMINENT FAT HERNIATION overlying the right iliac crest was felt; firm pressure on them reproduced the patient’s complaint of low back pain and referred pain to the leg.
The patient exclaimed: “That is exactly the pain that has been since the accident!”.
There were also lipomas overlying the left iliac crest; however, they were NOT TENDER.
He managed the patient in a combination of therapeutics with 90% of improvement after a 4-week of continuous course of treatment of the back mouse. Bond explained that during years he has tried to find a working chiropractic protocol. He summarizes his treatment as microcurrent stimulation and spinal manipulation.
Published in July 2018 by Marta Cañis Parera
- 1937 Reis E. Episacroiliac lipoma. Am J Obstet Gynecol 1937;34:492-8
- Copeman, W.S.C. and Ackerman, W. Fibrositis of the back (1944) . Quart.J.Med. 13,37.
- HUCHERSON DC, GANDY JR. Herniation of fascial fat; a cause of low back pain. Am J Surg. 1948 Nov;76(5):605-9. PubMed PMID: 18891320.
- R HERZ. HERNIATION OF FASCIAL FAT AS A CAUSE OF LOW BACK PAINWITH RELIEF BY SURGERY IN SIX CASES. 1945;128(13):921–925. doi:10.1001/jama.1945.02860300011003
- Curtis. In search of the ‘back mouse’. J Fam Pract. 1993 Jun;36(6):657-9. PubMed PMID: 8505609.
- Fairbank JC, O’Brien JP. The iliac crest syndrome. A treatable cause of low-back pain. Spine (Phila Pa 1976). 1983 Mar;8(2):220-4. PubMed PMID: 6222490.
- BAUWENS P, COYER AB. The multifidus triangle syndrome as a cause of recurrent low-back pain. Br Med J. 1955 Nov 26;2(4951):1306-7. PubMed PMID: 13269857;
- Singewald ML. Another cause of low back pain: lipomata in the sacroiliac region. Trans Am Clin Climatol Assoc. 1966;77:73-9. PubMed PMID: 4223124; PubMed Central PMCID: PMC2441105.
- Bond. Low Back Pain and episacral lipomas Dynamic Chiropractic– September 4, 2000, Vol. 18, Issue 19
- Curtis P, Gibbons G, Price J. Fibro-fatty nodules and low back pain. The back mouse masquerade. J Fam Pract. 2000 Apr;49(4):345-8. PubMed PMID: 10778841
- COPEMAN2 WS, ACKERMAN WL. Fatty herniation in low back pain. Lancet. 1947 Aug 2;2(6466):188. PubMed PMID: 20255787.