Bilateral Hip and Low Back Pain | Acupuncture Relief Project | Volunteer Community Health Clinic | Nepal

Bilateral Hip and Low Back Pain


Eliot Sitt LAc
December 2014
OVERVIEW

bilateral hip pain case study

19-year-old male presents with trauma-related chronic hip and low back pain with limits in range-of-motion that interferes with daily life. After 24 acupuncture treatments over the course of 6 weeks, the patient has increased range-of-motion and significant pain reduction. 

Subjective

19-year-old male patient presents with complaints of hip and low back pain. He describes the back pain as a dull ache that worsens while bending either forward or backward. He is able to walk fairly comfortably, but it is worse when carrying heavy loads. He experiences occasional tingling down the legs. The back pain began 8 or 9 years ago with a fall from a tree. He landed flat on his back onto a branch on the ground. He lost consciousness for about 5 minutes. After regaining consciousness, he found it too painful to walk. He did not receive treatment at that time. The back pain gets worse while working in a position of forward flexion for extended periods of time.

For the past 5 or 6 years, he has also experienced a gradual onset of hip pain, which prevents him from being able to squat at the toilet or separate his knees enough to straddle a motorcycle. The pain radiates down the anterior and lateral aspects of his thighs. He feels some hip pain while seated in a chair, and resting one ankle on the opposite knee is too painful of a position to maintain. He is also physically unable to place either knee above the other in a seated position. He reports tightness along his anterior thighs, as well as occasional neck and upper back pain along the spine.

Objective

The patient appears in good health and overall good spirits. He is alert with a small build and friendly demeanor. The patient has normal range-of-motion at the waist in flexion, extension, lateral flexion and rotation. The erector spinae are tight with tenderness along the lower borders of the spinous processes of L1 to L5.

Passive hip abduction is restricted to 40 to 45 degrees bilaterally (50 degrees considered normal), with a feeling of intense tightness in the inner thighs. There is tenderness upon palpation at the gluteus medius muscle, particularly on the right, at a point halfway between the greater trochanter and the top of the iliac crest.

The patient is unable to maintain a squatting position for more than a few seconds due to hip pain. The Faber test is positive for pain bilaterally in the initial position of one ankle placed on the opposite knee without downward pressure applied by the practitioner. The pain is felt deep in the hip bilaterally, with additional back pain on the right side near the SI joint. The right leg appears shorter than the left by about an inch, and the right PSIS appears slightly higher. There is tenderness at the SI joints bilaterally.

In the supine position, the right leg appears slightly shorter than the left. Leg length measurements show 29 inches from the prominence of the greater trochanter to the lateral malleolus bilaterally, but 34 and 35 inches from the umbilicus to the medial malleolus on the right side and left side, respectively.

Braggard’s test (aka the reinforcing straight leg raise) is positive bilaterally with tingling appearing at about 70 to 75 degrees and reappearing with passive dorsiflexion at a slightly lower angle. The tingling is felt down the posterior thigh and popliteal fossa. Strong dorsiflexion with the leg fully extended, but not raised, also results in tingling in the popliteal fossa bilaterally.

The Valsalva maneuver results in a tingling sensation in his toes. The piriformis test is negative for tingling sensations, although the position causes discomfort in the hip. DTR’s at the patellar and Achilles tendons are normal bilaterally.

He has a wiry pulse, and pink tongue with a thin white coat.

Assessment

DX: Upon interpretation of the objective testing performed, this patient has multiple structural problems involving the low back and pelvis, including hip joint pathology, sciatica, possible sacroiliac joint subluxation and compensatory muscle tightness of the low back and thighs. 

The positive results of the Braggard’s test and Valsalva maneuver suggest sciatica caused by a space-occupying lesion in the lumbar spine. Possibilities include intervertebral disc herniation, osteophytes or spinal stenosis. Disc herniation is the most common of these causes and also consistent with this patient’s history of trauma. The trauma conceivably could have caused a subluxation of a vertebrae in such a way that it could compress a nerve root. However, no obvious misalignments of the spinous processes are observed upon palpation. Spinal stenosis and the presence of osteophytes are less consistent with the history of trauma and is unlikely in this case due to the patient’s young age. 

The sciatic symptoms, in this case, may also be caused by muscle tightness in the pelvic area compressing the sciatic nerve. However, the negative result of the piriformis test suggests that the sciatic nerve is not being compressed by the piriformis muscle, which is commonly involved in sciatic compression due to muscle tightness. 

An imaging study of the low back such as an MRI or x-ray would be needed to determine the nature and location of any space-occupying lesion and to make a definitive diagnosis. There isn’t severe enough evidence of nerve root compression at L3, L4, L5 or S1 to affect DTR’s, as bilateral patellar and Achilles’ DTR’s respond normally. 

Due to the number of years that have passed since the original accident, it is difficult to ascertain the exact nature of the original injury that caused the back pain and radiculopathy. Given that this injury was untreated, it is likely that compensatory muscle tightness, serving to guard the initial injury, has resulted in slow-onset hip pain and subsequent structural imbalance. 

TCM DX: Qi and blood stagnation in the Du Mai, Bladder and Gallbladder channels 

PROGNOSIS: This patient has responded well, experiencing significant improvement, to previous acupuncture treatment for back pain. He is willing to come in frequently for treatment. The patient is likely to experience pain reduction and increased range-of-motion over the course of treatment. However, because his condition is complex and chronic in nature, he is unlikely to see a full resolution of all of his symptoms. 

Plan

Treat with acupuncture and/or electro-stimulation 5 times per week for 2 weeks, before reassessing. Focus primarily on hip pain, which has not received previous, direct treatment, and continue to reduce back pain. 

Typical treatment for hip pain: GB40, GB34, ST34, SP10, LI4, TB5, GB28, Ah Shi x2 superior to the greater trochanter, deep insertion towards the joint. Electro-stimulation 100/2 from GB40 and GB34 to the Ah Shi points superior to the greater trochanter bilaterally

Typical treatment focused on back and/or neck pain: SI3, BL62, BL60, BL23, LI4, DU20 and Hua Tuo Jia Ji points at tender vertebral levels (often L2-L5) 

Outcome

After 24 treatments within 6 weeks, the patient had only occasional, mild back pain, sometimes brought on by carrying heavy loads. He came for many treatments reporting no back pain at all with the majority of the treatments focused on addressing the pain in his hip. 

The patient was able to sit in a chair without pain. He could place one ankle on the opposite knee with only minimal pain, which he still felt deep in the hip. He was able to place one knee on top of another, while seated in an even more crossed position, whereas before treatment this position was impossible. The left knee over right knee position was more comfortable than right over left, but he still felt some deep, hip pain on both sides while seated in this position. The patient could now tolerate downward pressure during the Faber test, with significantly reduced pain in comparison to the initial treatment. 

The patient was able to maintain a full squat position without pain with both heels flat on the ground, but it was difficult to maintain his balance if his heels were farther apart. He reported feeling much looser in the thighs and pelvic girdle, with passive abduction showing normal range-of-motion at about 50 degrees. 

His apparent leg length on the right from the umbilicus to the medial malleolus measured a half inch shorter than the left side at 34.5 inches instead of a full inch shorter at 34 inches, as was measured in treatment 12. A leveling of the PSIS’s was observed. 

Braggard’s test remained positive bilaterally, but the tingling sensation was reduced by about 70%. He no longer felt tingling during the Valsalva maneuver.

Although the patient’s condition was not fully resolved, he experienced an increase in range-of-motion and a significant reduction in pain and overall tingling sensations.

Discussion

This case was challenging because there were multiple structural abnormalities coexisting without a clear diagnosis. It was initially difficult to decipher where to focus treatment. Because the back pain had already been improving from previous acupuncture treatment, the back pain resolved to a manageable level early in the course of treatment, resulting in an overall treatment focus on the hip pain. 

The patient found the hip pain difficult to describe, but the functional limitations were clear. While many people in the west find it difficult to squat because of how often we use chairs and seated toilets, the inability to squat is unusual and inconvenient in a rural Nepali environment, particularly because squatting is the normal position during bowel movements. It was also a detriment to this patient’s quality of life that he couldn’t sit normally without discomfort prior to treatment. 

Continued treatment of this patient with acupuncture would focus on continuing the pain relief of the hip joint with distal Gallbladder points and deep local needling, as well as a continued loosening of the local musculature of the pelvis, low back and thighs. Additional assessment is needed to determine the cause of the leg length imbalance. The nerve root compression causing sciatica should also be more precisely assessed, ideally with an imaging study. 

This case study suggests that acupuncture with electro-stimulation can have a significant therapeutic effect on complex, long-standing musculoskeletal conditions, and has the potential to be a valuable therapy in an environment with limited access to diagnostic imaging and allopathic medical care.

Acute Cholecystitis

Acute Cholecystitis
70-year-old female presents with acute abdominal, chest and scapular pain, vomiting and diarrhea. At the local hospital, she was diagnosed with acute cholecystitis via labs and ultrasound. She received anti-nausea medication and was turned away for further treatment. After 7 treatments using… Read more:

Ankylosing Spondylitis

Ankylosing Spondylitis
25-year-old male presents with low back and sacroiliac pain, beginning approximately 15 months prior to consultation at this clinic, for which he had received a diagnosis of ankylosing spondylitis at a hospital in India. After 18 treatments with acupuncture in conjunction with moxibustion and… Read more:

Atrophic Vaginitis with Recurrent Urinary Tract Infections

Atrophic Vaginitis with Recurrent Urinary Tract Infections
57-year-old post-menopausal female presents with constant burning uterine and bladder pain for 3 years. Allopathic care has been unsuccessful in diagnosing and providing relief of symptoms. In using combination therapy of acupuncture, Chinese herbs and western antibiotics, the patient has had a… Read more:

Autism Spectrum Disorder

Autism Spectrum Disorder
20-year-old male patient presents with decreased mental capacity, which his mother states has been present since birth. He lacks verbal communication skills and his mother states he is prone to angry outbursts. Within 5 acupuncture treatments, he is less agitated, his violent outbursts have… Read more:

Bell’s Palsy (Facial Paralysis)

Bell’s Palsy (Facial Paralysis)
A 50-year-old female with Bell’s palsy presents with hemi-facial paralysis involving the eye and the mouth. After 5 weeks, 10 acupuncture treatments and 2 months of Chinese herbal medicine, she experienced a 90% recovery. Patient is a 50-year-old female presenting with right side paralysis of… Read more:

Bilateral Hip and Low Back Pain

Bilateral Hip and Low Back Pain
19-year-old male presents with trauma-related chronic hip and low back pain with limits in range-of-motion that interferes with daily life. After 24 acupuncture treatments over the course of 6 weeks, the patient has increased range-of-motion and significant pain reduction.  19-year-old male… Read more:

Bilateral Leg Weakness and Paralysis

Bilateral Leg Weakness and Paralysis
42-year-old female presents with an inability to walk due to slow-onset, partial bilateral leg paralysis occurring over a 15 year time span. After 23 treatments focusing on strengthening the DU and Kidney channels with acupuncture, electro-stimulation and moxibustion, the patient gained a… Read more:

Candidiasis and Vaginal Discharge (Type II Diabetes)

Candidiasis and Vaginal Discharge (Type II Diabetes)
63-year-old female presents with chronic purulent vaginal discharge, pruritus vulva and tingling in the extremities. Test results show hyperglycemia of RBS 540 mg/dl as well as vaginal candidiasis. Patient received 9 treatments of acupuncture, referral for insulin therapy, advice on diet and… Read more:

Cervical and Lumbar Spondylosis

Cervical and Lumbar Spondylosis
70-year-old male presents with severe cervical and lumbar pain, neuropathy of the arms, hands, legs and feet, incontinence of bowels and anal rash. His doctor has advised surgery. After 8 treatments he is able to sustain 40 -50% relief of pain for 4 days. Patient presents with severe lumbar… Read more:

Chronic Abdominal Pain

Chronic Abdominal Pain
31-year-old male presents with chronic abdominal pain. The patient has suffered from abdominal pain for the past 11 years, but has had a worsening of symptoms in the past year. Case analysis after 11 visits over 2 months. Patient presents with pain in the epigastric, umbilical, hypogastric,… Read more:

Chronic Gastritis

Chronic Gastritis
52-year-old female presents with chronic, burning epigastric pain accompanied by acid reflux, nausea, belching and decreased appetite. The patient also experiences daily headaches and dizziness. With conjunctive therapy of acupuncture, Chinese herbal medicine and antacid treatment, the patient… Read more:

Chronic Gastritis with Inflammatory Bowel Syndrome: Crohn’s Disease

Chronic Gastritis with Inflammatory Bowel Syndrome: Crohn’s Disease
40-year-old male presents with chronic, burning gastrointestinal pain with accompanied acid reflux, belching, fullness, diarrhea, weight loss and occasional rectal bleeding. The patient also experiences fatigue and insomnia. Receiving only acupuncture and Chinese medicine therapy for this… Read more:

Chronic Headache (Typhoid Fever Sequela)

Chronic Headache (Typhoid Fever Sequela)
43-year-old female presents with a severe headache. 9 months ago, the patient contracted Typhoid fever. During the illness, she had a headache that covered her entire head and a mild fever for 5 days. She has had severe headaches ever since. Acupuncture is providing some relief from the… Read more:

Chronic Non-Healing Ear Ulcers

Chronic Non-Healing Ear Ulcers
15-year-old female presents with purulent, non-healing ulcers in the right ear canal. After 20 treatments, using an integrative approach that included Chinese herbal medicine, acupuncture and antibiotics, the patient experienced a reduction of pus, reduced pain and itchiness. However, the… Read more:

Chronic Obstructive Pulmonary Disease with Osteoarthritis

Chronic Obstructive Pulmonary Disease with Osteoarthritis
65-year-old female presents with dyspnea and continuous cough. The patient also presents with chronic, severe pain and inflammation of all joints of the hands and feet. With 9 acupuncture treatments and the use of Chinese herbs, the patient experienced a 6% O2 increase, more than a 50% reduction… Read more:

Chronic Vomiting

Chronic Vomiting
80-year-old male presents with vomiting 20 minutes after each meal for 2 years. At the time of initial visit, patient was vomiting undigested food and water several times per day. Other symptoms include burning esophageal pain, the feeling of constant hunger, and a sensation of “something… Read more:

De Quervain’s Syndrome

De Quervain’s Syndrome
57-year-old female presents with hand tingling and severe wrist pain that began 9 months prior to visiting the clinic. Both wrists are affected. Patient reports pain began first in right wrist, but currently feels more pain in her left wrist. The western diagnosis for this patient is De… Read more:

Dupuytren’s Contractures

Dupuytren’s Contractures
  58-year-old male presents with persistent contraction of 3rd, 4th and 5th fingers of right hand. He reports it began insidiously 3 years ago, and that it might be due to a leech bite from 25 years ago. After just 3 treatments using electro-acupuncture and manual therapy, passive and active… Read more:

Emotional Depression

Emotional Depression
40-year-old woman presents with depression, emotional stress and dream-disturbed sleep. She presents with a secondary complaint of chronic ringing in her ears. 2 months ago her daughter committed suicide, and she is emotionally distraught from the incident. The clinic provides a safe place for… Read more:

Facial Paralysis (Bell’s Palsy)

Facial Paralysis (Bell’s Palsy)
35-year-old female presents with left-sided facial twitching and paralysis. After 7 acupuncture treatments, the patient regained over 50% of her facial functioning with 80% of the facial twitching resolved. Patient presents with left-sided facial twitching and paralysis. There is painful… Read more:

Febrile-Induced Cerebellar Ataxia

Febrile-Induced Cerebellar Ataxia
58-year-old male patient presents with ataxia, severe dizziness, vertigo and slurred speech. Symptoms started after a severe febrile illness in November 2012, and appear to be getting worse since that time. After 8 acupuncture treatments, patient reports a minimal decrease in overall dizziness… Read more:

Ganglion Cyst

Ganglion Cyst
11-year-old female presents with large lump over left radial artery at radial styloid process, causing pain to the local area. She had minor surgery to remove a gelatinous substance from within the cyst and was informed by the doctor that it will keep growing back. After 9 acupuncture… Read more:

Hemiplegia (Stroke Sequelae) with Acute Lung Consolidation

Hemiplegia (Stroke Sequelae) with Acute Lung Consolidation
81-year-old female presents with complete left-sided hemiplegia following ischemic stroke 2 months ago. Over the course of 7 weeks of acupuncture treatment, the patient regained limited voluntary dorsi and plantar flexion of her left foot, flexion and extension of her knee and elbow, and… Read more:

Hemiplegic Stroke Sequelae with Aphasia

Hemiplegic Stroke Sequelae with Aphasia
Patient presents with right-sided paralysis of his upper and lower limbs due to an ischemic stroke 9 months ago. Additional sequela includes speech impairment with the inability to say anything, but the phrase “la”. On presentation, this patient had not received any other post-stroke treatment.… Read more:

Hemorrhagic Stroke Sequelae

Hemorrhagic Stroke Sequelae
53-year-old male presents with right-sided hemiplegia following a hemorrhagic stroke 1 year ago. Patient complaints include decreased range-of-motion, pain, numbness and weakness of his right side including the shoulder and arm. Concluding 10 treatments, comprising of acupuncture with electrical… Read more:

Huntington's Disease

Huntington's Disease
38-year-old female presents with a 4-year history of involuntary spasming throughout her entire body. The patient does not have any available medical records and the cause of spasming is unknown. Over the course of treatments, the patient experienced a feeling of ‘lightness’ in her body,… Read more:

Ischemic Cerebrovascular Incident

Ischemic Cerebrovascular Incident
60-year-old male presents with sudden onset of motor deficit of right hand, tingling and weakness of right foot, as well as marked changes in function of glossopharyngeal and hypoglossal nerve. Within the course of 15 acupuncture treatments, including electric stimulation and moxibustion, there… Read more:

Juvenile Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis
10-year-old female presents with active phase of Juvenile Rheumatoid Arthritis (JRA) as demonstrated by multiple articular bony joint deformities, severely limited range-of-motion in all affected joints, and a history of recurrent episodes of alternating fever, chills and profuse sweating,… Read more:

Low abdomen pain due to roundworm and Urinary Infection

Low abdomen pain due to roundworm and Urinary Infection
30-year-old female presents with lower abdominal pain, burning urination and shortness of breath for the last 5 months. With the discovery and treatment of a parasitic infection, and with concurrent treatment of a urinary tract infection, the patient found significant relief. Patient presents… Read more:

Low Back Pain with Radiation

Low Back Pain with Radiation
30-year-old male presents with severe back and left leg pain, exhibiting postural deviation as a way to relieve pain from an L5/S1 disc herniation. When prescription of daily acupuncture and massage was followed diligently, patient experienced a more dramatic reduction in pain, improved posture… Read more:

Low Back Pain with Urinary Difficulties

Low Back Pain with Urinary Difficulties
32-year-old woman presents with constant low back pain and burning urination. She has been diagnosed with severe hydronephrosis in the right kidney and, due to pain, recommended to have a nephrectomy. After 10 treatments with various Chinese medicine modalities, her pain was reduced by 50% and… Read more:

Lumbar Stenosis due to Osteoartritis

Lumbar Stenosis due to Osteoartritis
36-year-old female with lumbar spinal stenosis presents with severe low back pain with referred pain down the posterior left leg and anterior right thigh. The patient lives several hours from the clinic, but was able to stay in Kathmandu temporarily in order to get daily treatment for 2 weeks.… Read more:

Massage for Chronic Back Pain Associated with Spondylosis of the Spine

Massage for Chronic Back Pain Associated with Spondylosis of the Spine
70-year-old male referred for massage treatments for pain associated with spondylosis of the spine and neuropathy. The patient is simultaneously receiving ongoing acupuncture treatments. At the time of the referral, he had completed 18 acupuncture treatments. The main objective, through the… Read more:

Neck Pain with Radiation

Neck Pain with Radiation
40-year-old male presents with right-sided neck pain, without nerve radiculopathy, down the arms bilaterally. He has seen his physician who diagnosed him with nerve impingement and wants to do injections of Xylocane and Tricant local to the area of pain, inferior and slightly lateral to his… Read more:

Outer Ear Infection

Outer Ear Infection
52-year-old male presents with right-sided, burning head and ear pain, right-sided hearing loss and anosmia. It is determined, after an initial ear examination with an otoscope, that the patient has a severe right-sided ear infection. After 12 treatments, which includes the use of acupuncture,… Read more:

Painful Ulcerations of the Throat with Chronic Sinusitis

Painful Ulcerations of the Throat with Chronic Sinusitis
28-year-old male presents with chronic sinusitis, nasal blockage, throat pain and ulcerations for 18 months. The patient also presents with gastric pain. After 9 acupuncture treatments over the course of 1 month, the sinus blockage is 100% resolved, with a complete resolution of subjective… Read more:

Palliative Care of Parkinson’s Disease

Palliative Care of Parkinson’s Disease
62-year-old male was diagnosed with Parkinson’s disease 8 years ago and has been receiving treatment in this clinic since 2009. This case explores the positive role that Chinese medicine can play in providing palliative care to patients living with a chronic degenerative disease. 62-year-old… Read more:

Palliative Management of End-Stage Emphysema

Palliative Management of End-Stage Emphysema
71-year-old male presents with cough and severe shortness-of-breath, caused by emphysema. Initially, patient was stabilized during an emergency home visit. At patient’s request, palliative home care was provided. This type of care is necessary for anyone suffering from chronic illness, yet as… Read more:

Parkinson’s Disease

Parkinson’s Disease
72-year-old female presents with left hand tremors that extend up the arm and into her neck and jaw. Tremors have been present for 2 to 3 years. Hospital and doctor records report Parkinson’s disease. Over the course of treatments, the patient experienced periodic relief, with regression and… Read more:

Primary Hypertension

Primary Hypertension
3 patients present with stage 2 essential hypertension (HTN), 1 of which is a female (76 yo) and 2 of which are male (61, 50 yo). In addition, each patient presents with knee pain and various other tertiary complaints. All 3 patient’s conditions are pharmaceutically unmanaged. However, through… Read more:

Psoriasis with Neck and Shoulder Pain

Psoriasis with Neck and Shoulder Pain
45-year-old male presents with psoriasis for 5 years, possible psoriatic arthritis for 2 years, and idiopathic neck pain and stiffness for 2 months. After 17 treatments of acupuncture and herbs, he has regained full range-of-motion, has less pain in his neck, his rashes are less painful and… Read more:

Rheumatoid Arthritis

Rheumatoid Arthritis
35-year-old female presents with multiple bilateral joint pain beginning 18 months previously and had received a diagnosis of rheumatoid arthritis at the Arthritis & Rheumatic Diseases Treatment Centre in Nepal. After 10 treatments of acupuncture, in conjunction with herbal medicine, she… Read more:

Sequelae of Osteoarticular Tuberculosis

Sequelae of Osteoarticular Tuberculosis
A 58-year-old man, of rural Nepal, presents with left hip pain, reduced strength and mobility in his left hip and significant muscle wasting in his left leg. After 30 electro-acupuncture treatments over 6 weeks and Traditional Chinese Medicine, the patient reports a significant decrease in his… Read more:

Spastic Quadriplegic Cerebral Palsy

Spastic Quadriplegic Cerebral Palsy
Severely malnourished and non-ambulatory 11-year-old female presents with increased tone and spasticity in all extremities, frequent seizures, and currently requiring assist for all mobility. Patient was seen for a total of 10 physical therapy treatments with significant improvement in passive… Read more:

Spinal Trauma Sequelae with Osteoarthritis of Right Knee

60-year-old female presents with spinal trauma sequelae consisting of constant mid- to high grade pain and restricted flexion of the spine. In conjunction with the treatment for the spinal pain, the patient is treated for pain of the right knee with mid-grade pain and global swelling of the area… Read more:

Stroke Sequela

Stroke Sequela
50-year-old male presents with post-stroke sequelae symptoms manifesting as severe right-sided paralysis. After 10 treatments starting in September 2012, the patient exhibited improvement in his condition and fair measurable progress. The patient had a stroke in November 2011. He received… Read more:

Typhoid Fever Induced Paralysis

Typhoid Fever Induced Paralysis
32-year-old female presents with left-sided paralysis of upper and lower limbs. At age 12, the patient suffered from a fever due to Typhoid that caused convulsions and coma. After a 20-year history of paralysis, this patient recovered most of her upper limb function and some lower limb function… Read more:

Ulcerative Colitis

Ulcerative Colitis
70-year-old female patient presents with urgent, frequent diarrhea. No enteropathogenic organisms are present, however blood is found in the stool. Allopathic care has been unable to resolve her symptoms. After 17 acupuncture treatments and the use of Chinese herbal medicine, the patient has… Read more:

Compendium of Clinical Case Studies

clinical case studies

Download our entire collection of clinical case studies.

View Flipbook

Download PDF

Subscribe to Our Blog

Enter your email address to receive news and updates from our clinic in Nepal

Featured Case Study

  • Ankylosing Spondylitis Ankylosing Spondylitis
    Lindsey A Thompson MAcOM EAMP LAc
    February 2013
    OVERVIEW

    25-year-old male presents with low back and sacroiliac...

  • 1
  • 2
  • 3
  • 4

Your Donations Help

In addition to volunteering their time and energy, our practitioners are required to raise the money it takes to support their efforts at our clinic. Please consider helping them by making a tax deductible donation in their name.

Donate Now