Hi Maxine,

Thank you for reaching out. If I am understanding correctly, the patient has not had surgical intervention other than inguinal repair. It sounds as though she is presenting with L3/4 symptoms and may be a result of the MOI in 2020 from the fall. If she fell primarily on her L ischium, I'd recommend (if you haven't already) to clear out some of the mechanical possibilities such as TL dysfunction, L3/4 and L5/S1. She may also have an upslip that, if left untreated, can gradually lead to the symptoms that she is presenting with based on the change in tissue structures from side to side as a result of the upslip.  What is her QST score? I would also be sure to check the femoral nerve and sciatic with the prone femoral nerve screen and then supine SLR. This may assist in further evaluating her source.

With respect to IDN, I am not seeing any contraindications for you delivering this. In fact, I urge you to try. I think it will compliment the therapy you're doing well. Based on the poor positional tolerance you may have to modify how you deliver: possibly try in sidelying if not able to tolerate prone. Or know that you may only be able to deliver 1-2 H points and then allow position change. 

With that being said, it may be beneficial to needle L2 and L5/S1 H points and run e-stim for a minute or two B to cover L2-S1 B. I would also needle inferior gluteal H point. (You could run stim L5 to inf glut also as an option). Symptomatic points I may consider either hip rotator or proximal hamstring (assuming the symptoms are posterior/lateral) and possible ITB H point. If she tolerates needling well then I'd also look at needling TL paraspinals based on the innervation around and into the inguinal and lateral hip/pelvic region. It sounds as though the pudendal or obturator nerve may also be entrapped or irritated, which is along the lateral and ILA of the sacrum. This could be a symptomatic region you'll want to check. For anterior, the inguinal region is a 'no go zone' considering the Foundations instruction. If you work around this, you should not be anywhere near the hernia repair. If concerned, you can contact the surgeon and ask where repairs and anchors may be. You may want to do a few anterior symptomatic needlings (adductors, hip flexors, or ITB H point) for the 3D approach

If you work with this type of patient population, you might want to join me in the Lumbo Pelvic Clinical Integration course this September. We work through patients struggling with issues such as this (and more).

I hope that this offered you some direction and relieved some of your fear. Know that the bowel urgency is most likely responding to a nerve 'message' as a result of overactivity. With the IDN approach, you can directly have an impact on that 'dysfuctional' message and assist in homeostasis. What a relief this will be for your patient.

Please don't hesitate to reach out again if you have further questions. Hope this helped you some,

Shani

Lumbar Pelvic Clinical Integration Course Instructor