A Recipe For Disaster
Victoria L. Magown,
CMTPT, LMT and George S. Pellegrino, LMT, CMTPT
Margaret loved to cook. In her retirement years, she enjoyed “Cooking
for the sheer joy of it”. She watched every cooking show on television
and owned a veritable library of cookbooks including her mothers
now out-of-print treasures. Her most treasured recipe collection
of all was her grandmothers handwritten secrets handed down for generations.
Her collection of cooking related paraphernalia didn’t stop there.
Her kitchen, she says, was decorated with paintings and prints related
to cooking along with utensils and devices long since replaced with
“Teflon coated, electrified, anodized and just plain useless gadgets
that” as Margaret says, “have taken all the fun out of cooking!”
Recently, the fun of cooking seemed like it would come to an end
for Margaret due to right hand and elbow pain. “Chopping” she said,
“did me in”. To Margaret, using electrified gadgets to do the work
isolated her from the tactile joy of preparing food with her hands.
When Margaret was first told she had “tennis elbow” about two
years ago, she protested vigorously. She said she’d never played
tennis in her life. When she came to MyoRehab for an evaluation,
we explained that the term tennis elbow was the generic term for
pain at the lateral epicondyle of the elbow. (Illustration A)
This pain can arise from many sources. In Margaret’s case, a brief
examination revealed Myofascial Trigger Points as the underlying
source in more than one way! A Myofascial Trigger Point is a hypersensitive
spot in a muscle that when stimulated, usually produces pain referred
in a predictable pattern away from the Trigger Point.
These points also trigger contractions in muscles that are called
taut bands. Sustained contraction of a taut band can pull relentlessly
at the muscle’s attachment causing painful inflammation. In Margaret’s
case, both the referred pain and the pain at the attachments of muscles
near her right elbow produced a recipe for disaster.
The repetitive motion of chopping established Trigger Points predominantly
in one of the three heads of the triceps muscle. (Illustration A)
The triceps pulls the forearm into a straightened position (extension)
as in the motion of chopping. These points trigger referred pain
to most of the arm and forearm from the wrist to the shoulder with
a focus of pain at the elbow.
There was also significant pain at the web of the thumb Margaret
attributed to holding her favorite Wusthoff chopping knife too tightly.
Our evaluation told a different story. The brachioradialis (Illustration
B) brings the forearm back into its bent position (flexion). Overuse
of this muscle produces points that trigger pain at the web of the
thumb and at the elbow. Margaret’s chopping arm didn’t stand a chance
with Trigger Points in this dynamic duo.
Although Margaret was treated two times a week for two weeks with
great success, there was still a spot of pain at the elbow that persisted.
Reevaluation of the muscles identified and treated for Myofascial
Trigger Points did not reveal the source. While preparing slides
for our next seminar later that week, the light went on. An often
overlooked muscle called the anconeus (Illustration C) produced just
such a pain.
With this and other contributing muscles successfully treated,
a specific home exercise program restored Margaret’s joy of cooking.
We have been keeping tabs on her progress by carefully sampling the
wonderful breads and deserts Margaret drops off at MyoRehab now and
then. Margaret is doing just fine.
Is there a “point” or two cooking up a recipe for disaster in
your life? If you there is,
give us a call at MyoRehab.