A Recipe For Disaster

By

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 OR click here to set up your thirty minute consultation.