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Back In The Saddle,
The Desk Jockey Rides Again
By
George S. Pellegrino, LMT, CMTPT and
Victoria L. Magown, CMTPT, LMT
After a family outing, Bob noticed low back pain that wouldn’t
go away. In reviewing his actions, all that came to mind was
the pain began after lifting his 6 year old son. Bob remembered
leaning forward, twisting to the left and lifting the boy.
When he came to MyoRehab, he described his pain starting
at the mid back and traveling down his to the hips. He said
his pain was worse in the morning and getting out of bed was difficult.
Bob had been able to control his pain with a hot shower and over-the-counter
pain medication. This no longer worked.
Bob was athletically inclined and was concerned that his
inability to workout at the gym over the last few months was causing
him to put on a few extra pounds. He felt that the extra weight
contributed to the increased back pain.
Bob was a technician and spent long hours sitting at a
desk. He described himself as a “desk jockey”. By the
end of the day, his low back pain was nearly unbearable. Bob
said he had difficulty standing upright and occasionally found himself
walking to the restroom bent over.
 After reviewing his medical history in-depth, we did a
range of motion evaluation. This enabled us to identify
a
significant player in the origin of Bob’s pain. As you can
imagine, the muscles on both sides of the spine were painful and
in spasm. Collectively, these long muscles are known as the
paraspinals. (Illustration A)
When palpated, the Trigger Points in the paraspinals reproduced
most of Bob’s pain. A Trigger Point is a hypersensitive point
in a muscle that when stimulated, produces pain that is referred
in a predictable pattern usually away from the Trigger Point.
Trigger Points in the paraspinals of the mid-back were referring
pain into Bob’s low back and buttocks.
Bob also described more specific pain along the lumbar
spine. This pain pattern was produced by the iliopsoas. (Illustration
B) The iliopsoas muscle attaches to the front of
the lumbar spine and travels down through the pelvis to attach at
the upper thigh.
The iliopsoas, together with the paraspinals, contributes
to keeping the body erect. Usually, when one of these muscles
is injured, it is only a matter of time before the other muscle develops
Trigger Points.
When treating one of these muscles, the other must also
be treated. Failure to do so can create an imbalance that could
lead to increased pain. Additional muscles were also treated
to insure this painful condition would not easily return.
We also addressed factors that would perpetuate Bob’s pain.
We discovered that Bob was sleeping in a fetal position. Keeping
the hips flexed (knees drawn up to the chest) provided partial relief
from the low back pain, but kept the iliopsoas shortened all night
long. When Bob tried to stand up in the morning, his iliopsoas
muscle resisted lengthening producing its typical pain pattern.
Likewise, in this position his paraspinals remained stretched
all night long. Due to the Trigger Points in the paraspinals,
when he stood up and shortened them, their pain pattern became obvious.
The fetal position is not unlike the position of the body
seated at a desk. This accounted for Bob’s inability to stand
upright after long periods of sitting. Eliminating perpetuating
factors by providing Bob with alternative sleep positions combined
with a specific exercise program for work and home put this “desk
jockey” back in the saddle. Bob also learned that bending his knees
and keeping his back straight while lifting would prevent this injury
from reoccurring.
Are you a “desk jockey” with low back pain? Is your
pain increased when you get out of bed in morning or sit at a desk
too long? Give us a call at
MyoRehab.
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