Fiddler on the Roof

By

George S. Pellegrino, LMT, CMTPT and Victoria L. Magown, CMTPT, LMT

One of the many chores faced by millions who live in the southwest is the annual servicing of the evaporative cooling system in the spring and fall. Every year, Mark promises his wife he will hire someone to do the job; but this year is like every other and Mark finds himself on the roof once again.

Turning on the evaporative cooling system did not take a great deal of time providing Mark with an opportunity to stand on the pitched roof of his house taking in the sights. Just before he lost his footing and nearly fell off the roof, Mark said standing up there reminded him of the story Fiddler on the Roof.

Mark’s feet went out behind him, falling down face first with his arms outstretched to break his fall and his hands grasping the peak of the roof. Mark realized he was OK. “No bones broken here, thank goodness.”

Mark neglected to share his mishap on the roof with wife until two days later when he began to experience pain. At first, Mark didn’t make the connection between his near fall off the roof and the pain in his right shoulder and low back.

A friend recommended Mark visit MyoRehab for a consultation. During his visit, his pain patterns combined with a few Range Of Motion Tests told the story. Mark had established Myofascial Trigger Points in the muscles used to prevent his fall from the roof.

A Myofascial Trigger Point (TrP) 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. Interpretation of the pain patterns and identifying taut bands with ROM Testing gave us the information necessary to develop a treatment plan.

When Mark described how he landed with his arms outstretched, a shoulder muscle that can produce low back pain was suspected. His pain pattern (Illustration A) was that of the latissimus dorsi. This was the muscle that provided the strength to prevent Mark from hitting his face as his arms stretched forward and over his head.

The latissimus dorsi is the largest muscle of the body. It attaches to the hip, half of the spine, several ribs and the front of the shoulder. This muscle covers more than half of the back and when injured can produce both back and shoulder pain. (Illustration B) It pulls the outstretched arm down as in chopping wood or swimming the crawl.

When we asked Mark if he was experiencing headaches or dizziness, he looked at us with a puzzled expression. He said he had been having dizzy spells and headaches for the last two years following a minor fender bender for which he did not seek treatment. The headaches and dizzy spells had increased since his near fall off the roof.

The most frequently involved muscle in a whiplash injury is the sternocleidomastoid (SCM). (Illustration C) Even in a minor fender bender, the SCM can be injured. Mark re-injured this muscle whiplashing his head when he fell forward. Aside from head pain, when this head-turning muscle develops Trigger Points, it also produces dizziness and loss of balance.

Many people who have had a motor vehicle accident or even a near slip and fall develop symptoms of SCM Trigger Points. Symptoms include inability to walk through a doorway without hitting a shoulder on the door jamb; ringing in the ear; runny nose; tearing eye; drooping eye lids and redness of the eye.

Part of Mark’s treatment was a specific Home Exercise Program designed to keep the muscles at their full resting length. The Home Exercise Program prevents Trigger Points from re-establishing, keeping the muscles pain free.

During treatment, Mark experienced a few exacerbations of his head pain and dizziness. At first, he was a bit discouraged and thought the treatments weren’t working. After questioning Mark about his daily activities, we learned that he watched TV sitting on a couch with his head turned to one side. This posture kept the SCM shortened on one side, allowing Trigger Points to re-establish.

Distorted posture is one of many behaviors that fit into a category called Perpetuating Factors. These distortions of posture or movement re-injure the muscle, stalling treatment progress. Identifying and eliminating Perpetuating Factors is most often the difference between success or failure in the treatment of Myofascial Trigger Points.

Now symptom free, Mark said his days of “Fiddling on the Roof” are over. He promised next year to take his wife’s advice and hire a handyman to do the job.

Is your body out of balance and in pain like our “Fiddler on the Roof”? Give us a call.