The Tale of the Tummy Tantrum

By

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

At the age of fifty five Regina was finally comfortable with her life and her profession. After working for several years for a noted architect, she was now on her own. Her architectural design business was every bit as successful as she had hoped it would be. There was only one problem; the aches and pains she had ignored for so long were now demanding her attention.

When she first came to MyoRehab, it was for pain at the lateral elbows and the base of the thumbs which she said she’d been able to ignore for years. The pain at the right elbow increased shortly after learning how to play tennis. The pain at the left elbow and both thumbs became much worse after pulling weeds in her garden in preparation for this spring’s planting.

During her initial visit, an in-depth review of the history of her body’s injuries and a detailed analysis of pain patterns combined with Range of Motion testing pointed to Myofascial Trigger Points as the source of her pain. A Myofascial Trigger Point is a hypersensitive knot in a muscle that produces a taut band. When stimulated, Trigger Points produce pain referred in a predictable pattern usually away from the Trigger Point.

Myofascial Trigger Points are a frequently overlooked and often misunderstood source of musculoskeletal pain. The results of two studies involving nearly 400 patients seeking medical intervention for pain showed that Myofascial Trigger Points were involved as the source of pain as much as 93% of the time.

In Regina’s case, trigger points in the supinator (Illustration A) and the brachioradialis (Illustration B) were producing their typical pain patterns often referred to as Tennis Elbow. As you can see from the illustrations, both muscles will produce pain at the lateral elbow and at the base of the thumb.

Treatment inactivates the Trigger Points eliminating the taut bands and allows the muscle fibers to return to their normal resting length. The result is the elimination of pain with return to full function. A specific home exercise program and modification of activities ensures the permanent elimination of the pain.

Regina was thrilled with the results of her care. In just a few visits her elbow and thumb pain was completely eliminated. She mentioned neck and upper back pain she wanted us to evaluate. She said she would be out of town for a few days and made an appointment for the day after she was to return home.

When Regina arrived the morning of her evaluation, we were expecting to evaluate her neck and upper back. Instead, she was doubled over with her arms folded across her abdomen. Her husband had to drive her to MyoRehab because, she said, the pain in her abdomen was so bad she was unable to drive. Her upper back and neck pain was “off the scale” and coincided with her other acute symptoms. It began the night before.

As she tried to talk, her breathing was labored and very shallow. She could hardly speak a complete a sentence without taking several breaths. When we asked her what she thought happened, all she was able to say was “Tummy Tantrum”. She tried to lie on our treatment table, but was unable to do so with out experiencing excruciating pain.

It didn’t take very long to figure out the culprit causing Regina’s pain. The combined pain patterns and symptoms (Illustration C) told us part of the story. It wasn’t her tummy at all. For us, how this could have occurred was the real mystery. The answer to that question would have to wait for now.

The diaphragm is a muscle. Its role in the body is to cycle air through our lungs and keep every cell supplied with life giving oxygen. When this muscle harbors Myofascial Trigger Points, the consequences could be severe. Regina’s diaphragm had developed a very painful contracture due to Trigger Points on the left side.

As you can see from the illustration, Regina’s neck and upper back pain were more than just “a pain in the neck”. Pain in the upper shoulder and at the base of the neck is often produced by the diaphragm. Her treatment that day focused on the superficial muscles of the abdomen and the diaphragm. A modified back bend stretch was given as her homework assignment.

When she returned a few days later, she was sore but pain free. She also remembered what caused her “Tummy Tantrum”; a breathing technique she learned in an exercise class for which her diaphragm was not ready.

Is your tummy throwing a tantrum and ruining your day? Do you have Tennis Elbow . . . and you’ve never even held a tennis racquet? If so, give us a call and make an appointment for an evaluation. Our phone number is 872-3100.