The Hidden Prankster

By

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

Hal, a 47-year-old Adaptive Physical Education teacher observed a child with tendencies toward uncontrollable behavior running across the room.  Holding out his right arm, he caught the child as he ran by.  He immediately felt a sharp pain in his low back as his torso was twisted to the right.

His pain level was a constant 7 on a scale of 1 to 10, with 10 being the worse possible pain.  He had difficulty sitting down or rising from a chair without assistance.  During his initial visit, Hal said he was an avid body builder and for a few years, he had even been a “power lifter”.

A few years earlier, he had been diagnosed with a herniated disc in the lumbar spine and feared he had re-injured himself.  Hal had chosen not to have back surgery and feared he may need it now.

During examination and testing of Hal's low back, a muscle deep in the core of his body called the iliopsoas lived up to its nickname, "The Hidden Prankster".  The iliopsoas is a combination of two muscles joined together (see illustration).

One part, the iliacus, is found on the inside of the hipbone.  The other half is the psoas, which attaches to the front of the lumbar spine and the discs.  It then travels down through the “well” of the pelvis where it joins the iliacus.  Together, they attach to the upper thighbone.  These two muscles make up the primary hip flexor, which brings the knee to the chest.

In many cases, when there is low back pain and a history of a bulging disc or disc herniation, the psoas is found to be involved.  When the psoas is shortened on both sides of the spine, it increases lordosis, commonly known as "sway back”.

When one side is contracted more than the other, it narrows the spaces between the vertebrae on one side and widens the disc space on the other side.  This creates a wedging effect that can predispose the low back to the dreaded problem of a herniated disc.

From years of heavy weight lifting, Hal had developed Myofascial Trigger Points in his psoas muscle.  Although other muscles were involved, the hidden prankster was the main cause of his low back pain.

Trigger Points are a hypersensitive focus of pain in a muscle that restricts range of motion and refers pain in a predictable pattern usually away from the site of the Trigger Points.  They can be laid down in muscle through direct trauma, overload or repetitive motion.

Appropriate treatment by the Certified Myofascial Trigger Point Therapists at MyoRehab eliminated Hal's pain.  A specific Home Exercise Program and modifications to Hal's body building regime, prevent the return of his symptoms and the need for surgery.

Do you have a "Hidden Prankster" causing your low back pain? Give us a call at MyoRehab.