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The Incident On Ice
By
Victoria L. Magown,
CMTPT, LMT and George S. Pellegrino, LMT, CMTPT
Sam was walking out to his car one cold winter morning and had
just reached the driver’s door when his feet started slipping and
sliding on the black ice he had not seen. Although his feet
flailed beneath him, he never hit the ground. Sam said “I must
have looked like the clown in the Ice Follies who couldn’t stand
on ice skates, but never falls”.
The day after the incident occurred, Sam began noticing low back
pain. He noticed his pain increased when he coughed or sneezed.
Since he never actually fell, he did not connect the incident on
the icy driveway with his pain.
Sam tried heat and over-the-counter pain medication, but none
of this relieved the pain. Bed rest made it worse. He
tried to continue his workout program at the gym because he thought
exercise would make him feel better. While he exercised, the
pain was decreased, but a few hours later, the pain was worse.
His personal trainer suggested he might have a muscle injury and
referred him to MyoRehab for evaluation. Reviewing his history
during intake, Sam never mentioned his near-fall. He related
an incident when he moved several heavy boxes months earlier, but
didn’t notice the pain until recently.
When asked if there was a more recent incident that could have
stressed his back muscles, Sam related the story of the near-fall
on ice. He added “This couldn’t possibly be it, because I didn’t
actually fall”. Hitting the ground is not a necessary ingredient
for a muscle injury.
Whenever the body becomes unstable, such as in a motor vehicle
accident or near-fall, a group of muscles will contract forcefully
in an attempt to protect against injury. One of the most likely
to forcefully contract is the quadratus lumborum. (Illustration
A)
The quadratus lumborum is a very strong muscle at both sides of
the lumbar spine which contributes to stabilizing the torso when
coughing, sneezing or laughing. When seated, this muscle contracts
to bring the back upright to a standing position. Sam said
rising from a chair had become very painful.
When asked to point to his pain, Sam placed his hand over his
low back and hip. You will notice in Illustration B, the pain
is not at the site of the muscle. This is characteristic of
a Myofascial Trigger Point which is a hypersensitive spot in a muscle
that when stimulated, usually produces pain referred in a predictable
pattern away from the Trigger Point.
After treating the quadratus lumborum and other related muscles
that contributed to the low back pain, Sam was given a specific Home
Exercise Program which focuses on lengthening the involved muscles
back to their normal resting length. We also taught Sam how
to stand and sit without aggravating his low back.
During this time, we asked Sam not to do any resistance or weight
training at the gym as this type of exercise could retighten his
muscles and aggravate his low back pain. We did encourage Sam
to walk on the treadmill or use the elliptical machine at the gym
as long as it did not increase his low back pain.
When Sam was no longer in pain, we discussed strengthening exercises
with his personal trainer that would bring Sam back to the previous
level of his workout program without an exacerbation of his pain.
Within a month, Sam was enjoying his full workout program and life
without low back pain.
Have you or a friend had an “Incident on Ice” or a similar near-fall?
Do you have unexplained or unresolved low back pain?
Give us a call at MyoRehab.
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