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 OR click here to set up your thirty minute consultation