Victoria L. Magown,
CMTPT, LMT, RMTI
and George S. Pellegrino, LMT, CMTPT, RMTI
When Sean was a bit younger, he was quite the daredevil. Today,
at age fifty eight and having suffered for two years with low back
pain, rock climbing, skydiving and backpacking are not currently
at the top of his list of things to do. Making it through a day at
work without the brain fog often associated with pain medication
and muscle relaxers would be welcomed at this point.
Sean said he never suffered a serious sports injury. Even after
numerous falls and a few work related injuries, Sean was convinced
repainting the living room caused all his current back pain.
A back injury is rarely attributable to a single event. Most back
pain is the result of several incidents of muscle trauma “accumulating”
over a period of time ranging from a few months to decades. In Sean’s
case, the unaccustomed overload placed on his back while painting
may have been the final trauma.
When we reviewed Sean’s pain patterns, we suspected several muscles
of harboring Myofascial Trigger Points. A Myofascial Trigger Point
(TrP) is a hypersensitive spot in a muscle that when stimulated,
often produces pain referred in a predictable pattern away from the
Trigger Point. Trigger Points develop in muscle as the result of
direct trauma, overload or overuse.
Sean’s pain seemed to “radiate” into the low back and buttocks.
Since X-rays ordered by his doctor ruled out degenerative disk disease
or arthritis, Myofascial Pain was suspected. Following a review of
the patient’s history, the pain patterns and range of motion tests
pointed to active Trigger Points in at least two muscles.
quadratus lumborum (Illustration A) is frequently overloaded when
we work stooped forward for long periods of time. As the computer
guru for a large company, Sean spends much of his day standing stooped
forward in front of several computers.
We also observed that as the result of a right knee injury from
a skiing accident, Sean habitually shifts most of his body weight
to his right side. Walking and/or standing with more than fifty percent
of our body weight carried on one side will produce Trigger Points
in the gluteus medius (Illustration B) on the overloaded side.
The gluteus medius is one of the muscles that keep our hip from
collapsing when we put weight on it. A sprained ankle or knee injury
on one side is usually the cause of this imbalance. Even after the
pain of the sprain or knee injury is gone, the habit of shifting
the weight can persist for years.
Fortunately for Sean, it wasn’t long before he began to see positive
results from treatment. Hands on therapy combined with a very specific
home exercise program made up most of the treatment plan. Learning
new behavior made up the rest. Sean said he won’t work on a computer
unless he is seated directly in front of the monitor.
Treatment of the muscles of the right knee enabled Sean to distribute
his weight more evenly. As treatment of his knee progressed however,
pain began to develop in the right buttock. Restoring full function
and normal knee mechanics uncovered a muscle that wasn’t ready to
“go with the flow”.
It seems that the right piriformis (Illustration C) was complaining
about having to stretch to its normal resting length and allow Sean’s
foot to point in a more forward direction instead of being turned
outward. He also had to discontinue sitting with his right ankle
over his left knee as this would “train” the right piriformis to
remain in the shortened position.
Sean was able to incorporate the changes we recommended in order
to eliminate the factors that would otherwise perpetuate or reestablish
his pain. Very often, overlooking these Perpetuating Factors is the
difference between being out of pain for a week at a time, for months
on end and getting out of pain and staying pain free.
Are your ‘daredevil days’ numbered? Have you measured the loss
of opportunities in your life due to the ‘sighs’ of your low back
pain? We may be able to help you.
Give us a call.