About six months ago a friend of mine started having trouble sleeping. He was being kept awake by a nagging pain under his rib cage. During the day when he was standing or sitting up the pain was barely noticeable but at night it was enough to disturb his rest. It was also worrisome because he had had cancer surgery a number of years earlier.
He went to his primary care doctor, who ordered an ultrasound and blood work, followed by a HIDA scan to check for gallbladder problems. All of these came back negative. Still concerned, my friend sought out a GI specialist, who, after verifying that he was not experiencing any digestive symptoms, told him that this was not a GI matter but muscle-related. Both doctors felt around his abdomen and found nothing; neither had anything further to suggest to help him get a better night’s sleep.
By coincidence, I had been seeing a certified massage therapist who works with athletes. When I described the situation to her she said immediately, “That is a herniation of the iliopsoas muscle and I’ve seen several of them recently.” When she examined my friend she was able to feel a lump about the size of a quarter where the muscle belly protruded through an opening in the muscle band. In a standing position, she explained, the muscle was pulled flat and the hernia would retract into its proper place; but lying down caused the tear in the muscle band to open up and the hernia to bulge out like a balloon, creating a pinching sensation. After several sessions with the therapist, my friend was able to sleep again. What to do in order to prevent a recurrence? Strengthen the muscle so that it is less likely to tear.
The tests at the hospital had done nothing for my friend but generate medical bills and expose him to radiation. The real answer was waiting at the gym. There are a number of common and disabling injuries where muscle weakness is implicated as a contributing factor, such as rotator cuff tears and carpal tunnel syndrome, yet few doctors talk with their patients about the importance of maintaining muscle strength. Isn’t it time for physicians to collaborate with fitness professionals for the benefit of patients?