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?
