Graceless Fall

Graceless fall

That was me. I was walking along 9th street and I swear the brick sidewalk in front of Teller’s reached up and grabbed my toes!  It felt like I was falling in slow motion … trying not to fall, but not being able to stop.  There had to have been a few people around who got a good chuckle out of seeing that, if for no other reason than to say, “I’m so glad that wasn’t me!”

I landed on my right knee and outstretched right hand.  Thankfully, I was able to roll over and just get up and walk away.  Someone was nice enough to roll down their window and ask if I was okay.  I laughed and waved them on, “I’m fine, thank you.”  However, by the time I got to Optimus, I discovered that I just couldn’t go down the stairs normally.  Putting weight on my bent knee was not a good idea.  I must have landed on my knee a little harder than I thought.

That was a few days ago now and my back has started to hurt, the top of my right shoulder area is irritated and I think even my neck is reacting.  As a massage therapist, I’ve been replaying the order of events that could have occurred to cause my discomfort.  Obviously, I tripped. In that motion, my right foot and leg (tibia and fibula) were stopped short from moving, while my thigh and the rest of my body continued traveling forward.  I’m guessing that my left foot was already forward because I put out my right hand.  So, the simple act of impacting the sidewalk bricks with my right foot could have been enough to jar the soft tissue of the body. It probably wouldn’t have been enough to tell anyone about, but from a soft tissue perspective, it could have been enough to create a weak link somewhere.

However, it didn’t end there. After my right thigh and the rest of my body continued moving forward, my brain tried to stop me from falling forward by trying to move forward faster.  To the naked eye, it probably didn’t look like anything, but to me, if felt like I lurched forward twice.  The problem with that is that my right foot and leg (tibia and fibula) were still somewhere behind me, unable to move fast enough to catch up.  As it tried to catch up, my knee flexed and met the bricks below me.

So now, I have impacted the bricks with both my big toe (shoe) and the medial side of my right knee.  That was enough to cause a bruising sensation right at that spot, which sent another jarring sensation up my body. Since my knee was now planted, my upper body had no choice but to accept that energy and continue to expel it upward and outward, so that I flexed my hips and torso and probably would’ve landed on my face had my right arm not already been in the forward swing.  Thus, I caught myself on the ulnar (pinky) side of my hand, which saved my face from also meeting those bricks.

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So, as a massage therapist, what does all of this mean?  What would I think about, if this happened to you and you came in to see me? Landing on my knee jammed my knee up into my pelvis.  That’s really not as horrible as it sounds, but in looking with slow motion, that’s how I would describe it.  What I feel like that did was to pull my thigh bone (femur) away from bula … super quickly … so that it stretched my hamstrings (back of the thigh), which is weird because my hamstrings were in a shortened, flexed position. However, in having hamstrings that have gotten locked short, that is putting tension into my quads (front of the thigh).  Therefore, it feels like my right quads are really tight.

All four of the quad muscles cross the knee joint, but one of them, the rectus femoris, crosses the hip joint and attaches onto the pelvis.  A tight rectus femoris could, theoretically, put enough tension into the pelvis to pull it into enough of an anterior tilt which could irritate the low back.  Thus, that could be why, after a couple of days, my low back has started to hurt.  (Summary – low back pain from tight quads caused by hamstrings which got locked short.)

The other explanation for why my low back could hurt could be from landing on my outstretched hand.

Stay with me here. Latissimus dorsi, or lats, is a muscle that attaches to the humerus (upper arm).  It’s also that muscle on your back that attaches into that diamond shaScreen Shot 5-11-2013 8.40.38 PMped aponeurosis (the white stuff in the pictures of the back).  So, by falling on my outstretched arm, I jammed my arm into hyper flexion (way up high), which stretches the lats. Because of that, the lats could be irritated all the way down through the aponeurosis and low back to where it inserts onto the sacrum.



Also, by jamming something into hyperflexion, the whole shoulder girdle gets irritated, including the 1st and 2nd ribs.  So, every muscle that attaches into this area is also irritated (scalenes, sternocleidomastoid, and trapezius just to name a few).

So, as a massage therapist, what do I treat first (after verifying that medical intervention is not needed)?  I would assess both the knee and the shoulder range of motion and determine any undue accessory motions or sensations caused by either movement.  I would probably start with whichever movement caused the most accessory pain (not acute, local pain). For example, if the knee hurts to bend it (passively), but it doesn’t bother anything else, and shoulder movement causes discomfort in the low back, I would start with the shoulder. This might mean addressing the lats, or the scalenes or pectoralis major, just to name a few possibilities. After that, I would look to the knee to see which muscles are being held short. In my case, it’s the hamstrings, even though it feels really ‘good’ to foam roll my quads.

Has this happened to you?  How many times have you tripped and fallen down hard enough to cause a bit of a limp for a while?  Our bodies don’t just shake this off.  We may forget about it after a while, but our brain stores the memory, and the pain, somewhere until the right time presents itself and we are reminded that yes, indeed, we do still have that lingering little problem.

Massage therapy can help this.  Even chronic, long-ago injuries can come back to haunt us.  Try massage therapy a few times to see if it can help you move through to the next level.