I am in therapy to treat chronic back pain. Initially, I was suffering for over three years from terrible, sharp, daily pain deep between my shoulder blades. I saw a doctor and she recommended #1. That I read the writings of Robin McKenzie (who teaches people to treat their own back and neck problems by focusing on posture and gentle exercises and to #2. See a physical therapist.
Using props at work, in the car and even in bed, I’m been able to give myself support that has greatly reduced my pain. Also, my first few physical therapy sessions left me feeling strong and thrilled to be improving.
Then things started to go downhill. I started having a backlash the day after therapy. I was having deep, sharp pain again. Also, the pain has spread into my mid-back. It’s not nearly as bad as before, but my progress has certainly plateaued. I’ve been hearing a lot of “I don’t know” from my therapist and they have been cutting back on the difficulty of my exercises.
It was suggested to me, by my therapist, that I should go back to the doctor. She may run some kind of tests. I’ll be seeing her tomorrow.
I’m wondering if anyone has any experience with this. What happens next? Am I going to get an MRI or something??
#1 by The mom on December 28, 2009 - 10:32 am
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I wouldn’t be surprised if the orthopedic surgeon ordered an MRI. There has to be some reason for the severe pain, and until you know what that is, you aren’t likely to get better. Physical therapy alone isn’t always enough to do you any good, and in some cases it can actually make matters worse. There are other things to help you eliminate the pain, and possibly even treat the root cause. But you really do need to visit an orthopedic surgeon to find all that out. In the meantime, I’d say since the PT isn’t helping, and seems to be making matters worse, it’s time to call a time out on that- at least until you do see the doctor and get the diagnosis and recommendations. A physical therapist wouldn’t be qualified to do that. Posture and exercise are good ideas to deal with back pain of a muscular origin, but not in cases where you actually have a spinal problem. You may well have a bone spur, and all the exercise in the world wouldn’t help that. If you were just sitting slumped over, or doing a lot of bending that stressed out of shape muscles, it would. But that’s not what it sounds like you have. One other odd thought I had- and this is wondering what size bust you have? If you have a large bust, and the bra isn’t providing sufficient support, you tend to slump the shoulders forwards. And the sheer weight can also pull things out of place as well. If this is the case, then a change of bra and possibly a bust reduction would be your answer. Chesty gals do tend to have that shoulder blade kind of pain. Otherwise, this is one for the expert to sort out for you. Good luck, hope you get some relief.
#2 by jackie_j on December 28, 2009 - 2:16 pm
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I have had 3 back operations and chronic back pain. I went through physical therapy and it really did not help me. I am sure you will get an MRI or Cat Scan scheduled by your doctor. I have found that the one thing that helps me is Trigger Point Injections. You might ask your doctor about them.
#3 by katie-di on December 28, 2009 - 2:28 pm
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Have you had an MRI? That could pinpoint exactly what is causing the pain and give you more options for treating it. If you haven’t had one, ask. Good luck!
#4 by Anonymous on December 28, 2009 - 8:34 pm
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You’ve read Robin’s book, but have you been seen by an MDT credientialed provider? The book is excellent for someone with a simple derangement, but if you do not fit in that diagnostic classification, or if you do have a derangement but are unable to reduce the derangement yourself, you may need further clinician assistance. If you do not fit into the derangment classification, you may need further assessment to further classify your symptoms.
If your PT is not credentialed in MDT, I would say this is your first step. It could be that your physician was trying to fit you into a diagnostic classification to which you don’t belong…end range repeated movements may or may not be what you need.
If you do not fit into the derangement, dysfunction or posture syndrome, the MDT certified therapist may be able to help, but it will take a different approach…but this needs to be the first step.
I would go to http://www.mckenziemdt.org
An MRI is certainly possible, but for someone with chronic pain, trying to find something on an MRI to “explain the pain” is like shooting fish in a barrel (something almost always shows up an anyone’s MRI), the question is whether the findings would be clinically relevant.
#5 by Anonymous on December 29, 2009 - 2:32 am
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I am sorry that your experience with that therapist has not been a good one. The suggestion that you return to the doctor is not a wrong one. If there is to be anything learned from having an MRI then by all means have one. It will help the doctor and therapist know what direction to go. Now as for the therapist I would suggest one of two things. If you have confidence in that particular therapist sit down with them and talk things over. If you no longer have any faith in that person find another therapist and sit down and talk to them before they do anything. A good therapist should be happy to sit down and talk to you about what has happened, why you are unhappy with that other therapist, and what they would do. Reading a book by McKenzie is fine but having someone there to really show you what to do is better. Now in my experience treating someone that is flexible is more of a challenge. The reason for that is the ligaments are usually loose and an injury will stretch them to a point that they no longer hold effectively. To overcome that you have to work on stabilization movements that often start much lower in the back and have to be gradually worked up into the injured area. Remember that the muscles were designed to carry load and stress and the ligaments were designed to hold things in place and to prevent too much movement. The therapy you should be getting is hands on either on a landbased or aquatic program. The program is not going to be rapid because the muscles have also been torn and they have to heal and be aligned properly to achieve better function. Another way of treating this is to work another body section that will overflow into the area that is injured. So in the case of the mid-back region that would mean working the lower back or chest area to get the mid-back to relax. One has to get the muscles to relax first before working to strengthen them. So if your therapist is unfamiliar with this or you are just plane unhappy with them find another one that will do some of these things to help you. As for a stretch to the mid-back there are a few. As if they have a foam roll and place that at the level of the pain and lay on it. That will stretch the back. Another is to lay on your back and bring the knees into the chest and hold. Now bring up the head to touch the knees. Another is using a large gym ball and laying on the ball and rocking forward and back on the ball. I don’t know if you can handle this one but if you are up to it give this a try. Hang from a bar either from a long sitting position or entirely. This will definitely stretch out the mid-back. Without seeing you more specific types of stretches cannot be given. Don’t give up on the profession because of one person.