Chronic Back Pain - Triathlon Training - Help

[Dr Damien]

dear dekkly

it sounds like a torn muscle from your description...to be sure resisted tests will need to be done....take ur arms away from your side...bend your elbows, keeping your back straight push your elbows against a wall, what happens? (almost like you waant your shoulder blades to clap but you resisting the movement with your elbows)
secondly, while sitting, rest your hands on the arm chair and lift up like you would do a reverse dip, do once, what happens? (almost like you want to bring your shoulder blades down,)
thirdly, place one hand behind your head and resist taking your head back with your hand, what happens?
if your wife is there, ask her to place her hands on your shoulders, tell her to resist your while you try to lift your shoulders up (like in a shrug?) what happens?
Do you get pain on full range rotation?
if so...fold your arms acros your chest, turn left just before the pain increases...ask your wife to ressist this movement, what happens?
do the same for the right? what happens

my thoughts again:
I am excluding a subluxed rib hypothesis because you are not getting this pain when you expand your rib cage, you are getting your pain mainly when you move your spine, when you elongate it and when you turn it...as a variety of muscles cross from neck to spine, from spine to scapular, and within spine...
we are resisting these movements to see which aggravates...

if when your spine is stable and the resistance tests are positive..i.e keeping your back straight and pushing elbows against wall, resisted shrugging etc...then its probably a muscular problem...
if its not and you only get the pain on end range of spinal movements, I would put my money on a torn ligament in one of the verterbrae...

However it is essential that you get an xray to make sure nothing is out of place...

Your therapist maybe right to think it is posture related as if you have a faulty posture, i.e a forward neck, you could have a rigid neck/chest junction...with regards the possibility of you having arthritis...spinal dysfunction may become evident...

reply and we go on with our reasoning...

cheers

[SigMik]

Dear Dekkly and Damien.

I've enjoyed reading your posts on this issue, and it has been interesting to follow the development of your reasoning. I think both you and Damien are doing a great job in narrowing things down and I agree on most of the comments Damien has made about the information you have been giving him.

If you don't mind, I'd humbly like to offer some thoughts that sprung to my mind whilst reading about your pain. The one thing that really stood out, was that it hurts more when you put your chin to your chest, and while holding that position, when rotating, it hurts even more. To me, that strongly suggest the involvement of a neurodynamic component. A simple test could provide further evidence to this being likely or not, and you can easily do this yourself. This link should give you a good start.

YouTube - Slump Test as described by Dutton

After slumping your upper body and lower back, with the chin flexed towards your chest, the discomfort is likely to increase, as you already told us. I'd advice you to stop the slumping at that point where you just feel the discomfort starts to increase and then proceed with the next movement in the test. The main component here is when your STRAIGHTEN OUT either of your knees and dorsiflex your ankles, does the discomfort between your shoulder blades INCREASE? Start with one leg first, compare with the other leg. If both are painless, do it with both legs simultaneously. If this also does not increase the discomfort, slump more tightly and repeat the movements, if still no increase in the discomfort between your shoulder blades, ask someone to put some pressure through (longitudinally) your upper body. A skilled therapist could explore these movements even more, changing the order from bottom-up, add rotations to your upper body and so on to search for any relevant signs. Both the chiro and the physio, in my opinion, should have done this on the first session with you, as it is a standard, simple test, that is recognized world-wide and taught in most undergraduate programs.

There is already a lot of good information in what you have shared with us, and some of this also supports my thoughts. Personally, I'd think of a torn muscle as less likely, and more towards intervertebral disc issues to be honest.

Both myself and Damien (and several others on this forum) can tell you more about neurodynamics and how a disc or its nearby structures can interfere with it, but it would be helpful to know if the slump test is positive or not before we go too deep into that discussion. Any additional information you can come up with, and details of how the slump test went would be helpful. Good luck!

Kind regards,
Sigurd Mikkelsen