Charles V. Toman, MD - 4/20/2009

Question
My lower back began hurting randomly exactly 3 months ago, as if I was on my feet all day. The pain radiates around, but most of the pain seems to be about 2 inches above the tail bone, on either side of the spine. This is where my back first began hurting, but gradually began hurting in another place as well. Not as bad as the 1st, but still constant. That 2nd worst pain area is in the curve of my back--such as when I arch it backwards--in the two main muscles on either side of the spine. I am--was--a healthy, 18 year old female who danced for 8 years, quit one year ago, and took up sprinting every other day for exercise 6 months ago.
The pain has been constant for 3 months, and I find that sitting hurts more than standing, and just twisting my body makes the pain worse later. I hardly feel any additional pain at all when I do stretches, and they often feel slightly relieving, but as soon as I stand up again or straighten my back, the pain quickly returns and the stretches have made it 3x worse than before. It seems that whenever I stretch a certain way or am active, I never have a sharp noticeable pain apart from the constant dull ache. So I don't think that what I am doing is hurting my back more, but within a few hours after I have done the movement, the pain intensifies and sets in. Anything but having a straight back makes the pain worse, although I find immense relief when I lay on my back on the ground and bend my legs up in a chair.
My entire back also seems to be fragile now, when it never has been before. Leaning in one position for just 10 mins causes a new pain in a new part of my back that lasts all day...(such as in between my shoulder blades, my neck, and my shoulders) in addition to the lower back pain. I also have pain in my mid-back when I take deep breaths, and 90% of the time I can hear/feel my back crack when I take the breath, which has never happened before. Then of course the pain gradually gets worse, and 3 hours later I remember it is because I did something like took a deep breath.

My doctor took X-rays, blood, and urine tests. She found nothing wrong and did not give me advice. I do not have any sports medicine physicians in my area either.
Also, I can actually feel tenderness in some spots on random parts of my two back muscles (whatever major two are on either side of my spine), and the muscles seem to be the cause of my pain also.
I don't know who to see about this. I have been given advice to see a spinal doctor, a sports medicine doctor (which I don't have), a D.O., a physical therapist, a chiropractor (but I hear most of them just want your money), and a orthopaedic surgeon. Yet, I don't know who would be the best to see. I am leaving for college in 3 months and am terrified this pain will not go away and I will be stuck with it for years. We cannot afford so much treatment and I want to find the best doctor and what your advice is on everything, so I don't go waste money. Someone mentioned an MRI, but I know those are costly, I don't think are covered by insurance, and could be useless in helping me.

I miss being active and which I could exercise again and burn off SOMETHING. I am just so tired of being in constant pain...I am too young for this!

Answer
Barbara,

First of all I am sorry that you are having to deal with this!  It sounds horrible.  

Back pain is the #1 or #2 cause of missed work and school and activities.  I have heard many people with the same story that you have so vividly detailed above.  

My suggestions for you are to seek a out a physiatrist or orthopaedic surgeon to evaluate your back pain.  

The most common treatment for back pain is rest ( about 3 days), activity modification, over the counter anti-inflammatory medications, and perhaps a trial of physical therapy.  

Usually X-rays are negative especially in someone so young.

I would ask your physician for your complete medical record and X-rays and ask for a referral to an orthopaedic surgeon or physiatrist.  
These types of doctors are trained to deal with the symptoms that you have described.  You should ask them about a spine therapist.  these are physical therapists that work specifically with patients with spine pain.  They are very in tune with various treatment modalities and regimens for people with your symptoms.

If the orthopedic surgeon or physiatrist feel that you have symptoms that are consistent with a herniated disk or spinal stenosis, or spondyloysis or something like that they may order a CT scan or MRI to evaluate these conditions.
Again, these types of doctors have special training and often an interest in these specific conditions and will be better able to help you.

I wish I could comment more, but  without examining you it is impossible.

Hang in there and let me know if there is any specific point you would like me to elaborate on or any new concerns you have.

By the way a physiatrist is the same as a physical medicine and rehabilitation doctor (PMR) and they ae basically nonoperative orthopaedic doctors.

Good Luck