Question
I am 55 year old male, and have had other back injury, L-3 L-5 hernation with no surgery. 2 years ago I fell 8 ft landed flat on my back. one year later I had a mri done, the dr said that I had cracked two thoracic vertebre and would have to wait untill they fuse themselves together. meanwhile it is very painful, and does not seem to be getting any better. I am using massage once a week to get relief,and still working on my job. the pain is centered just below my sholderblades, and radiates down both sides  giving me muscle, and spine tenderness down those two long muscles. I was "refered" by my gp. to this spine specialest. I dont know what I should do next in my treatment. work is getting very tiring becaus of the constant pain level, medication is the only thing getting me thru the day...thank you for your answer

Answer
Dear Gary,

Thoracic fractures can be difficult to recover from due to the inability to immobilize the area, but should still heal.  A normal fracture of a long bone will typically heal in 6-8 weeks with immobilization while vertebral fractures may take longer.  

If you have an MRI 1 year after the initial trauma that shows continued fracture of the vertebra this is not good news for resolution.  I am not sure what kind of fracture you have though...a posterior element fracture, transverse fracture or compression fracture.  The compression fracture is actually quite easy to resolve with minimally invasive surgical procedures such as kyphoplasty or vertebroplasty, and the success rate is very high...people get significant pain reduction almost immediately after the procedure has been completed.  I am assuming you did not have a compression fracture, or the compression was very minimal if this was not offered.

If you have a posterior element fracture that is stable, or a transverse fracture of the vertebral body Which is rare) then resolution is much harder.  Bone requires immobility to fuse quickly and properly which is not likely to occur without some form of external or internal stabilization.  All movement will place some amount of stress on the spine which can prolong healing rates.  

On the other hand, if the fracture has resolved then you are likely in a chronic pain pattern of the myofascial system, or muscular system from altered function due to guarding mechanisms post injury.  If so this can be helped with deep tissue massage techniques, active stretching protocols, and functional rehab exercises to target the areas of dysfunction concerning your normal movement patterns and postural demands, and chiropractic care or physical therapy is a good avenue to pursue.  

Bottom line though is that your doctor should have given you a diagnosis with an explanation of what tissues are the pain producing, and those tissues should be the focus of care. You also need to determine if the fracture still exists.   Unfortunately, most "spine experts" are not really spine experts...they are either orthopedic or neurosurgeons who are not well versed in conservative care of the spine....rather they are experts in surgical techniques Unless it requires a surgical correction they are not likely to advise you on further care other than sending you to a physical therapist which is their standard non surgical protocol, and if that doesn't work, then pain management might be recommended.

My recommendation:  get confirmation on the fracture, healed or still present.  Chiropractic and functional rehab care is a good option if the fracture is healed, otherwise, you should be promoting fracture healing with nutritional support and reducing the stress / mobility in that area. You may also want to explore acupuncture to help control pain.  I have co-treated patients with a local acupuncturist and they have been very helpful in reducing chronic pain.  Good luck Gary.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net