Question
Dear Shawn Leatherman,
I have been suffering from lower back pain (specifically in the lower pelvic area and down the legs to the knee) from muscle spasms on the mid back right below the shoulder blade armpit area and from lower neck pain. Sorry the explanation is lengthy. I am an engineer and I was working in a floating stage which is basically a large wooden platform/stage that our equipment on. The stage is about 3 feet high and to access any cables running underneath the stage there is a 3 by 3 foot access panel/hole. I was standing in the hole and trying to repair something, when I bent over to plug a cable in the lid to the access panel, (reinforced wood weighs about 50 lbs) which was propped against the wall, came down on top of the back of my head and back. I was knocked out so I am not sure of any injuries that may occurred when I fell to the ground. When I came to I was trapped in the stage, the lid had fallen leaving an 8 inch or so gap. Because the panel was heavy (I only weigh 108 lbs) I was unable to lift it, so I wriggled out possibly causing further injury. I was taken to the hospital where a cat scan of my neck and and X-ray of my lower back were taken. I have been to an occupational doctor for months now, seen a neurologist, tried physical therapy, massage, seen a chiropractor and had 2 mris taken (one of my lower back and one of my pelvic area). The doctors have been unable to determine what is wrong. I was okay for about the first couple of days after the injury, then I started getting lower back pain and neck pain. The back pain consisted was severest in the pelvic area I would feel a burning sensation at the very bottom of the spine/pelvic area often continuing down the mostly the left leg, but sometimes the right leg. After about 2 weeks the pain increased to the point I was unable to sit for more then 5 minutes at a time or to work. After missing a month of work I found that massage helped relieve some of the pain. I tried physical therapy that didn't help. I am currently seeing a chiropractor with the massage and that seems to help some. I have been back to work for 2 months now, but am steal having problems. I am unable to sit for more then about an hour without/ pain down the leg and if I sit too long the burning in the lower pelvic area is severe. I've been having sever muscle spasms (especially at night) in the area (excuse my ignorance at medical terms) just under the shoulder blade (I think its sometimes called the chicken wing muscle). My neck is often stiff and painful and I find my range of motion has been reduced a little bit.

I have learned over the past 4 months to manage the problems by not doing anything to aggravate them (IE sit down for long periods, or bend over or drive for long periods of time). I find some weeks I'm okay and some weeks It's about all I can do to make it through the work day. Though I can manage my problem by limiting my activities and motions I'm afraid in the long run this may be causing more harm then good, because I may be loosing muscle and range of movement. I used to be extremely active before (I liked to dance, rockclimb, golf etc), but now I am unable to do any of the activities or any physical activities (except walking or gentle swimming) without causing further injury or pain. I am unable to take most medications because of a very sensitive stomach. Though I can manage, I am unable to do the activities I enjoy, or even go to a movie or to church because I can't sit for long periods of time.
Any suggestions or ideas would be helpful.
Thanks,
Becky

Answer
Dear Becky,

First of all, sorry for the lateness of this response, I have been out of town for the past week and have not had Internet access.  Sorry to hear about the chronicity of this injury, but a forceful trauma can cause a host of problems.  Specifically, you were exposed to compressive forces from the weight of the plate, and the fall to the ground...I would suggest that you probably have some form of disk injury even if it is not a distinctive bulge, but
I have to assume that nothing significant was found on x-ray, CT, or MRI, because you have not reported on any of the findings of those diagnostic tests.  If you have any other significant information concerning those studies, it may change my opinion, therefore send it to me if available.

Now concerning your situation, there must be chronic inflammation in the myofascial system, and likely continual hypertonicity/spasm of the muscular structures of the neck and back. The massage is a good technique to address these issues, but you may need something more aggressive such as Active Release Technique (ART). Google it for more complete information on the technique and certified practitioners around the country.

Physical therapy is usually not successful in helping with broad myofascial problems unless the tissue is being passively and actively worked, and you may have just been in too much pain for the therapeutic exercises to be performed correctly.  Now that you are experiencing some relief and you are back to work, active physical therapy protocols may be of greater benefit, and I would suggest that you should be incorporating them as much as possible.  If you do not have access or do not remember any of your previous therapy approaches, your chiropractor should be able to help you with home exercise protocols.

Limiting you activities is not a favorable solution to the problem.  the act of reducing your normal movements and activities only serves to further weaken the affected structures and promote the stagnation of inflammation in the body.  Movement forces the inflammatory chemicals to be circulated and therefore removed from the body.  I would suggest that you try to remain as active as possible, and swimming is a great way to do that...definitely continue.  You should also embark on a comprehensive nutritional supplementation protocol to help your body recover the tissue damage, provide for reduced inflammation and antioxidant repair as well as joint support.  This is not something that should be taken lightly however, as multiple nutrients will be needed, and metabolic testing for individual need is what I would recommend.  This can be easily and inexpensively accomplished with a simple test and the supplements can be ordered for delivery according to your profile...I use it with my patients all the time.  If you would like more information, I would be more than happy to set you up with the company I use.

Good luck Becky...send me more information if you have it, and feel free to follow up with additional questions.

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