Question
QUESTION: I am 33 yrs old female. A little bit of history: 10 years ago i fell and broke my tail bone and for the past 2 years i have suffered from 3 bouts of costochondritis which affected my right breast bone. I have also had 2 c sections both using epidurals and spinal blocks.

I have been very inactive  recently (bed rest for 5 months due to complicated pregnancy and then spent 6 months at home looking after baby and as he was very premature I didn't leave the house with him until he was 8 months old. In other words I have been very lazy for almost a year) Anyway in December I went out for the first time in a whole year on a very long shopping trip when I came back home my whole body ached and I had a persistent lower back pain which my doctor put down to muscle strain. This soon totally disappeared in a few weeks. One thing that i found very odd was that during the shopping trip my upper back region kept feeling like I had to crack it as it seemed like it was all tense and knotted. This too subsided when I came home and rested.
Well two weeks ago I returned back to work. I wore very high heels for the whole two weeks as well as carried a heavy bag full of books and folders. I have now developed a sore tender spot on my spine in the mid back (where the bra strap is) there is basically a very tender area that hurts when I press hard on it. It is on the left side of the spine. At rest there is no pain and the pain doesn't worsen when I breath or cough but only when I use my left arm to pull a heavy load or sometimes when i twist my upper body. When I press hard it feels like the spine and the area on the left is bruised. When I press the pain is very sharp but doesn't radiate anywhere else. I can't really lie flat as any pressure on that particular area causes sharp pain.
What do you think it is due to? does it soynd like inflammed muscles or damaged disc? I am not over weight at all in fact I have a very skinny upper chest area but I do feel physically unfit due to lack of exercise. Thank you in advance.
S

ANSWER: Hello Ms. S,
Thank you for reaching out to me for your inquiry.  Your description of your complaint is quite thorough and complete for me to give an opinion with considerable certainty.  The diagnosis at the top of the list is a costotransverse joint compression or a costovertebral joint compression. There are other conditions which could produce this type pain and consultation with an expert diagnostician is suggested.  The symptoms you describe however are classic for the condition.  This occurs when a rib slightly shifts out of place and compresses the sensitive joint lining or synovium of the rib articulation. The pain from this rib misalignment is always positionally exacerbated and described as sharp.  The ribs move in a complex pattern during inspiration and biomechanical alignment of the articular surfaces is essential for pain free movement.  The fall 10 years ago may have a slight contribution if there was an axial compression and injury to a few of the intervertebral discs in your thoracic spine.  Over time the injured discs degenerate and there is a loss of vertebral column support.  The ribs in turn attach to the vertebrae and misalignment of the rib is subsequent to the loss of vertical height of the intervertebral disc.  

Treatment with a chiropractic physician is absolutely appropriate for rib and spine pain as described.  This is often very simple and quick with considerable pain relief in 4-6 visits.  An MRI of the thoracic spine may be necessary if symptoms are recalcitrant.  Disc herniation or disc degeneration is also a contributing factor to consider.

Let me know how you are doing.

All the best to you and your baby,

---------- FOLLOW-UP ----------

QUESTION: Thank you for your detail reply! I too believe that it is an issue with the joints attached to the rib and spine. It is definitely slightly on the left side. Could sleeping in awkward positions do this? I have recently changed bed mattress and feel this may be the cause. It is the only thing I can think of as a possible cause. It has been over a week now and the area that I mentioned before is not as tender to touch and at times it feels as if the pain has totally gone however I lifted my baby in his car seat and twisted to the side and the pain returned for a day or two and now it only returns when i bend or twist my body in a certain way. Is the fact that the pain seems to subside for short periods of time and is only aggravated when I twist that area, a sign that it is healing? I will consult my GP regarding this but I'm concerned that it won't heal and I will have to take time off work which won't go down well with my employers. What can I do at home to help with this and if it can heal itself how long will it possibly take? Thank you so much for your advice.

Answer
Dear Ms. S,
I must emphasize that I have successfully treated thousands of patients with similar complaints. You should seek out the treatment skills of a chiropractor or suitably trained osteopath.  A mechanically induced pain requires hands on treatment or similar physical intervention.  There are no medications that will physically realign your ribs.  Laser therapy is an excellent adjunctive treatment to help reduce the pain, if you can find a practitioner with a therapy laser.

Please follow-up with me after you have talked to your doctor.