Question
Dr. Gillman,

I've read many of your posts and learned so much including where to find guidelines on the duration and frequency of treatment (CCGPP), finding qualified DCs (www.acbsp.com), and the importance of diversified methods of care (manipulation, soft-tissue, physiotherapy, etc). Thank you! I now know how to proceed in getting qualified care for my back pain. In the meantime, I'd be thrilled if you'd comment on my case (potential nature of my underlying injuries, possible treatment protocols to discuss with DC). Thank you in advance for your consideration.

I'm a 41 y.o. male with a 10 year history of increasing pain where my 2nd rib attaches to my spine (left), an 18 mo history of low back pain near SI joint but generalizing across lower back, and a 6 mo history of pain in the area of my left QL. I've played recreational sports (basketball, football, volleyball), swam, ran, cycled and lifted weights 4-5 x/wk most of my life.

The causes of my pain are unclear. For years I mistook the first injury for muscle tension and did not seek care. The second injury coincided with my taking the cholesterol-lowering drug Simvastatin (since discontinued), w/in weeks of completing a sprint tri, within a few months of purchasing a memory-foam mattress, and within 6 months of starting a moderate cross-fit exercise program. The QL pain began when my PT corrected an apparent dysfunction near my SI joint that had me favoring and/or leaning to my left when bending forward and back. He did this thru spinal manipulation and targeted exercises. He said the QL pain was a soft tissue injury that would remit with time. It hasn't. And the low back pain has never resolved!

My back is mostly ok when exercising but standing & sitting aggravate my upper and low back pain. Pain is 2.5/10 during most waking hours but can be as much as a 5/10 when standing or sitting for several minute or when I bend over following a period of inactivity. Sleep is ok. Yoga, core-strengthening exercises, and stretching help but provide no enduring relief.

I've seen my PCP, a DO, and two PTs. A CT scan revealed nothing significant. No improvement after 16 months of PT.

History/Stuff that may relate

- Broke left leg in 3rd grade (below knee).
- Hx of hip problems in the groin area dating to age 16 following a rough high school football game. (Pain when raising leg just to put pants on.) Doctor at time was unable to dx or resolve. Had to stop playing but otherwise rarely noticeable. "Tight" hips.
- Blunt trauma to low back near SI joint when falling down stairs when 21. PCP at time discouraged me from seeking further evaluation or treatment. Pain resolved after several months.
- Some recurring issues with right achilles tendon/lower right calf. Aggravated this during that sprint tri in 2010.
- DO attributes my SI area pain to aging. Recommended meds (anti-inflammatory, nerve, muscle relaxants, or injections).

I'm seeking a DC in the Ann Arbor, MI area. Unfortunately, the ACBSP directory shows only one CCSP practitioner (and no DACBSP practitioners)in my immediate vicinity. The emphasis he places on x-rays and the subluxation complex leaves me skeptical. Still, I feel more capable of making an informed choice since consulting your website and the posts you've placed on this site.

Regards and thanks again,
Gary

Answer
Gary,

Thanks for the positive feedback!     It's too bad there's not a greater pool of DC's in your area.   From what you stated above, you need an expert to do the right kind of joint manipulation AND targeted soft tissue work to your spine.    I'm thinking graston technique and FAKTR for soft tissue work to your upper back, neck/traps, etc, and your lower back QL.    You also might want to consult with an interventional pain management doc to see if you have a costotransverse joint syndrome that would respond with a simple injection (by the 2nd rib/spine attachment).   No more x-rays!    You must find a good hands-on practitioner to get in there and work that stuff out.   

I hope this was helpful.   Feel free to ask more questions if need be.

'Best regards,

Dr. G'