Question
Dear Dr. Leatherman,
I'm seeking advise on what course to pursue in identifying the reason for my (now more frequent) lower back pain localized to the right side of the base of my spine slightly above the buttocks. I'm a 50 yr old male, fit and ht/wt proportionate who's lived a physically hard life of sports, work and then more work. I can distinctly remember the day 12 years ago when I was lifting an extremely heavy trailer tongue and felt the "pop" in my lower back during an unexpected lateral movement in the course of lifting. The event nailed me pretty good, swelling up my waist 3/4 around from the point of injury and I walked like a cripple for 5 days. I was in a remote area and medical help was a long way off so I just made do. The injury haunts me more frequently now and is becoming a real painful reoccurrence sometimes as frequently as 7-8 times a year.
My question is should I pursue this with a chiropractor or MD? I live in Mexico and both x-rays and MRI's are relatively inexpensive and can be done on a non-referral, walk in basis. With the a snapshot of my back's problem area I'd then head for either the chiropractor or MD depending on your recommendation. What's your take on the situation, MRI or X-ray or both? Chiro or MD? Thanks in advance!

Answer
Dear Lance,

In short, a chiropractor is more likely to help with this chronic injury. Now, although an x-ray will be helpful in looking at the structure of the spine, you will likely not need an MRI for this issue....from what you have described this sounds mostly like a soft tissue injury to the myofascial structures.  

The initial amounts of swelling around the waist indicates soft tissue injury and it is likely that your originally tore a muscle, and the fact that the pain dissipated after a few really bad days also indicates muscle vs other tissue.  Muscles have good blood supply and swell appreciably with injury but heal quickly compared to tendons and ligaments.  Your ongoing issues are likely related to scar tissue formation and adhesions in the tissue at the original injury site.

Bottom line here is that you a need a good functional examination of the tissue to help determine the exact cause and this is what chiropractors do everyday in office.

Hope this helps Lance...feel free to follow-up if needed.

Respectfully,
Dr. Shawn Leatherman
www.suncoastehalthcare.net