Question
QUESTION: Hello,
My daughter has been complaining about back pain for about six months now. I initially took her to a chiropractor who said she has some kind of slight malformation in her spine that is causing her discs to rub together. However, my daughter wanted to stop after a couple of weeks of treatment because she said the adjustments were starting to hurt. So, I wrote this off as growing pains. Well, we took her to a back doctor and they said the x-rays looked fine and they want to do an MRI. BTW, she had blood work done about three months ago on a separate issue and it came back fine. Should we be worried? My wife is kind of a wreck about it thinking worse case scenario. My daughter can never pinpoint the pain, but says the pain is "all over". Could this be a "popped rib"? Would that have shown up on the X-rays for a back doctor to see? Is it just growing pains and she needs to stretch more often? She is very involved in sports. She is mainly a soccer player, but the pain first started when she was playing basketball. She also swam all summer. Your advice is greatly appreciated!!

ANSWER: Hi Paul,

First, I am not clear about what the chiropractor conveyed to you.  If you can get an actual anatomic diagnosis from the chiro', that would be helpful.  If your daughter is athletic at age 11, she is putting a lot of strain on her spine.  It is possible, with her young bones, that she is stressing them to the point of fracture.  This mostly happens at the 4th or 5th lumbar segments, and often at one particular anatomic site, a bridge of bone called the pars interarticularis.   The MRI will show if she has a stress fracture, stress response (just short of a fracture, sort of like shin splints), or nothing at all at the bone.  Young athletes are prone to breaking the pars', and when both break, the vertebral bone can slide forward.   This is called a spondylolisthesis.  Some kids are simply born with un-formed pars, but the former scenario is more typical.  This is especially so in early adolescence and when there is a lot of sports-related strain to the spine, and also in huskier kids.   Doubtful it's a popped rib.  X-rays are, for the most part, useless in diagnosing back problems.     Has she had a chance to take a break from all activities?   The chiropractic treatment should not be a painful experience, so either the joint manipulation was too forceful, or she has too much soreness/tenderness, or she needs some prep' work to her muscles to make the adjustments easier, or she has a problem that the manipulation is irritating.   I'm also curious if the chiropractor did any soft tissue diagnosis or treatment...   I'd be interested to hear back from you with more information.

'Hope some of this was helpful.

Dr. G
www.drgillman.com


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

QUESTION: Thank you again for your time Dr. G. The MRI came back OK. The doctor said she has a perfectly healthy looking spine, and the MRI would have shown any stress fractures or malformations in the spine. Which begs the question, what did my chiropractor see on the xray that she thought was a malformation? Is it common to sometimes misread the xrays? I'm a little confused by the whole thing. The doctor recommended physical therapy for strengthening and stretching. This was a huge load off our mind so thank you again for your expertise.

Paul


Answer
HI Paul,

I'm glad to hear that the MRI was normal.   You should as what the "malformation" actually was.  If the DC said it, she should own up to it.  Stretching/strengthening is a cop-out response to some degree.  What actually needs to be stretched?  Does stretching even fix stuff?  Strengthen?  Okay, then someone needs to asses what.   Core?  Balance?  Not a bad start.  But what if your daughter is limber and has a strong core and still has pain?  Is anyone addressing myofascia?   Also, has anyone talked about vitamin-D?   Do you know that there is a link between vitamin-d and pain?   More an more research is coming out pointing to vitamin-D deficiency as a cause of many problems, including poor healing and vague/indiscriminate pain.  I would suggest taking a close look at this.  Also, find a provider on this list: www.grastontechnique.com  

Please feel free to e-mail me to let me know how she's doing ([email protected])

'Best,

Dr G