Question
Hello Dr. G.,

Let me start by saying I was somewhat skeptical that my "back spasm" could be fixed by a chiropractor, but I was tired of going to outpatients suffering in severe pain, only to be told to take some pills and come back in a week if the problem didn't go away.

I had been to a chiropractor one time years ago for a back problem and admit the three visits did fix my ailing back, but I was still one of those who was not convinced with the "cracking".

I went to a chiropractor yesterday as I my recent problems have compounded and everything he told me about my problem made sense to me. Some sort of scanning machine he used also indicated I was having troubles in the exact places where I am experiencing discomfort.

I think I have finally found a place where the caregiver actually wants to correct the problem, but I wanted to also run this past you to see if you concur with the diagnoses (you seem very knowledgable, as does my chiropractor, but since this is all new to me I'd love to hear another expert's take).

I'll start at the beginning.

About 10 years ago I was going to pick up my girlfriend off a picnic table (horseback ride). Instead of slowly getting on my back, she jumped from the table. Unready for this, my back immediately went into spasm. I hit the ground and could not get up for about 30 minutes, with intense pain and an inability to take a normal breath (I used to have to take quick short breaths and hold it as long as I could until the pain somewhat subsided).

I thought I had a back spasm. Eventually, with the help of muscle relaxers (and beer), the pain went away. In the past 10 years, I've had about 12 of these spasms, mostly brought on with physical activity like carrying heavy boxes (usually with a twist involved). I play hockey on a regular basis, work out, etc. so it's not like I'm in bad physical condition. I think my back is as strong as anyone's.

I do often get a burning pain right between my spine and shoulder blade on the left side with very little physical activity (I'm getting it now while typing), but it usually takes a catalyst to get it to spasm (I say usually because the most recent one happened while just sitting at my desk).

My wife (who was the girlfriend who jumped on my back!), can feel two small lumps - what I always thought were knots in that area and whe she presses on them it pains, but it's that good pain where you want her to keep pressing hoping the know will "release."

While getting a professional massage a few weeks ago the therapist said she thought they were "rib heads." I had never heard the term before, nor had any doctor mentioned this as a possibiilty when I would visit them for my "spasms."

Without telling the chiropractor this, he came to the same conclusion during our first visit (he wouldn't pop them back in place as he said it would cause me a lot of pain - like the spasm again - but did do some work on it and plans to put it back in place Wednesday on a second visit).

I have some other issues that may or may not be related to this long on-going back problem, but I've gone on long enough.

If you can give me your opinion on the diagnosis of a subluxated rib, I'd really appreciate it.

Answer
Sorry, Stephen, but it is difficult to answer your question.  I need a little more concrete data.  You say "Back Spasm" and also mention symptoms between your shouder blades, and title your quesiton "back neck hip."   I need you to give me one at a time or tell me which part of your back you are talking about (I know it's difficult to to this stuff via internet).  The knots you mention are likely myofibrotic lesions, and if you sprained your spine where it connects to the ribs, then the ribs will have a prominent feel to palpation and the surrounding tissues with develop either scar tissue or degenerative spots (gaps that fill with fatty/fibrous tissue, like grizzle) in the small tendons.  The ribs may or may not be truly out of place, and even if they were, they would not just pop back in place in a chronic (long term) situation like yours.   The scanning gizmo is not a valid instrument and it is used more for marketing purposes to impress the patient and keep them coming back until the lines match up...  The only valid outcome measures at this time are your symptoms and your daily living activity scores.  You can score yourself at the following web site: www.clinicalhealthservices.com/Lenoir/    (go to OSWESTRY or SF-36)

' Regards,

Dr. G