Question
QUESTION: Hi, Dr. Newhart.  I have been having pain and discomfort in the middle of my back, right about where the shoulderblades meet, although it's tough to pinpoint it.  It feels as if there is something out of place, and there is slight pain (although it varies day to day). And I have a constant urge to crack it, which feels good for about as long as it takes to crack it.  I can crack it by pushing my shoulderblades together, and the muscles that do so sometimes get sore I do it so much.  Also, I play marimba/vibes/xylophone, and when playing for over an hour my right lat and the middle of my back will get very stiff.  I do not have pain, numbness, or tingling anywhere, except the pain in my back.

I am 21 years old.  I don't think age is an issue.  I weight train, which I think could be related.  However, I have been lifting a few years without a problem, and there was no instance where I knew I'd hurt something; this pain just started for no (known) reason.  I do train heavy, my max squat and deadlift are 1.5 and 2 times my body weight, respectively.  I am 6'1", 190 lbs.  Some days certain lifts hurt, other days it's fine.

I tend to be stiffer in the morning, and looser but in more pain by bedtime.  The pain varies from almost none to so bad I take a couple aspirin.  I saw a physician, he gave me muscle relaxers and I saw a chiropractor five weeks, once a week.  That didn't help.  He had me get x rays, of the thoracic spine, the chest (he thought it was a displaced rib) and a scholiosis series, all of which came back normal.  I tried quitting weight training for two months, no lifting whatsoever (which I hated to do but was willing to try it) and it didn't help.  

I would like to get an mri but cannot afford to on my insurance, it would be about 1000 dollars co pay and I'm not sure it will even show anything.  

Do you have any idea what might be my problem?  Mainly I am worried that continued heavy lifting could lead to a serious back failure.  But so far lifting has not improved or worsened the problem.  I am very confused.  Any input would help at this point.  I appreciate your time very much.  Sincerely,

Jim R.

ANSWER: It sounds as if you have a bit of a muscle weakness, even though you weight train.  You may want to try a targeted exercise to strengthen the Rhomboids. We tend, in weight training, to neglect them and the smaller muscles of the spine.  I will use the rowing exercise for an example.  Put on a comfortable weight, and with your arms extended in front of you, grip the handle.  Squeeze the shoulder blades together before doing the rowing motion.  This will activate the small muscles, and help target the Rhomboids better.  You can do the same with upright rows, and again, it will activate the small muscles.
As far as the chiropractor, I would personally take a more aggressive approach; 2-3 times a week to start.  Myofascial release and trigger point treatment for the muscles, and adjusting.

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QUESTION: My physician also told me to do rows.  I can row about the same as my bench press, within 10lbs.  I don't think my back is weak.  Tight, maybe, but not weak.  

So you would say this is not a spinal problem, but rather a muscular one, despite all the crunching?  That would be good to hear, since I was worried of that.  Again, I appreciate your expert opinion.

Answer
Hopefully when you target specifically it will help.  Make sure to see a chiropractor for alignment.  Your bench and row can be exactly the same, or close, because we tend to use the 'big" muscles for these exercises.  Utilizing the little ones helps with the spinal stability (you can find these muscles in an anatomy book or online.  They are interspinalis, rotatores, intertransvaserii, etc).  If you can find a good picture, you will see how small they are.