Question
Hi Shawn

I wonder if you can help?   I am a 41 year old male who has been overweight to differing degrees for the last 20 years.  that said I am physically active and have played many sports, but predominantly Rugby, since childhood.  

For the last 15 years or so I have developed a large hump between my shoulders.  Some of the hump is clearly fatty tissue but there is a harder 'core'.   My playing position in rugby is one where significant pressure can be put onto the bones at the top of my spine and I still recall an event several year ago when I was rolled over onto my head during a rugby match resulting in much clicking at the base of my neck.   Although no other problems arose form that event - no numbness or pain - I wonder if this could be a contributory cause of the hump?   

the hump is large enough now to be a nuisance i.e. clothes are ill fitting and it is cosmetically bad.   I know that some weight loss would help reduce it's size but I feel that I owuld still be left with a significant hump.   I have also found that neck movement to look over my right shoulder is now reduced to 2 o'clock (if noon is straight ahead) as opposed to 9 o'clock over my left shoulder.   I also get painless but obvious clicking and crunching in the joints at the base of my neck when moving my head from  side to side (ears to shoulders).

I am on no medication for other medical problems and the most serious medication I have received in my lifetime has been antibiotics.

Any advice would be greatly appreciated.

Andy

Answer
Dear Andy,

The problem you have described is often called a dowagers hump.  The initial cause needs to be determined for the best treatment approach.

We have some issues to handle:  First of all, yes getting rid of any excessive weight is going to help the problem from a gravity and stress perspective, but it will not solve it.  A dowagers hump can easily be the result of multiple factors such as:  forward head posture, rounded shoulders and a kyphotic spine, being overweight, thyroid dysfunction, trauma to the thoracic spine (kyphoplasty or verteboplasty procedures help), or congenital malformations of the thoracic vertebra.  This is a multifaceted question.

Since you have describe weight issues for your entire life, I am assuming that you already have thyroid problems...most likely hypothyroid.  You are also likely to be in adrenal fatigue due to prolonged cortisol release, and probably already have pancreatic trouble...may be diabetic.  The bottom line is that there is endocrine dysfunction for sure and may encompass all of the above or just some.  When this happens, the body is prone to fat deposition, and consequently we often see fat deposited in the upper back and neck.  This may contribute to the problem.  Crushing's Syndrome would be an advanced form of endocrine dysfunction due to high cortisol levels,high ACTH levels, or steroid usage...this may be where you are headed.  It should be obvious from the above that weight loss is important for your overall health even more than to eliminate the dowagers hump.  Even if blood test come back normal, hair analysis testing will often reveal underlying endocrine dysfunction (subclinical).

Posture:  Again this is very important...you have a lot of extra stress on the spinal column and cord due to the added weight on your frame.  If your posture is poor (very likely) then you are compounding the increased loads even further.  Forward head posture causes a host of systemic (body wide)problems, but the 1st and main problem is with the neck and upper back.  Research shows that this posture directly increases ligament strain, disk degeneration, muscle stretch and contraction, as well as deconditioning of the multifidus muscle which is the prime stabilizer of the disk and the facet joints in your spine.  Some quotes:

揂bnormal postures are well known to play a role in the causation of pain and functional impairment leading to disability.? Calliet, R. M.D., Low Back Pain Syndrome, Edition 4, Pain Series, F.A. Davis Company Fourth Printing, 1991, pgs. 5-8 and 26-43.

Dr. Alf Breig, Neurosurgeon and Nobel Prize Recipient stated, 揕oss of the cervical curve stretches the spinal cord 5-7 cm and causes Disease.? 

揊orward head posture leads to long term muscle strain, disc herniations, arthritis and pinched nerves.? The Mayo Clinic, Nov. 3rd, 2000.  

揊or every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds.?Kapandji, Physiology of Joints, Vol 3.}

Now with your previous trauma (RUGBY), you may have more difficulty with the hump as there may be structural cause from vertebral collapse that went undetected.  If the underlying structure has been not only functionally changed, but the bones are mechanically deranged individually (compression fracture), then a procedure such as balloon kyphoplasty or vertebroplasty may give you benefit, but often this can only help with a fresh injury.  Kyphoplasty is usually used in acute traumatic cases like compression fractures.  Others have used a similar procedure called vertebroplasty to aid in the reduction of bony abnormality.  You would have to be screened, and discuss this with an orthopedic surgeon, interventional radiologist, and or neuro-surgeon for a more indepth review and examination for efficacy.  On the other hand, your problems with reduced neck rotation and function could be from abnormal soft tissue such as scar formation due to previous rugby injury.  A functional examination of the spine is the only way to know for sure, and this should include weight bearing x-ray analysis of the neck and upper back.  A chiropractic physician is a great choice for this examination process...if there is anything serious found, the appropriate referral can easily be made.

Lastly, if you do lose weight, and you do not have a traumatic collapse of the vertebra, and your endocrine function is relatively normal, then you can actually be helped by a technique in chiropractic called Chiropractic Biophysics.  You can check out the technique at www.idealspine.com.  I have seen profound changes in patients who have been treated this way in my clinic and in other clinics around the country.  If you so choose this option, make sure that you find a doctor who is certified in the technique for the best examination and results.  It helps to get the weight down first though...again I don't know where you at concerning weight, but you probably need to be under 250 lbs before this technique will be an effective choice for you.

Concerning the endocrine function/dysfunction, here are a few books I would encourage you to read.  The information is paramount.

1.  Adrenal Fatigue- James L. Wilson, N.D., D.C., Ph.D.
2.  Living Well with Hypothyroidism - Mary J. Shomon
3.  The Antidepressant Fact Book ?Peter R. Breggin, M.D.
4.  Potatoes Not Prozac: Are You Sugar Sensitive? - Kathleen DesMaisons, Ph.D.
5.  Know Your Fats: The Complete Primer for Understanding the Nutrition of Fats, Oils, and Cholesterol - Mary G. Enig, Ph.D.
6.  The Schwarzbein Principle - Diana Schwarzbein, M.D.
7.  The Schwarzbein Principle II - Diana Schwarzbein, M.D.
8.  The Omega RX Zone ?Barry Sears, Ph.D.
9.  Health and Nutrition Secrets That Can Save Your Life ?Russell Blaylock, M.D.

Lastly, I would recommend that your nutritional status should be checked concerning your metabolic processing of nutrients and their effect in the body.  This is an easy thing to do... and you can get the results in less than 2 weeks along with a custom nutritional package created for your metabolic function, your age and sex.  The testing coast $99.00 and can be done in the privacy of your home and shipped in a pre-paid FED EX envelope directly to the lab for processing. I have some of my patients do it, and they are always amazed with the results of the testing and after they have been on the program for a few months.  If you would like more information on this just write back and I would be more than happy to get you set up with the lab.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net