Question
Thank you very much for the response.  Up until a few years ago, I had always been overweight and out-of-shape.  There is nothing that I can recall that I would consider back trauma.  Ironically, one of the catalysts for my lifestyle change was the onset of low back pain.  When I first started going to the gym, I took things slowly.  I knew that going from a sedentary to active lifestyle overnight would have repercussions.  I spent the better part of a year doing cardio and Nautilus workouts.  After the first year, I started to work with a trainer doing various forms of weight training.  We started with very low weights and reps and increased as I got stronger.  Squats and overhead lifting were included in the training.  As time went on, I noticed that no matter how much I stretched, my muscles kept getting tighter and tighter.  It started on the right side thoracic and progressed to the left.  I noticed that I always felt great at the gym but felt horrible when I took a break from working out.  My body felt weak especially my arms and legs.  I also started to have incessant aching/burning in my upper back muscles.  At this point, I realized that something wasn't quite right and I started to seek advice from my doctors.  The first step was to mix up massage and ultrasound therapy.  Ultrasound did nothing.  I have the most wonderful massage therapist who refers to me as her little "mutant".  She has worked on hundreds of clients and has never worked on someone with back muscles like mine.  She is the only person who can confirm all of these tight ropy bands of muscles/ligaments that I complain about.  The scary thing is, she can do incredibly deep and painful work and my back doesn't turn red.  Most people would leave black and blue.  She can never make these muscles release.  On the right side, I have one ropy band about 3" wide that starts under my scap and goes down to my mid back.  I have similar bands that follow to the left and right of my spine.  There are tender points which I can feel at skin level.  Sitting without adequate support is a problem.  Standing for extended periods is unbearable.  I did one session of prolotherapy which involved 12 Novocain-like injections into the muscles and 12 injections into spinal ligaments.  I would have continued but ran into a problem with my insurance.  This problem has since been corrected so I can pursue prolotherapy again.  I felt no improvement after the first session.  I am now seeing a therapist who, like all of my doctors, has never seen a case like this.  He is willing to give a single round of Botox a try to see if he can loosen up some of these ropy bands of muscles.  I understand that the benefits are short term and I am looking for guidance as to how I can break the vicious cycle that I am in.  I don't want to hide the pain or deal with injections every 3 months, I want to make it go away.  There is a new facility near me that just installed sit down MRI equipment.  My PCP has given up on me so as soon as I find a new primary, I will beg for another MRI.  Thank you once again.  

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The text above is a follow-up to ...

-----Question-----
I am a 30 year old male who has been dealing with chronic back pain for over two years now.  At age 27, I lost a significant amount of weight and took on a very active lifestyle which included cardio and weight training.  Most people who lose weight and get healthy feel better.  I, on the other hand, started to feel worse.  I am currently dealing with undiagnosed chronic throacic back pain.  Sitting without adequate upper back support is painful.  Standing for long periods of time drives me crazy.  I have back muscles that are in constant spasm.  Simple things like doing laundry and shaving cause radiating aching/burning/spasming in the mid thoracic area.  I have had x-rays, MRIs, and misc. blood work.  The x-rays were negative but one doctor questioned mild scoliosis.  The blood work was clean.  I have had 4 separate reads of my MRIs.  The initial read indicated mild disc bulge at T7/8.  The other 3 doctors disagreed with the initial read. I have done PT twice including ultrasound therapy.  I have seen 3 orthopedic doctors, two chiropractors, and a neurologist.  I have done deep tissue massage, prolotherapy, Graston Technique, and TENS.  Muscle relaxers do nothing.  I was given Baclofen which also did nothing.  I am about to do a trial of Botox injections for pain.  I have seen so many different dotors and have been spun in so many different directions and yet I still don't have a diagnosis.  At this point, I gave up the weight training and do cardio on a daily basis.  I feel better when I am warmed up at the gym.  Oddly enough, stretching seems to make the pain worse.  Any words of wisdom as to who I should speak to next?
-----Answer-----
Todd,

'Sorry you've had such difficulty with this puzzling condition.  You've surely covered lots of treatment bases. What stands out most is that 1) you started to exercise at the gym, and 2) being unsupported and also stretching causes pain.   Please give me some additional information:
Can you or any of your doctors touch the point/location of pain?  Can anyone palpate or press on one spot that duplicates the pain?  How many prolotherapy sessions have you had, and how many spots were injected?  When you started at the gym, were you doing any heavy overhead lifts or squats?  Ever injured your thoracics in the past?   Give me some more information and I'll again respond.   So far, it sounds like you may have capsular ligament instability.  The problem with this is that static xray or MRI will not show this.  It would likely show up with bending/motion xrays, but these are not typically done on the thoracic spine, though it's worth a shot.  Instability shows up on the lumbars with MRI only when the lumbar spine is loaded-up via harness and foot plate.  I've never seen anything like this for the thoracic spine.  I've heard of seated MRI, and this may be a way to see the problem, vis. being in the scanner, sitting, with symptoms provoked.  I await your response...

Dr. G
www.drgillman.com

Answer
Todd,

I'm glad you found an MRI center with seated MRI.  You need to have a chat with your referring doctor about communicating with the radiologist so they know to scan you in a position that provokes pain.  Surely, it won't be fun, since you must sit very still.    My gut feeling is that Botox will not work. On the list of things you haven't tried is Acupuncture.  I'd suggest this first, before doing Botox.  If the doctor doing Botox is a physiatrist, ask him/her about trigger point injections and also about "dry needling" techniques.  Todd, sometimes little things can cause a ton of pain.  You may have an unstable spot in your thoracic spine, with muscles that tighten up to guard it, and then ultimately grow taught bands within the muscle (or muscle-tendon unit...there's a tendon, too).  Any degenerative or arthritic change can make this more complicated, and degenerative changes are found on young folks, even teens.  I'd suggest getting a short course of acupuncture.  You'll know within about six to eight sessions if it's working.  There's no harm in trying.  Go for the good old traditional chinese acupuncture.  I'd be interested to know how you do with all this.  Please feel free to email me privately (via my web site, below).

'Best of luck,

Dr. G
www.drgillman.com