Question
Hi there, I am a 31 year old female and for the past 12 days I have been experiencing very bad pain in my right flank or middle back on right side, which had a suuden onset. I first noticed this pain at 9:30pm when I sat on my bed to dry my hair and until then had never had back pain. Earlier that day I went for a brisk walk for 45 mins and then I did some stomach crunches and also back exercises where I lie on my tummy with hands at ear level and raise shoulders for 15 reps or so. I did not feel any strain when I did this. That night I slept without pain but then I noticed the pain again the next morning as I sat in bed reading, this was about 15-20 mins after waking. Since then the pain has a pattern, it hurts every morning when I sit up in the bed 15-20 mins after waking, when I stand up it gets worse. I sit at a desk in work and the pain comes in waves throughout the day, I also feel it at some stage in the evening no matter what activity I'm doing. I have exercised as normal since then onset which is salsa dance class x 1, walk 30/45 mins x 5, light machine weights x 2 and crunches, squats etc x 3 (as is routine for me) - the pain has not affected my ability to bend or stretch or lift etc. My GP has ruled out kidney infection and also shingles (I have hives in the area too) He prescibed Difene 75mg twice daily which have not help whatsoever. The pain comes in waves and at max it grips me and makes me double over and catch my breath, this happens 3 to 4 times daily, otherwise at minimum it's just niggling away. I don't have fever or chills but I am feeling tired and run down. I really want to make this back pain go away as I am getting married in 6 weeks so the timing isn't great!! Help!!

Answer
Dear Tamara,

Upon reading the first part of your question I immediately thought kidney infection or kidney stones.  You mentioned that your GP had ruled out infection, did he/she also rule out the presence of stones by urinalysis and x-ray?  Not to mention have you been cleared of any gynecological problems, fibroids for example can cause flank and back pain.

You also mentioned that you have hives in the area.  This may sound crazy, but many people have unexplained pain before a life changing event such as getting married, because of the stress of planning, family, getting it right, as well as expectations of the perfect day.  Hives can easily manifest on the body as well because of increased anxiety due to life stressors.  This is something to consider because it may be easily corrected with self guided relaxation techniques.  Just as an aside, shingles breakouts are also due to physical and emotional stress that reduces our immune function.  Your tired and run down feelings may all a part of this, as well as having pain.

On the other hand, this pain could easily be the result of mechanical problems in the spine or a strain/sprain of the soft tissue in the back or rib cage. Think of anything that may have predisposed your pain...altered workout schedule, moving furniture, sport activities that you are not used to performing, painting overhead etc... You mentioned the pain has a pattern worse in the morning while sitting in bed. When pain is worse in the morning, that is an indication of muscle and/or fascial system involvement with adhesions, tightening or spasm.  It is also indicative of inflammation that may become static in the tissue due to the lack of movement while sleeping.

Concerning the fact that it starts in the morning while sitting in bed and is worse when you stand up, then continues to be problematic at your work desk, mimics deconditioning of the low and mid back extensor muscles due to poor posture.  What doesn't make sense is the fact that you seem to be very active and fit according to the exercises that you have described.  

Does the pain also have a pattern on your body:  always in the same area, or move around? Does it start at one location then move to another (radiating)?  Is there a pinpoint specific site for pain?  These questions will help determine the probable causes of your symptoms, and should be detailed to your chiropractic and medical physician.  

Before you do this I want you to try a simple task:  Place a small or medium back pack on with about 10-20 pounds of weight.  Make sure it fits properly on the back, the shoulder straps are snug, and it is not sagging.  Then just take an hour walk on uneven surfaces.  This will allow the back extensors to relax while the weight balances out what may be chronic postural imbalances. Do this for two days straight and see if your pain levels subside.  If so bad posture and deconditioning of the low and mid back musculature is the most likely cause.

I would suggest that you definitively rule out the previous medical and obstetric causes of the pain.  Once this is accomplished, a thorough musculoskeletal examination from a good chiropractic physician should be able to determine the source of the pain and discomfort.  Additionally, x-ray examination of the pelvis and torso should be a part of that examination. this is because your biomechanics of movement in relation to the structural alignment of your spine are important considerations in determining the most appropriate course of action concerning treatment.  

Respectfully,
Dr. J. Shawn Leatherman