Question
Hi Jessica,

I'm a 38 year old male who is pretty active with working out, playing golf etc. About two weeks ago i began feeling a throbbing pain in my upper back. The pain is located on the upper portion of my back between the shoulder blade and my spine. There is a small fleshy area. It was not due to a certain activity I was doing, I just recall it beginning to hurt. I saw an orthopedic Dr. and he said he was pretty sure it was a spasm caused mainly by poor posture when sitting at my desk at work. He said there isn't much to do except go to physical therapy. I went to my physical therapist who I have gone to before for a shoulder problem, and now the problem feels worse. The pain is so bad at times that it's radiating down my left arm and I'm feeling pain in my left tricep and even into my elbow joint. I seem to get relief when lying down and sleeping but it starts right back up when I wake up in the morning. I"m going to a different Doctor this week for a second opinion. Could this be a spasm or a pinched nerve? The first doctor did take Xrays and saw no disc problem. But would a spasm last this long and radiate pain down my arm?
What suggestions might you have to lessen the pain? Would I muscle relaxer work?

Answer
Bret-

I first need to inform you that I'm not a physician so I cannot make any diagnoses.

I do have some questions regarding your physical therapy treatment. Did he/she provide massage therapy in addition to other PT techniques (stretching, strengthening, ultrasound, electo-stim, etc).

As I said I cannot diagnose, but there are two things that come to mind with your description. A nerve issue or possibly a trigger point issue. I asked if your physical therapist performed massage because massage therapy can help relax a spasm. A trigger point can cause radiating pain in predictable means. You might take a look at a "trigger point diagram". Here is a page that also has stretches that should help deactivate trigger points (or at least help the areas feel better) http://www.pressurepointer.com/pain_reference_chart.htm
I would look under the section "arm pain" and/or "hand/finger pain" (some of the muscles are repeated. Look at the yellow areas and see if they correspond to the referral pain areas you are experiencing. If they are, you might try the stretches an you might want to try seeing a massage therapist. There are two websites that list reputable (licensed or certified) massage therapists: www.abmp.com and www.amtamassage.net . I would recommend asking if they perform trigger point therapy.

Also, how does your pain feel (burning, shooting, sharp, etc)? That can also indicate what is going on. It's a good thing that your doctor didn't see a disc problem. A second opinion isn't a bad idea.

As long as you have feeling in your arm, you also might want to ice the area - it will help the area heal and reduce any swelling. Ice will not hurt the area and will likely help it. Place ice on the area for about 10-15 minutes at a time.

One other avenue you might try is chiropractic (I don't know how you feel about it) but if it is nerve related, a chiropractor can cause significant relief and often take care of the issue.

Regarding muscle relaxants...did your doctor prescribe you one? Muscle relaxants can temporarily relax muscles, so they can help muscle pain and sometimes if a muscle is contracting and pinching a nerve you may feel relief as well. Another relaxant you might try is magnesium. I don't usually recommend brands, but I will say there is a good product that has a combination of calcium and magnesium (Peter Gilliam's Calm plus Calcium) - it is a powder that you dissolve and can dilute in about anything if you don't like the flavors. It helps prevent and resolve muscle spasms and contractions. (a health food store should have it, Amazon.com also carries it)

Another thing you might try is an epsom salts bath - soaking your arm and shoulder. If you don't like to take baths, a basin might be able to cover part of your arm, but not your shoulder.

All of these you could try simultaneously. You can also try one or two at a time and see what works and what doesn't.

I hope some of this information provides you relief. I hope your second opinion helps as well.

Does this make sense? Please don't hesitate to ask me further questions. I'd be interested in hearing what your second opinion says as well as what helps, if you are willing to share.

I hope your pain is relieved soon.

Always,

Jessica