Question
QUESTION: Hi. 7 months ago I injured my back helping roof a house. I think it was the roofing. A few days after the work, I was unable to sleep because my neck hurt so bad. Trying to sit up/move my head forward was especially painful. Since that time I have been to a DO 3-4 times, 2 physical therapists and a chiropractor. I am still in pain, although it is better.  The pain is now more of an annoyance now, but there is an ebb and flow to it and it gets pretty bad sometimes. There have been no x-rays, only adjustments and stretches.  Part of the problem is that my pain, which seemed to start in the neck, seems to be all over my back.  especially lower back, shoulder blades, and neck. The DO said it would be difficult to isolate with a scan. My back/neck never used to crack, now I can crack my neck and back at will and they always seem "tight". the mere act of puffing out my chest (straightening up) almost always causes cracking. My last visit to the DO resulted in a referral to a chronic pain specialist, which is NOT what I wanted to hear as a "next step".  I'm looking for alternative "next steps" to help get rid of this pain.

ANSWER: I would recommend you get some imaging done - at least a set of cervical x-rays or more appropriately, an MRI of the neck since that is the area your pain seems to be originating from. You may have a disc bulge or herniation and the only way to be sure is to have an MRI.

The good news is your pain is decreasing so whatever you injured originally seems to be healing. You may be prolonging the healing process because of your occupation, physical activity or lack thereof. In any case, an accurate diagnosis needs to made first, and appropriate imaging will certainly narrow down the list of possible disorders.

As for the cracking sounds, your joints are probably a little hypermobile now from the manipulation and manual therapy you've been receiving. I wouldn't worry about it too much as long as you are not having pain. Be sure to do appropriate strengthening exercises to stabilize your neck and spine, and do some research on upper and lower crossed syndrome, which are common postural dysfunctions that many people suffer from. The chronic nature of your pain be in part be due to muscular imbalances.

Hope this helps,

Dr. Park

---------- FOLLOW-UP ----------

QUESTION: Thank you for your recommendation. I play to do this right after the holiday.  I'm 6'2" and 195lbs. I do exercise about 3 times a week for 45 minutes (elliptical because treadmill seems to cause back pain the next day). I have been given a set of "core" exercises to do ,but since they haven't been helping much I thought I'd stop them for a while. It sounds like you would recommend that I continue with them?  I'm a computer programmer so I spend a lot of time parked in a chair typing on a keyboard.  perhaps upper and lower crossed syndrome are plausible given my profession?

Answer
Absolutely. Sitting for long periods of time is probably the number one cause for chronic neck and lower back pain. Biking is probably not the best exercise for you because you would be sitting. I'm sure you do enough sitting while you're at work so exercising in an upright position (ie. elliptical or stairmaster) or swimming would be better. Try to add lower back extension exercises as well so you are off-setting all the postural challenges related to sitting.

Good luck,

Dr. Park