Question
Hello Doctor,
I am a healthy, athletic 20 year old student. For around 20 months now I've suffered from awful tightness/pain/discomfort in my back. For the most part there's extreme tightness and pressure in between my shoulder blades and middle back. My back/scapula always cracks, and I mean always. When I inhale, move positions in bed, turn my neck etc... The tightness does not simply present itself when I'm in a particular position, it's constant. I have felt zero relief in the last 20 months. It all started April 2011 when I was on a decline bench-press and I noticed that my right arm could not put any weight up at all. My left side went up normally and I literally couldn't lift the bar alone with the right. I felt some "issue" in the lat/teres area but it there was nothing excruciating at the time of the incident. (note this was the 3rd month of my weight lifting, never before had I lifted, played sports w/o weight training) Then over the next couple of weeks I noticed a sharp shooting pain that followed by right scapula only when I would lean forward, whether that be my bed or a desk. At rest I felt nothing. Then a couple of months later the discomfort expanded and began to cause severe tightness throughout my entire scapular region as well as my lower back. I went to physical therapy 3x/week for a few months and noticed little help. I then went to school and suffered from the same pain for 7 months. I stopped performing physical therapy for those 7 months while at school. If my body's positioning is not perfect, then I begin to squirm and bend around. I have enormous trouble sitting at tables/desks (not good for school). I picked up PT again in May when I returned home and again saw little improvement. Then, seemingly out of nowhere, I began to experience severe discomfort and burning pain in that original under-arm area. It feels like it's around the lat - basically where the scapula (shoulder blade) meets the ribs under my right arm. I'll be standing/walking/sitting and just feel immense pressure in that area. It's not an acute sharp pain- its this severe festering hot pressure that just never leaves, feels like somethings just pressing on the area. With every lifting of the arm, a cacophony of cracks follow. It's far worse on the right side but for some reason even the left shoulder area cracks and feels terrible. If I extend my arm straight to my side and begin raising it, there's this awkward pulling sensation that seems to impede further movement. I can go all the way up but it just feels terrible and forced. I was tested for lymes recently and the tests were negative. I've had a cervical, right shoulder and spinal MRI - and all have been remarkably unremarkable. They have shown zero irregularities. I must have seen 20 doctors over the past year+ to no avail. Without trying to be overly dramatic, I can wholeheartedly say this injury is ruining my life. I have not been able to exercise or play my favorite sports (basketball, tennis, baseball) and more importantly I have tremendous difficulty sitting at desks. I had to leave my internship on multiple occasions because I found sitting with a computer at a desk to be unbearable so I went home and just laid in bed. Even when I enjoy myself be that watching tv, eating out, seeing a movie, driving etc I always have this tightness and pain occupying half of my thoughts. Also in the past 3 months the aforementioned underarm issue has dissapeared while a new issue has emerged, I have a terribly uncomfortable and pressure sensation in my right ribs. It extends towards the front/side of the lower ribs and then back towards the mid back. I feel like "something" is tracing itself on those ribs, almost feels like a series of "knots." It also has this dull burning feeling to it. Again all of my mris, blood tests, bone scans have come back unremarkable. In having an abdominal scan once (after complaining of this rib discomfort) my spleen was measured to be 14cm. I tested neg for mono and had the spleen remeasured 3 weeks and a month later (results: 13.5, 13.7). Blood work was all normal so there is currently no known diagnosis for this - also no word on if it could be related to back. MDs have also said that I may just have a large healthy spleen since there is no historical baseline to compare to. My life has been terribly affected by all of this so if you had any recommendations I would be forever grateful. Also just a note: lymes tests were negative but I personally have heard stories of undetected lymes causing strange symptoms. 6 mo. ago my rheymatologist thought I could have some form of seronegative spondylarthropy, as an SI joint xray showed moderate inflamation. But then my blood work said that I lacked the HLAB27 gene common to 97% of those with the condition. An MRI of the joints came back inconclusive with results neither confirming or rejecting the potential diagnosis. Also have been told recently to seek out a neurologist.

Answer
Dear Matt,

Thank you for your submission and for the details of your history. There are elements of your information that tell me you have some misconceptions about chiropractic.  To give you the greatest benefit in responding, I抣l first need to give you some background on the chiropractic profession.

There are two branches or schools of thought in chiropractic. Briefly, they are differentiated by whether they deal with the limited therapeutic approach for aches and pains (commonly termed "mixed" chiropractic because it represents a mixture of a chiropractor with a non-chiropractic matter) or a non-therapeutic approach to optimum body performance (termed "straight" chiropractic because there is no mixing of chiropractic with anything else). My expertise is in non-therapeutic straight chiropractic.

Therapeutic "mixed" chiropractic is the older approach based on a split from the founding principles of chiropractic about a century ago.

Non-therapeutic "straight" chiropractic is the more modern of the two. It deals with a particular, common situation called a vertebral subluxation. This is not revealed by the complaints or findings mentioned in your question, though they may exist together. The spine is made of many bone segments which house and protect the spinal cord and the smaller spinal nerve branches that come off the spinal cord and exit between the bones. These nerve pathways carry information or messages between the brain and the cells of the body. These messages are essential for the life of the cells. Without brain messages, the cells immediately begin the process of dying; i.e., they can no longer function the way they should to maintain life.

Because the bones are moveable, they can misalign in such a way as to interfere with the messages and, ultimately, the ability of the person to function at their best or express their optimum potential. People with vertebral subluxations are not able to get all they can out of life.

Vertebral subluxations can be caused by a wide variety of factors, what we'll generally call stresses. These stresses can be physical (such as being born, strenuous physical activity, sleeping posture and mattress condition, sneezing, falling down, etc.), mental / emotional (in its many forms, probably the most familiar use of the word stress), or chemical (such as pollution, drugs, etc.), which are, unfortunately, regular parts of daily living for all age groups. In short, a vertebral subluxation can occur for a multitude of reasons.

Tragically, vertebral subluxations are rarely obvious to the individual they affect. They usually have no symptoms. The reason is that most of what goes on inside you happens without your awareness. As an example, try to "feel" your liver. What's it doing right now? You can't know, so you can't know if it's functioning at its best or something less. To complicate things, nerve pathways that carry messages of control (termed "motor" nerves) have no way of transmitting ache or pain messages, so your body function may be far from perfect and you'd not have any alerting signal whatsoever. The branching of the nerve pathways is complex and extensive, making it exceedingly difficult to predict or determine exactly how the person will be affected. For this reason alone, it is impossible for anyone to give you reliable answers as to what may cause the various complaints you describe in your question or if these may be related to a vertebral subluxation. Even if it were possible to guess at what may be causing them, however, it is not pertinent to the matter of whether you will benefit from being free of vertebral subluxations. In order to know if someone has a vertebral subluxation, it is necessary to have that person抯 spine checked by a non-therapeutic straight chiropractor using a method of "analysis." When a vertebral subluxation is detected this way, it is obviously important to correct it as soon as possible.

Since vertebral subluxations are caused by so many different things, people choose to go to a non-therapeutic straight chiropractor on a regular basis to enjoy the most time free of the life-robbing effects of vertebral subluxation. There's a saying that straight chiropractic is not about your back, it's not about your pain, it's about your life. Each person has a unique potential in life. With vertebral subluxation, it's impossible to realize that potential.

A key question to ask for your purposes, then, would be, Is someone who has had the history you describe be better off with vertebral subluxation / nerve interference or free of subluxation / with the nerve channels open? It is easy to see that having all the available nerve messages getting through is better than only some of them getting through, regardless of the person's situation otherwise. So, having one抯 spine checked for vertebral subluxation is tremendously important, but it抯 not for the purpose of dealing with the difficulties or pains you describe. In other words, non-therapeutic straight chiropractic can be of benefit to any spine-owner, but perhaps in ways that you may not have considered. It抯 not that you should see a non-therapeutic straight chiropractor FOR these concerns ?you should visit one in an effort to be free of vertebral subluxations, even WITH such matters in your history.

As I mentioned earlier, not all chiropractors adhere to this and it is important that you be able to distinguish which ones do if you're going to seek this type of service. You need to understand very clearly that the practice objectives of therapeutic mixed chiropractic and non-therapeutic straight chiropractic are quite different, as described above. What I can tell you must not be interpreted from the mixed viewpoint.

Additionally, your question deals with the limited objective of therapeutic care. Remember, what we抳e covered here is about non-therapeutic matters and the two objectives are not the same.

Further, and quite importantly, even though this is not a service that I would provide in my field, I would say to you that diagnosis under the best of circumstances is something of an art. It would be irresponsible for anyone to give you a guess by e-mail or the web about your situation. Diagnostic work and therapeutic advice is difficult enough when done properly. It becomes a riskier proposition when done poorly. You would be better served getting opinions from someone with first-hand knowledge about you, not a limited acquaintance through internet correspondence. Anyone who is willing to speculate about your situation by e-mail is providing you little more than a guess and perhaps a dangerous one, at that! It may be that you already have a body of therapeutic-model information from the appointments you've had with the various providers, however, it still sounds as if you are seeking more.  Your own experience, then, is showing you the uncertainties and trial-and-error pathway that can come with diagnoses and therapeutic approaches when done in-person.  These can be magnified when done remotely, as with e-mail.  

All that said, it would certainly be wise to have your spine checked for subluxations by a non-therapeutic straight chiropractor, even if you still elect to have therapeutic attention for your reported concerns and/or symptoms. If you are interested in finding out how to locate a non-therapeutic straight chiropractor in your area, please contact me at this site again or directly at [email protected].

Matt, I wish you the best in understanding what non-therapeutic straight chiropractic has to offer. It has been my pleasure to provide you with some information.

Sincerely,
James W. Healey, D.C.