Expert: Dr. J. Shawn Leatherman - 6/30/2008

Question
I am a fit 27 year old woman. 5'3, 110 lbs, I eat right, work out, but struggle with chronic back pain. I endured a rib injury a 2.5 years ago and have had back pain ever since. It's definitely muscle pain, and I think it may be muscle imbalances. As long as I'm moving around, I'm OKay. But, if I sit down, the pain is severe. Sitting at a computer for any length of time causes severe tightness in my back. Or, sitting in general causes me a lot of pain. Also, doing things that involve my back muscles repetitively causes me pain. Anything that tightens my back muscles for any length of time causes me pain. I've been to chiropractors, massage therapists, holistic doctors, regular doctors, and nothing has really helped. My massage therapist told me that back pain is a result of weak muscles, so she told me to strengthen my back and core muscles. I'm scared to try stregthening my back muscles though for fear of causing more pain. Since my insurance has run out, I am no longer seeing anybody for the back pain, but am still looking for releif. Is there some specific exercises that you can tell me about? Or, can you recommend a book or a DVD?? I would greatly appreciate it!

Answer
Dear Kristy,

Without an examination, it is difficult to give you much advice on this because I am not able to evaluate what your current level of function really is, if you have deficient movement patterns, etc...Not to mention is the pain in the low back or upper back?  These areas need to be addressed together, but in a separate manner for proper muscle activation.

I would opine that you probably have some type of chronic myofascial pain syndrome since the initial injury seems to be the causative event for your ongoing pain.  With that in mind, stretching programs are your first step.  You need to make sure that you have the acquired flexibility to accomplish an adequate strengthening program.
There is a website for the Stretching Institute that I think you will find helpful: www.thestretchinghandbook.com

Once your flexibility is adequate, core strengthening is the first step.  However, many people train their core inappropriately, or think that the core only involved the abdominals and the pelvic floor muscles.  In fact, the core involves the entire torso (upper/lower/front/back/pelvic floor).  While it may be advantageous to start training the core with abdominal hollowing exercises, therapy balls, extension and bird dog exercises, you should make a shift to more dynamic activities that require multiple movements with resistance.  A device I utilize in my office is the Pulse Flex system. This is newer on the market any many doctors, trainers etc... do not know of the system or how it is used.  You can check it out on tier website:  www.pulseflex.com

Once the dynamic stability has been achieved, it is then that I would suggest moving on to a traditional strengthening type of approaches such as gym machines, resistance bands, and free weights.  I would recommend that you seek out information from the National Strength and Conditioning Association concerning appropriate form and exercise:  www.nsca-lift.org

Good Luck Kristy, Hope this helps.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net