Expert: Dr. J. Shawn Leatherman - 8/26/2008

Question
Hello,

Thanks in advance for your insight, it's very appreciated.  I'm a 27 y/o male, 175 lbs, 5'10", athletic for most of my life (baseball, tennis, marathons, recently cycling, but not much yet).  Had some occasional back problems growing up, some in high school with occasional chiropractic visits, usually just muscle issues / spasms.  

Last September tweaked my lower back playing softball, and it got progressively worse with sciatica and such.  No progress on PT, chiropractic, anything, after MRIs eventually had surgery to L4/5 for herniation.  Felt a significantly better, after about 5 weeks though, reherniated even worse.  Had repeat surgery, with same doctor (one of top in DC area), and within days after the surgery felt much much better.

6 weeks after surgery started light swimming, 8 weeks out started stretching, and now about 3 months out I do a stretching regiment for 30 minutes 5-6 times a week and have recently started light running and resistance training.

However, I have had some tightness in my neck over the past month.  It's more in the upper back, but felt when I move my neck.  Got even tighter yesterday, and this morning was very painful.  I can feel it at any angle of neck movement, feels like a thin string of pain down left side of spine, ending near mid-shoulder-blade level.  Feels deep inside, almost sensation of also being inside my chest on the front.  Had 20 minute focused massage on the area to loosen up, but didn't help too much.

I've run marathons before and done century bike rides, and would like to do a much better job from the ground up on my conditioning.  I know now it's important to focus on areas such as the core abs and upper back to stabilize my lower back, but I feel like now working on my upper back just a little bit has caused this new issue.

At work I'm sitting for many hours a day, but I walk a lot in the morning to loosen up, go to the gym every day mid-day for 90-120 minutes of stretching and cardio and now light resistence, I have a very ergonomic workstation will Aeron chair and raised monitor, I stretch a lot at my desk and get up every hour at the least, and have a raised foot platform to vary my leg angle.

Sorry for all the background, just wanted to be detailed, but I have two questions... one, what can I do to immediately focus on alleviating this very annoying and restricting sharp neck/upper back pain?  And what do you recommend for general best health approach to fully rehabbing my lower back?  If I need to have periodic chiropractic work, that's fine, I just haven't had the greatest experience with that in the past (with the individuals, not the field in general), so I want to ask these questions of a non-financially motivated expert to educate myself first.  Thanks so much, I hope this dialog can help others as well.

Answer
Dear Chris,

First of all...great history, I feel like I really know your situation well.  I have to admit that I am pretty impressed with your level of attention and detail with conditioning, stretching etc... and the fact that you have already addressed the ergonomics of your workstation.  I think that you are already doing the right things, however you may just want to focus on a few core exercises for the low back.  For example:  with your history of disk problems, you need to focus on the stability of the multifidus musculature  because the multifidus connects directly to the facet joints and disks in the spine and provides the most stability.  Not to mention that studies have indicated that the multifidus is the most important muscle to condition in response to lessen back pain.  Specific exercises:  prone extension, cat/dog exercises, bird dog exercises.

For the neck: I have less background information here so this is mostly speculative.  Even though you have an ergonomic work station, people who spend their days in desk jobs tend to overwork the anterior neck musculature creating tight scalene and SCM (sternocelidomastoid) muscles.  This is because of the head being forward of the neck and upper back which creates increased tension in the musculature of the upper neck and back specifically the levator scapulae, sub-occipital and trapezius musculature.  These muscles are straining to hold up the head which is not their intended job.  The fix: resistive extension exercise in the neck, and time spent in a neck extension position...at least 15 minutes per day.  Also, there are some great books to help you at home:  I recommend you read everything written by Pete Egoscue, I think he has 3-4 books...they are all reaaly good.

Along with this, yes, I would suggest that you get some spinal manipulation on an ongoing basis just as the top athletes in the world do so that you can function at peak performance.  With your level of conditioning, I would expect that twice a month adjustments would be a good regimen.  I hope you can find a chiropractic physician who is progressive and scientific to work with you.  A sports certified chiropractor would be the best choice with your activity level.  Look on www.acbsp.com to find a doctor close to your location.  Good luck Chris.

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