Expert: Scott F. Gillman, DC, DACBSP - 2/7/2009

Question
My daughter is a 17 year-old distance runner.  She began experiencing sharp pain in her mid back which wraps around her side during 5K cross-country races this past fall.  She started running in middle school and had not experienced similar problems previously.

We have sought treatment from a chiropractor (no relief), a sports medicine back specialist who sent her to physical therapy, and her family doctor who ran multiple blood tests for inflammatory and auto immune disorders.  She has mild scoliosis, exercise-induced asthma, and celiac disease.  

She was in a car accident in June and experienced a minor pneumothorax which kept her overnight in the hospital.  She has had three sets of x-rays since her accident, none show anything other than mild scoliosis.  She took one-month off of running at the end of cross-country season in November at the direction of her Physical Therapist.  She attended physical therapy three times per week for 4 months.  Her mobility and posture are markedly improved, but she still has unbearable pain when she races.  She feels the pain is somehow related to deep breathing, and the onset is generally after the first mile of a race.  

We are completely at a loss at this point.  She has been seeking treatment for 7 months with no improvement and no idea where to seek additional assistance.  She plans to run on scholarship in college and wants to finish her senior high school track season successfully.  We would greatly appreciate any insight you might provide.  Thank you for taking time to read this question.

Answer
Pat,

This sure sounds like either pleural irritation, rib/spine joint irritation, or the combination of both.   X-rays are a waste of time unless you are looking for broken bones.  If she has not had a chest CT scan, that would be one way assess the lung pleura.  MRI would be a way to see if she has a herniated thoracic disc.   Though this is rare, to have a disc lesion in the thoracic spine, it would explain the pain that wraps around her thorax.   Why are doctors shooting x-rays over and over?  Get the tests that are most appropriate, CT or MRI or both!   Also, what did the chiropractic care consist of?  This is a big question.   No two chiropractors are the same, and "chiropractic care" often implies spinal joint manipulation.  But there is a host of soft tissue therapies out there, including Graston Technique, as well as an emerging "Multi-Modal" style of care that integrates joint manipulation, soft tissue therapy, and targeted rehab all in the same visit.  In this case, the DC would have your daughter run to the point of pain and then examine her.  This would mean running laps up and down the road and when the pain kicks in she should run into the examining room of the chiropractor.  At that point, the DC can have an opportunity to see what provokes or alleviates the pain, or get an idea if it is more of a lung/pleura issue or a spine/rib joint issue.   Treatment (Multi-modal) can be tried and she can run out the door and test it.   My last comment is this: FOUR MONTHS OF PT?!  Nobody has a clear diagnosis, so how can the PT's or DC have a target to hit?  Shame on the PT's for keeping her for so long.  Her condition should show change in weeks, not months, with the appropriate treatment.    My suggestion is first to get the appropriate imaging (CT/MRI) and preferrably after she runs and provokes her pain.  Then see if these find the target, and then resume treatment with a multimodal-approach to care with a chiropractor.   See if you can find a chiropractor certified in Graston Technique, Active Release or both.  Avoid DC's that are going to use clicky-guns or other gizmos, want to take more x-rays, or try to sell you a long-term package of care (e.g. months).   If your daughter cannot feel better in a few weeks, then something is wrong in her diagnosis or treatment approach.  PLEASE keep in touch with me on this.   If you email me off-list, I may be able to help you find a sports chiropractor with the right training and expertise.  

'Regards,

Dr. G