Expert: Dr. J. Shawn Leatherman - 3/26/2007

Question
I have had almost constant lower back pain in the last ten years, and I try to manage this by doing sensible exercise in the gym including stretches.  (I had kidney surgery just over 10 years ago so I have a large scar across my right oblique muscle area.)

However more recently (the last 2 years) I have had problems with neck pain (and initially, pain in the deltoid area) and some sciatic pain in the last year.  The neck pain is mainly on the left and goes up towards my head, but I can experience stiffness and discomfort right across my shoulders.  It can be bad in the morning or it can last all day.  I try to do gentle head turns (left to right, up and down) which helps a little.  

Is there a link between my lower back pain (which is mainly sore at the beginning of end of the day, and sometimes after exercise) and the neck pain – could one be a mirror of the other?  Or is the neck pain just stress?  

Also approximately 4 months ago, after doing some jogging on the treadmill, I experienced mild pain in my left hamstring and since that time, whenever I do any walking, cycling, cross-training etc the hamstring gets sore.  As a result I have tended to focus on swimming instead.  I should mention that at the time of the hamstring injury, I was exercising almost daily (light exercise) and including one-leg squats.  What can I do to ease the problem with the hamstring?  

With the swimming, it seems to be okay but recently trying to breath on both sides (I normally breathe to the right) has caused extra stiffness on that side of my neck.  I see a chiro regularly who is excellent, however the stiffness in my neck won’t go away (I am no longer trying to do bilateral breathing).  

Finally, I have also started to experience pain in my knees in the last few days, with both walking and swimming being difficult.  The pain feels like it is behind the knee cap, and is worse on the right knee.  

I appreciate that some of these issues could simply be down to technique.  I have had a great deal of personal training over the years to ensure I am exercising correctly, however my current gym provides very little guidance.  Up until 3 years ago, I was exercising with hardly any issues.  I really want to be able to exercise on a regular basis to stay fit and well.  Any advice you can offer would be greatly appreciated.  Many thanks.  

Answer
Dear Claire,

It is obvious to me that much of your problems are related.  I say this because when you have a pain/motion/dysfunction problem in one part of the body it will easily affect associated structures due to the fascial connections of the body.  

Now, saying that it is also very important that all of the problems you are having be looked at as separate conditions.  they need to be evaluated individually first and then put together as a whole like completing a puzzle.  This will allow a more complete understanding of the dysfunction and why you are experiencing pain with your activities.

Barring any degenerative or structural conditions that would need to be diagnosed with x-ray analysis, functional correction is the key to eliminating your symptoms.  

You say that you have a good chiropractor which is good, but let me play devils advocate.  Has the doctor evaluated each problem individually with a functional examination?  Has the doctor analyzed your walking/running patterns to look for biomechanical problems?  Have you had your feet analyzed for problems that can cause knee/hip and low back pain?  Has the doctor structurally analyzed the spine according to the published normative data in the medical research? Have you had any prescribed exercises or stretches to alleviate tensions in the myofascial system, or to lengthen shortened and tight muscles?  Has the doctor prescribed any myofascial deep tissue work such as active release technique, graston technique, or deep tissue massage?  All of these approaches should have been discussed or tried with your long history of pain and activity.

Specifically, from what you have describes it sounds lie you have a pulled hamstring-rest and minor stretching for resolution; condromalacia patella is a degenerative condition behind the kneecap that causes inflammation due to increased friction which may be your problem.  Strengthen the medial oblique muscle of the quadricep, and take glucosamine sulfate 1500mg, chondroitin sulfate 1500mg, and MSM 750mg daily to help repair damage and eliminate pain. If you have not had recent x-rays of the neck and low back, get them to rule out degenerative causes and structural causes...then that leaves you with joint fixation and muscular imbalances to work with.

Discuss all this with your chiropractor and expect logical answers to these questions, without conflict.  If he gets mad or won't address these issues, then find a better chiropractor, preferably one with a sports injury certification.  If you need help researching this I would be glad to help you.

Also, read books written by Pete Egoscue.  He is a educator in functional anatomy and will shed a lot of light on your conditions just by educating you on the proper way the body should work, and by teaching recovery exercise to regain function.  The books are easy to read, understand and implement at home.  I highly recommend them to my patients and actually use some of Mr. Egoscues techniques in my clinic.

Good Luck Claire!

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