Please help me get back in the saddle!

February 19, 2009 5:32 AM

Where should I start - a chiropractor, a sports massage, an orthopedist, acupuncture or what?

I recently started horseback riding again, and though I have NOT suffered a fall or other acute injury, I have had crippling pain in my upper back (between shoulder blades) for about 2 weeks. I have tried stretching and gentle yoga, soaking, heating pads, ibuprofen etc., resting the muscles - and none of it has helped. I really want to get back in the saddle sooner rather than later, because it is really helping me cope with a very difficult personal situation and has become my primary form of exercise.

I know there are a lot of directions to go, and I've gotten some conflicting advice about what to pursue first: a chiropractor, a sports massage, an orthopedist, acupuncture or a few other things. If anyone has some advice on which may be most likely to help, which should logically precede the others, which is not likely to help at all, or any other thoughts, I would be really grateful. If you want to accompany your advice with any recommendations for specific practitioners in the Bucks County, PA area, I would welcome that, though it is not the primary purpose of my question.

Assume cost is not really an issue (my insurance covers these things if referred by my PCP) and I have easy access to each type of practitioner. I am female in my 20s.

posted by bunnycup to health & fitness (11 comments total)

I would ask for a referral to a sports medicine specialist if I were in your position.
posted by TedW at 5:45 AM on February 19 [1 favorite has favorites]

Doesn't that shoulder blade pain suck? What a nuisance and annoyance. I've been dealing with that for a few years. It comes and goes almost on a weekly basis. I've tried having it treated by a physical therapist with only temporary relief. Mostly what seems to help now (for a few days at a time) is a heating pad and stretching.

The stretching exercise that seems to provide the most relief is to bend at the waist and let both my harms just hang down. The gravitational pull from this will tend to loosen up whatever stress I am feeling in my shoulder blades. Sometimes I will even feel a pop that provides immediate relief, but not always.

Unfortunately this has become a condition that I just have to deal with. It comes and goes on a regular basis. Hopefully you don't experience the same predicament and will get permanent pain relief once you get to the root cause. Best wishes to you.
posted by netbros at 6:02 AM on February 19

Based on my bitter experience, and based on your circumstances, I'd also advise going directly to a sports medicine specialist rather than straight to any paramedicals immediately. Let the doctor assess you, then go to the appropriate therapist they suggest.

Here in Toronto, I go to a major sports medicine clinic that charges about the same as smaller clinics for physiotherapy, but they have a huge staff of paramedicals, a medical supplies shop, and ultrasound and x-ray services on the premises (done immediately and read immediately by my doctor). If you have a similar lavish operation available to you and your insurance covers it, I'd recommend going there, as the savings in time and travel alone make it worth it.

One last thing: I've always been pretty openminded and optimistic about acupuncture, but I saw no results with it on two different areas of my body, much to my surprise. I have always gained relief from appropriate heat or cold, weekly or twice weekly massage and assessment by a physio, and home exercises.

(I once wound up with a very sore upper back after riding, but that was an acute insult from a Quarter Horse-Arab cross who had only two speeds: plod and mad gallop. It seemed deeply insulted if asked for any other gait. Recover soon -- the outside of a horse is good for the inside of a (wo)man, you know :-)
posted by maudlin at 6:25 AM on February 19

A former doctor of mine swore by active-release chiropracty (as opposed to the scrunch-you-up-and-crack-you kind). It, along with tinkering with your form, can be good for injuries that come from doing your sport incorrectly, like if you were a runner who could hold her arms better (not that I have any idea that that's what's going on here).
posted by Airhen at 6:37 AM on February 19

"a chiropractor, a sports massage, an orthopedist, acupuncture"

One of these specialties requires rigor and science during years of graduate studies.

The others, well, don't.

Just my $0.02.
posted by TheNewWazoo at 6:50 AM on February 19

Go ahead and see a sports medicine doc first.

My experience with frustrating neck/shoulder pain and stiffness: if the pain doesn't keep you up at night and they can't find an obvious cause, it's possible that the only treatment they'll be able to provide is muscle relaxants and anti-inflammatory meds. I found that over-the-counter anti-inflammatory meds were just as a effective and had fewer unpleasant side effects than the prescription options. And muscle relaxants, well, sure, I wasn't in pain when unconscious. After flare-ups for nearly ten years, a combination of massage plus chiro brought it under control. (I have a sane, Western-medicine-believing chiropractor in Bala Cynwyd if you need a rec.)
posted by desuetude at 7:14 AM on February 19

I had similar pain at the bottom of my left shoulder blade (burning, throbbing, restricted movement) and I tried the typical heating pad, soaking, massagers and pain relievers with little to no effect.

I finally went to a physiotherapist complaining of my "muscle knot''. She told me it was not a muscle issue but that I had a disk that was slightly out of place and was impinging a nerve. She got me into a specific position, applied a little pressure and I actually felt a "clunk" as something went back into place. After a day the residual soreness went away and I have been fine ever since.

My physiotherapist put her fingers right on the spot of the pain, without me having specifically described the location, based on what she felt in my back. I have had other so-called practitioners start treatment without ever even touching me.

Moral: Pain lasting for 2 weeks is likely a symptom of a more serious issue, as TheNewWazzo says go to someone who has actually studied under a rigorous, certified medical specialty, and if someone attempts to diagnose you without actually touching your shoulder blades, muscles and spine, feel free to leave.
posted by pixlboi at 7:14 AM on February 19

Nthing orthopedist first, for dx, then if recommended, a physical therapist who can specifically administer treatments and suggest exercises for the injury.
posted by terranova at 8:51 AM on February 19

Thanks, all. I have an appointment with a sports medicine doctor tomorrow morning, and will go from there. I appreciate the advice very much.
posted by bunnycup at 9:02 AM on February 19

What you likely need is a physical therapist, but the only way to see one is through a physician referral. An orthopedist who specializes in sports medicine is probably the right choice, unless you have access to a physiatrist.
posted by caddis at 11:34 AM on February 19

I went to to the ortho folks and found out that I had a nerve related issue. When I say nerve I mean one of those coming out of your spine, it was actually located in my neck but, since it was a nerve, the pain radiated outwards. The ortho doc recommended physical therapy and I was amazed by the improvement after one visit. I too tried self help but quickly learned I was going about it all wrong. So, my vote is an orthopedic group and see what they tell you.
posted by bkeene12 at 8:08 PM on February 19