My neck, my back... (they both hurt, not THAT song)
January 3, 2011 7:24 AM   Subscribe

Help me end my intense back and neck pain and figure out the best way to go about doing it!

Quick overview about me: 27 years old, 145 pounds (slightly underweight but with an athletic build), eat well, go to the gym 3 times a week. Doc told me I had mild scoliosis over a year ago.

A little over six months ago, my neck started acting funny. When I would ride my bike I noticed that it pained me to turn my neck to the left (so I could see if cars/people were behind me). Moving it to the right was better, but I felt the my mobility was being limited. Additionally, if I rode without holding onto the handlebars, there was a natural tendency for the bike to veer to the right (I think it was the right) and I never felt like my body was properly seated on the bike (as in, it felt like one side of me was ever so slightly higher than the other).

Flash forward to now. When I walk, my left leg feels slightly longer as if you were walking with one shoe on and one shoe off (just not as extreme). My lower back will kill me one day and be fine the next. My neck is extremely stiff. I can move it from side to side, and it KILLS to do so, but I can do it.

The real question here is not so much what should I do (I'll take ideas though) but who I should go to first to figure out how to fix this problem (doctor, physical therapist, etc). I'm young and shouldn't have problems walking, especially when it happened over the course of one year. I only forsee it getting worse if I don't treat it in some way. The only reason I haven't done anything about it recently is because I have had so much going on in my life that I didn't have time to do anything about it.

Thank you guys, I'm really looking forward to taking the right steps to get this rectified.
posted by darkgroove to Health & Fitness (10 answers total) 2 users marked this as a favorite
I suggest you need to see an orthopaedic surgeon, either straight away or as soon as your Physician refers you. Sooner rather than later. Here in the UK there is a sub-speciality of spinal surgeon and I assume the same goes over there. This really, really needs investigation.
posted by Wilder at 8:13 AM on January 3, 2011

Best answer: I would go see my doctor for a referral - see who they think you should talk to first. Some doctors might recommend a chiropractor first, others PT. I would try everything reasonable, including alternatives like Rolfing, before contemplating back surgery.
posted by ldthomps at 8:16 AM on January 3, 2011

Is the pain worse at night and in the morning and gets better as the day goes along? Do you loosen up with gentle exercise and stiffen up when you sit still? Are you fatigued? Do you have pain anywhere else, like your hips, feet, or ribs? Do anti-inflammatories help (aspirin, ibuprofen, naproxen, not Tylenol/acetaminophen/paracetamol)?

Depending on your answers to those questions, your description sounds enough like it could be ankylosing spondylitis that it wouldn't hurt to ask your doctor about that and whether you should see a rheumatologist.
posted by hydropsyche at 9:01 AM on January 3, 2011

First and foremost, go see a primary care physician. No need for a surgeon, besides even if that was what a dr. may suggest is best to look for any and all alternatives before ever considering such an invasive, drastic, potentially dangerous route.

I have a tad bit of scoliosis and I was informed years ago that it was not the cause of my pain.

Going to the dr. will start the process of figuring out what to do next. Probably have an x-ray done of your spine/neck to see if anything is out of whack. If nothing shows up there next route would be a ct scan or an mri.

So in short, see a regular dr. and go from there. IANAD, just someone who's had back problems for over 10 years.
posted by handbanana at 9:57 AM on January 3, 2011

There could be something Very Wrong, or it could just be that you're at that age when your back and shoulders start to become less limber. Look at this holistically:

- Do you stretch at the gym? What about when you're not at the gym?
- Do you work at a desk all day? How comfortable is your office chair?
- Do you carry a sling bag to/from work? Try switching shoulders or using a classic backpack.
- Do you sleep on your side? Try a neck roll or something else more supportive.
posted by mkultra at 10:19 AM on January 3, 2011

Best answer: dude, i have the exact same thing. i would go see an orthopedist to rule out anything big and nasty, but assuming you haven't had an injury recently, you too might have a rotated pelvis/sacroiliac joint dysfunction.

as with herniated discs, a lot of people have this and don't experience any problems at all. sometimes, though, over time the imbalance can start to throw other things out of whack. because your sitting is imbalanced, you may have been unconsciously compensating for your poor mechanics with your upper body at your desk or on your bike. the sensation of one leg being longer than the other is because the hip joint on the affected side is riding a bit higher or lower than usual. not much, but it can throw off your balance.

fixing the dysfunction is usually just a matter of stretching out the ligaments and pushing it back into place. it doesn't hurt. then you will have some physical therapy to build up your core muscles to stabilize the joint. (on the plus side, this involves a lot of kegel exercises, which will improve your sex life. woohoo.)

so: if you can self-refer to an orthopedist, go to an orthopedist first. (otherwise, make the obligatory stop at your primary care providers and ask for a referral. you may be able to just call, explain your symptoms, and get a referral without having to go in for an exam.) you will have to see the orthopedist before you can start physical therapy because physical therapist needs the orthopedist's orders to begin therapy.
posted by thinkingwoman at 10:46 AM on January 3, 2011

Best answer: darkgroove, I assume you are a North America resident - correct me if I'm wrong. As a UK-based anesthesiologist and pain specialist my advice would be to go see an osteopath/chiropractor. The reason is that you need a diagnosis first, which could either be made clinically by an experienced osteopath or chiropractor, or with the benefit of radiographs.
I don't believe Wilder means you necessarily need surgery - it's simply that osteopaths and chiropractors are thin on the ground in the UK and she has a lot of professional dealings with orthopaedic surgeons, and is concerned about your symptoms. Of course a good orthopaedic surgeon should be able to make a diagnosis and proceed in a sensible fashion from there (in the UK National Health Service there is no looming incentive for them to recommend operating).
As you tell it, your problems came on gradually over a particularly stressful 12 month period, and you've been told you have mild scoliosis but you seem to still be able to work out regularly at the gym (far more than I'm managing, I have to say!).
Mild scoliosis is common in teenagers and young adults and rarely progressive whereas severe, disabling scoliosis tends to arise during infancy and childhood, so you shouldn't need to worry about that.
hydropsyche is correct in that it could turn out to be AS, but again I think that's not all that likely given your asymmetric problems (although if you also experience frequent eye irritation or inflammation that could be a strong pointer towards AS). Blood tests (CRP, ESR, white cell count, rheumatoid factor, MHC HLA-B27 typing) will show if you are seropositive for indicators of systemic inflammatory arthropathies, many of which have a genetic loading - what's your family history? Do you have inflammatory [not "irritable"!] bowel disease as well (there's a statistical association between the two)?
If you are otherwise perfectly healthy, your problem is most likely due to a gradual stress-related subluxation (misalignment) of one or even several vertebrae with each other and/or your pelvic bones, and this is exactly what osteopaths are best at resolving (pity we have so few over here!).
In terms of symptomatic pharmaceutical relief (unless you already have a damaged liver) I recommend acetaminophen (we call it paracetamol) which is cheap and when taken regularly (up to 4000mg daily) builds up in your body to exert a very potent analgesic effect - don't go down the NSAID or narcotic opioid routes unless you feel you have to, as the former not infrequently cause stomach ulceration and the latter (besides all their other risks) aren't particularly good for musculosceletal pain.
There are some mild "muscle relaxants" on the market and they may bear trying out but don't expect too much of them (and benzodiazepines such as Valium have obvious risks attached).
Alternative treatments such as acupuncture may also help but won't be enough on their own to sort you out. Have the stress factors in your life receded now? If not, can you work on that?
posted by kairab at 10:50 AM on January 3, 2011 [1 favorite]

btw, IANAD! just a patient who recognized almost identical symptoms. you may have something different. but an orthopedist isn't a bad place to start if your insurance coverage doesn't require a primary care referral.
posted by thinkingwoman at 10:51 AM on January 3, 2011

At the risk of stating the obvious, did you make any changes to your bike, seat, shoes, etc.?

I wouldn't have guessed that a new pair of (good) shoes would cause pain along the lines of what you described, but they did and all was well once I stopped wearing them. I and others have also experienced big changes from seemingly small changes in things like shoe brand and type, ergonomic-related stuff, etc.
posted by ambient2 at 11:29 AM on January 3, 2011

Response by poster: Thank you all for the advice! I am going to schedule a visit with my doctor and see if he can refer me to a specialist who can really examine my spine.

I know this is a short response to everything you all have said, but clearly this is something that needs to be looked at professionally. THANK YOU SOOOOO MUCH!
posted by darkgroove at 4:22 PM on January 3, 2011

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