| | Thoracic Facet Joint Syndrome
I have had this problem long enough "Thoracic facet joint impingement." It was diagnosed by a PT. My question is, "Is there a cure?" I'm only 24, so am I supposed to believe I have to live the rest of my life with this? As far as pain is concerned, I wouldn't define my pain as being severe, but it bothers the hell out of me. I experience tightness, cracking, and just bitter discomfort. It's limited my life and significantly effected my psyche. I'd appreciate any advice. At this point, I'm pretty open to ANYTHING that will help! Here's my orthopedic history of the problem:
Orthopedic Problem Medical History
Onset of problem: It started during the summer (July) of 2000. I do not know for sure what the reason or cause of this discomfort is. I know that it occurred in the same week I tried to test a stupid theory (1 set is equal to 3 sets) by being a guinea pig. I shoulder pressed 65-lb. dumbbells in one set about 10-15 times without a back support. I had to stabilize my spine without support. I do not know if this is the cause, of whether it was just coincidence.
Diagnoses: 1) Subluxation: *Chiropractor (American Back Clinic).
2) Strain of deep connective tissue: Dr. Madrigal (Former Primary Care Physician @ E.J.G.H.)
3) Shoulder/Upperback Strain: Dr. Magonet (Current Primary Care Physician @ Private Practice in Kenner).
4) Connective Tissue Strain: Dr. Garroutte (Orthopedic Surgeon @ E.J.G.H.).
5) Postural Imbalance: **Chiropractor.
6) Increased Muscular Tension or Tone: ***Chiropractor.
7) Chronic Inflammation of Paraspinal Muscles: Dr. Wallace (Primary Physician @ U.N.O. Student Health Services).
8) Chronic Inflammation/Strain of portion of Trapezius and Paraspinal Muscles: Dr. Gautier (Sports Medicine Doctor @ U.N.O. Student Health Services).
9) Slight Scoliosis, forward head, rounded shoulders, & slight leg length discrepancy: Dr. Hernandez, D.P.T. (Performance Physical Therapy).
10) Cervical Spine Problem Referring Pain to Thoracic Spine: Dr. Magonet (Current Primary Care Physician).
11) Postural Imbalance: Dr. Granata (Professor @ U.N.O.).
12) Facet Joint Impingement: Billy Naquin PT, (Crescent City Physical Therapy).
13) Costo-Chondral Articulation Temporary Problem: Dr. Alegre.
Subjective: My thoracic back tightness and discomfort has been with me for ~ 3 years now. I experience morning stiffness in the upperback, not really pain, but I know something is not right. It has decreased my quality of life by limiting what I can do physically, functionally, and athletically. It has also affected me psychologically by making me feel down and negative at times when I feel the problem throughout the course of a normal day. With respect to my age, it is very discouraging since I ironically am in this field, but more so because I am very practically involved in the academic-physical integration side of things. The pain and discomfort is about a ~7/10 in the morning, ~5/10 in the afternoon, and ~6/10 in the evening. The ********es and goes throughout different times of the year. During extreme cold or heat, the pain is quite noticeable and bothersome. It is not so much a pain, but more of a discomfort and a stiffness that bothers me when I feel it. It feels like my thoracic spine is locked up, and my lumbar has to overcompensate due to the decreased ROM of my thoracic spine. I also now experience an internal crepitus sound when I self-mobilize. It almost sounds metaphorically, as if my spine has secondarily aged as a result of this pathology. The pain originated (July 2000) as a shooting sensation at the medial border and inferior angle of my left scapula. It has now progressed to the following sensations: tightness, restriction, dull, pulling, pressure, pressure, stiff, constriction, compression, and discomfort. I have never in my life had a problem like this before that has lasted this long. The part that bothers me most is, not that I am 24, but that I am 24 year-young who has practiced what I have learned about, health, nutrition, exercise, stress management, and etc. I am basically in the low-risk population of health disorders, yet I feel as if I have done something contraindicated to have this current chronic orthopedic spinal issue.
Objective: The health/medical professionals I have seen each had an objective result.
1) *Chiropractor: Supine body position. He stabilized my lumbar region, and rotated my pelvis to the right, which caused a resulting popping/cracking sound in my back.
2) Dr. : He did a quick evaluation of my back and neck and concluded nothing serious. He prescribed anti-inflammatory medication and rest.
3) Dr. : He did a quick evaluation of my neurological function in the neck area, and concluded nothing serious. He referred me for an X-ray and sent me to Dr. Garroutte.
4) Dr. : He looked at X-ray concluding nothing serious and to restrain from doing stretch or exercises that bring on the discomfort. I asked about an MRI, and he agreed that it was ok to get an MRI.
5) **Chiropractor: Had me step on two scales, and concluded that more weight was distributed on right side. Also had this little beaded grid behind me and said I had a postural discrepancy.
6) ***Chiropractor: Had an electrical EMG type of machine that measured the amount of muscle tension bilaterally. He said I had less than ideal posture because my left side was pulling more strongly than the right side.
7) Dr. : Did a pretty thorough physical check-up. Concluded nothing really serious, and that as we age our bodies are not as quick to recover as when we are younger. He referred me to see Dr. Gautier and he also prescribed to me Motrin.
8) Dr.: Asked for subjective feedback, and explained how the trapezius is a large muscle and that there are many muscles in the upperback. He prescribed Naproxen.
9) Dr. : Did a quick back evaluation. Did the slump test, eyed up and evaluated anatomical landmarks and identified discrepancies. i.e. Looked at lumbar movement and also where and how the thoracic-lumbar articulation moved. Checked hamstring and piriformis flexibility.
10) Dr. : Did a neck evaluation and determined a decreased ROM in lateral flexion of the neck. Said these types of problems with my back are little, hard-to-fix-kind-of-problems. He also thought that my rib-articulation theory was not true. He said it was probably just a coincidence and that it was more of just a bony prominence of the ribs. He said an MRI is not necessary because my back problem is not serious. He recommended physical therapy.
11) Dr. : He said it could be a chronic problem that came from prolonged and chronic physical abuse. i.e. Carrying books on one-side and wearing a school bag with one strap that could pull body more to one-side.
12) PT: I spent 2 months going to rehabilitative physical therapy. Please refer to physical therapy summary notes and diagnostic documents for elaboration of physical therapy experience
13) Dr. : He said that it was nothing to worry about and that he had experienced a similar problem. He
speculated that it was nothing neurologically impinging, but rather it was a problem of orthopedic origin. He said it is something that will go away.
14) Me: I experience more popping anc cracking now when I do spinal rotations. I have also experience tight muscle spasms once in a great while on the left side. It just knots up. It is very acute and leaves when I move to another position.
Causes of Discomfort:
1) I experienced a very sharp tight pull when I (cervical flexion causes dull pull in thoracic; cervical flexion + slight right cervical rotation increases the pull in the thoracic; cervical flexion + slight right cervical rotation + left scapular abduction increases the pull more in thoracic). * All of these joint motions are done with an active stretch with my hand pulling behind my head.
2) Standing lumbar spinal flexion + anterior pelvic rotation + right lumbar lateral flexion.
3) Seated “slump test” + dorsiflexion + cervical flexion w/ active stretch.
4) Upperback exercise worsens pain when muscles in area become sore. i.e. Upperback rowing, Lat pulldowns, etc.
Possible Muscles Involved: Erector spinae, deep posterior muscles, splenius, semispinalis, upper trapezius, scalenes, rhomboids, trapezius III, levator scapulae, latissimus dorsi.
Assessment & Attempted Solutions: I have done the following: My main fear was that the condition would degenerate or get worse as a result
1) Taper in training.
2) Rest and give it time to heal naturally.
3) Limit joint movements, which bring on discomfort.
4) Stretching for back.
6) Hand-held percussion massager.
7) Heat and cold packs.
8) Partner massaging area of pain.
9) Limit stress.
10) Anti-inflammatory and pain medications.
11) Leaning against jets of a Jacuzzi.
12) Thinking positive thoughts to reduce the likelihood that this problem was manifested by a psychosomatic problem.
13) I now use a school bag with two straps, which allows for even distribution of weight.
14) I am constantly aware of my posture. i.e. Adducted scapula, retract head, keep spine in neutral alignment, etc. Things I already am aware of as a result of school and experience.
15) Research on thoracic spine and possible causes and treatments.
16) A home exercise Physical Therapy program using a theraband.
17) A full 2-month Physical Therapy treatment
18) Self-mobilization, excessive cardiovascular conditioning inducing transient hormonal and neurotransmitter distractions (neurotransmitter pain receptor inhibitions, increased circulation temporarily inhibiting intensity of pain signals).
19) Warm showers, allowing hot water to run over thoracic area for palliative relief.
20) Physical therapy intervention PNF patterns (stretch on eccentric, stabilization-strengthening on concentric) and upperback stabilization techniques. This serves only as a palliative measure in temporarily relieving pain.
21) Trigger-point therapy intervention. Laying on golf ball and holding for 20-30 seconds and self-massage by rolling over golf ball.
22) Self-mobilizations (seated on chair, laying on bed, etc.). Acute relief (joint distension), but possible chronic instability (joint laxity).
Theories relating to cause of pain:
1) Chronic Condition Theory: Thoracic region slight scoliosis from unequal muscle pull on spine, from acute injury that never healed. Muscles guarding, adaptation, degeneration, functional scoliosis. Cracking is from muscles being so tight that spine compensates. Also, a slight unequal leg length could be another contributing factor.
2) Rib Articulation Theory: When ribs “go out” or misalign in relation to their connecting vertebrae, the individual will often experience sharp pains in the area of the misaligned rib head, especially on twisting movements of the torso (www.dcdoctor.com).
3) Muscle Firing Pattern Theory: Improper firing patterns of spinal musculature. More firing and muscle guarding on left side, promoting possible functional scoliosis [url="http://www.dcdoctor.com)."]www.dcdoctor.com).[/url]
1) Is this normal to have back discomfort this long (~3-years)?
2) Is this a common problem for men my age or any age for that matter?
3) What is the technical medical term for my condition or problem if there is such a name?
4) What can we do to alleviate and solve this problem?
5) Once it is improved and alleviated or gone, what are the chances of a reoccurrence?
6) Will I need to avoid any specific activities for now and forever?
7) Will this pain ever go away?
Conclusion: This problem has led me to seek a very in depth scientific-clinical evaluation because I as well as other health and medical professionals have unsuccessfully been able to fix it. I need the assistance and help of a spine specialist/expert and the usage of special equipment and therapeutic modalities that I do not have access to on my own. Whatever the outcome, I greatly appreciate you helping and looking into the matter. All of the health professionals I have seen have just looked at me and assumed I’m young and healthy, but please do not do this. I would like an unbiased evaluation and I will do anything you need me to do and whatever it takes to aid in your intervention and treatment plan.