upper back issue

[fcasamento]

Hello folks,

I've been prone to straining/pulling muscles in the mid to upper back, especially the right side around my shoulder blade.  I'm right handed.  They go ahead after a couple days of rest.  But over the past six months i've had a re-occurring injury that is similar and takes a LONG time to go away.  Same pain in the region of the back I mentioned, but now it wraps around to right under my pec muscle.  I can push on my ribs under the right pec and it's sore/painful.  From what I've read it could be intercostal muscle strain.  I've seen a chiropractor and he thinks it might be costochodritis.  There's no way I can "play through it" and as mentioned, it's taking a long time to heal.  After about a 3 week rest I thought it had magically gone away ... but about 3 weeks after returning to golf it came back again.  Any thoughts/advice would be much appreciated.

[RandallT]

First, sounds like you need to suck up the costs and seek real medical attention on that. The red flag is that it is so persistent. Toughing through pain is one thing, but you are likely dealing with something that needs real treatment. 

If you're lucky you might get a couple folks with ideas or even a few that think they know exactly what it is. Maybe they're right, maybe they're wrong, but you're still going to probably want to get it checked out by a professional. 

Good luck!

[Club Rat]

38 minutes ago, fcasamento said:

From what I've read it could be intercostal muscle strain.  I've seen a chiropractor and he thinks it might be costochodritis.

Quote

Costochondritis is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the breastbone, or sternum. The condition causes localized chest pain that you can reproduce by pushing on the cartilage in the front of your ribcage. Costochondritis is a relatively harmless condition and usually goes away without treatment. The cause is usually unknown, but may happen from increased activity involving the arms.

Quote

Muscle strains have three gradings:

Grade I Strain: this is a mild strain and only some muscle fibers have been damaged. Healing occurs within two to three weeks.

Grade II Strain: this is a moderate strain with more extensive damage to muscle fibers, but the muscle is not completely ruptured. Healing occurs within three to six weeks.

Grade III Strain: this is a severe injury with a complete rupture of a muscle. This typically requires a surgical repair of the muscle; the healing period can be up to three months.

Symptoms commonly reported are either sharp, stabbing pains when breathing to an ever-present, painful ache or soreness located around the ribcage. The pain is aggravated by deep breathing, side bending and twisting.

The degree of disability, along with the rate of recovery, will depend on the grade of the muscle strain. Given above is a general guideline as to the rate of recovery from a muscle strain per se, however, the healing time may be longer due to our constant need to breathe and, therefore, low grade irritation to the healing site.

 

42 minutes ago, fcasamento said:

the right side around my shoulder blade.  I'm right handed.

I had a similar golf injury 15 years ago which was located just below my rib cage in the back.
The cause was by sideways tilt of my spine during a swing. (imagine hands over your head and wave left to right with shoulder movement while in bending motion.

Muscle injuries take a long time to heal and require slow stretching exercises once they do heal.
I go to both Orthopedic and Chiropractors, (both golf buddies) and each will have diff POV's sometimes.
Like @RandallT suggests, seek professional advice.

My docs usually tell me "take two aspirin and call them in the morning" ....

Rest, Ice and Ibuprofen can relieve discomfort, but typically any injury with serious pain needs Medical attention.

[fcasamento]

thanks guys, thoughtful of you to reply so quickly.

i did see my family doctor two months ago and he prescribed ibuprofen.  He obviously believes their is inflammation involved and it does help, no doubt about it.  But I believe the chiropractor had a better diagnosis and helped me just as much if not more.  The idea of seeing an orthopedic doctor seems like a solid next step.

[Club Rat]

14 minutes ago, fcasamento said:

The idea of seeing an orthopedic doctor seems like a solid next step.

Just to add another objective, an Orthro can view muscle tissue with Ultra-Sound or if needed schedule an MRI screening.
They also, would most likely have alternate treatment suggestions for recovery or repairs.

Massaging the area sometimes brings relief.

 

[natureboy]

If you have trouble sleeping on that part of your back or that side it might even be a stress fracture.

[woodzie264]

@fcasamento, statistically this will be an intercostal strain. As stated above, could be a costochondritis. Both of these are obviously treated with activity modification and refraining from aggravating activities. There is, however, a third diagnosis in the differential that responds almost immediately to physical therapy and that's rib dysfunction/subluxation. More of clinical diagnosis as imaging will be unremarkable, most PCP's will never make this diagnosis. As stated above, I'd see an Orthopod and get checked...it may be readily fixed in the hands of the right person. 

[fcasamento]

just returned from an orthopedic appointment.  X-rays showed two fractured ribs that have already healed.  Doctor believes the muscles around the area are inflammed and stressed.  Recommends a month of physical therapy.  What a relief to know what the hell is going on!  Doctors was seemed quite surprised golfing could do this, said this injury normally comes from blunt force.  So interesting.  I thought for sure I had intercostal muscle strain, but if I am understanding this correctly, the origin of the issue is a stress fracture ... guess I need to swing a little easier???

[woodzie264]

13 minutes ago, fcasamento said:

just returned from an orthopedic appointment.  X-rays showed two fractured ribs that have already healed.  Doctor believes the muscles around the area are inflammed and stressed.  Recommends a month of physical therapy.  What a relief to know what the hell is going on!  Doctors was seemed quite surprised golfing could do this, said this injury normally comes from blunt force.  So interesting.  I thought for sure I had intercostal muscle strain, but if I am understanding this correctly, the origin of the issue is a stress fracture ... guess I need to swing a little easier???

Agreed, nice to know that it's a non-issue in the long run. That's weird though -did they mention bone density scan and/or labs? If you truly got multiple rib fx's from swinging a golf club, I'd consider further workup...it's obviously not urgent, but I'd ask about it on your follow up

[fcasamento]

i'm doing some research online about golf and rib fractures and quickly found this assertion:

 

Upper back and shoulder pain is a common presentation at sports medicine offices. While lower extremity stress fractures predominate, upper extremity and, in particular, rib stress fractures often are overlooked and underdiagnosed. This is not an insignificant concern, as one study of 169 stress fractures found the ribs to be the third most common location, with golf being the fifth most frequent sport involved (¹⁰). This case report provides an overview of rib stress fractures, including the clinical presentation, diagnosis, and treatment of this condition.

[woodzie264]

1 minute ago, fcasamento said:

i'm doing some research online about golf and rib fractures and quickly found this assertion:

Upper back and shoulder pain is a common presentation at sports medicine offices. While lower extremity stress fractures predominate, upper extremity and, in particular, rib stress fractures often are overlooked and underdiagnosed. This is not an insignificant concern, as one study of 169 stress fractures found the ribs to be the third most common location, with golf being the fifth most frequent sport involved (¹⁰). This case report provides an overview of rib stress fractures, including the clinical presentation, diagnosis, and treatment of this condition.

well that's comforting I guess. I've been in orthopedics for 11 years and have never seen one...but I'm teachable and try to learn something everyday 

[natureboy]

On 1/30/2017 at 0:45 PM, fcasamento said:

i'm doing some research online about golf and rib fractures and quickly found this assertion:

Upper back and shoulder pain is a common presentation at sports medicine offices. While lower extremity stress fractures predominate, upper extremity and, in particular, rib stress fractures often are overlooked and underdiagnosed. This is not an insignificant concern, as one study of 169 stress fractures found the ribs to be the third most common location, with golf being the fifth most frequent sport involved (¹⁰). This case report provides an overview of rib stress fractures, including the clinical presentation, diagnosis, and treatment of this condition.

This happened to Rory McIlroy so you might want to research info on his diagnosis and recovery.

My own experience with a rib fracture was in the range of 2 months with no stressful activity to give it time to heal.

[JCrane]

How is the back coming along ?

[fcasamento]

It's actually was ribs on my right side, not back.  They have been great all season long ... until about two weeks ago ... same exact issue but this time on my left side.  I went crazy on Ibuprofen, ice and mild stretching and it has improved, but not totally gone.  This injury just lingers forever, threatening to become serious at any moment.  Going back to Orthopedic doctor as I am not going to mess around with this again without a proper diagnosis.  My guess is that last year I at first didn't have stress fractures, but first had muscle issues around the ribs.  Then I just kept playing and it resulted in the stress fractures.  Not good, ordeal lasted damn near five months.  Not going to let that happen this time.  I also believe the issue may be that I have a net and mat in my garage and just go at it too much, so backing off of that big time.

[JCrane]

yes, find out exactly what it is and proceed from there. I was going to suggest some  Yoga and some inversion therapy, but that is premature. I have found that by keeping the muscles lengthened it helps.