Q. What is the issue with my upper back?

Hello,

Welcome to icliniq.com.

From your query what I understand is that you have lower back pain that is well controlled with physiotherapy exercises, but have recently developed upper back and right shoulder pain which you think may have been brought upon by some of the exercises. Let us discuss your neck and lower back separately.

• The MRI report (attachment removed to protect patient identity) of your neck (cervical spine) does not sound very worrisome. However, the availability of the actual MRI images will tremendously improve our understanding of your problem.

• It looks like you have axial neck pain arising from degenerative disc disease at multiple levels from C3 to C6. This means that the three discs between C3 and C6 have lost their natural spongy consistency and have turned into flattened rubbery structures.

• This flattening is often associated with loss of the normal curved lordotic posture of your cervical spine.

• The muscles in the back of the neck have to work extra hard to maintain an upright posture of your neck and get fatigued easily and frequently go into spasm. The exercises that you did for your lower back pain may have fatigued your neck muscles faster causing more frequent spasms.

• The pain arising from those discs are usually perceived by your brain to be coming from the shoulder and upper back, a phenomenon known as referred pain. Hence, your shoulder and upper back x-rays are normal.

• The best way to take care of your cervical spine pain is again by physiotherapy. The neck muscles need to be strengthened in order for them to not get fatigue easily. The loss of your neck posture may be irreversible, but the exercises should help reducing the frequency of spasms.

• If you do have an acute spasm right now, then I would recommend taking muscle relaxants for a few days and not starting the neck exercises for now. Once the spasmodic pain gets better,then you can consult a physiotherapist for these exercises.

• Also, once the spasm is better, it may be prudent to get an upright x-ray of your neck to see how bad your posture truly is. If at any point you develop pain radiating down the arms, we may have to relook into your neck MRI to see if there is any nerve compression.

• Your lumbar spine MRI report (attachment removed to protect patient identity) mentioned annular tear and mild bulge of the L5-S1 disc. The annular tear is known to be very painful in the initial stages, but pain often gets better with time.

• If the disc bulge is not big and not pressing on the nerve roots, then nothing needs to be done. If the radiating pain down the leg is troublesome, you may think of an epidural steroid injection to reduce the inflammation around your nerves in the lower back.

Degenerative changes in neck due to postural habits and possible sedentary lifestyle.

Upright x-rays of neck and lower back.

1. C3 to C6 degenerative disc disease with axial neck pain and possible acute neck spasm.
2. L5-S1 annular tear, mild disc bulge and mild radiculopathy.

1. Muscle relaxants, if acute spasmodic pain is present.
2. Physiotherapy of neck and strengthening exercises.

Revert back with upright x-rays of your neck to a spine health specialist online.---> https://www.icliniq.com/ask-a-doctor-online/spine-health-specialist

Hi,

Welcome back to icliniq.com.

Thank you for uploading those images (attachments removed to protect patient identity). I see that you have uploaded almost all of the lumbar spine images and some cervical spine images.

• Your lumbar MRI, as I was expecting, is not very worrisome. The L5-S1 disc bulge is mild and does not seem to cause much trouble to the nerves. I did, however, find increase in the facet joint space and that suggests a tinge of instability.

• While the pressure on the nerves by the disc is static, the pressure due to the instability can be dynamic. That is, it can be more when you are in motion like walking. But, as your current symptoms are in control with exercises, I would suggest continuing with the same exercise regimen.

• The cervical spine MRI images are not very informative, but confirm the report that there is no obvious neural compression. The normal curve of the spine is straightened, which is suggestive of muscle spasm.

• The loss of disc height contributes to the straightening of the spine. Once the spasmodic pain is better, I would recommend consulting a physiotherapist and start working on neck strengthening exercises, while at the same time, continue your lower back exercises.

• The physiotherapist should be able to guide you as to which particular exercises to do in order to make the neck better without compromising on the lower back issue.

• I would also recommend upright x-rays of the neck and lower back, if not already done. An upright x-ray tell us a lot about the dynamic weight bearing posture, unlike the MRI which is done in lying down position and hides the effect of gravity.

Revert back with the x-rays to a spine health specialist online --> https://www.icliniq.com/ask-a-doctor-online/spine-health-specialist