Patient: I get sharp pains in my lower back that sometimes turn into a burning sensation in my left shoulder blade. What could this be?
Doctor: Most likely the pain in the shoulder and lower back may be occupational, meaning related to repetitive working activit ities. Mechanical low back pain (LBP) is the second most common reason for seeing a physician in the United States. Of the US population, 85% will experience an episode of mechanical LBP at some point during their lifetime. Fortunately, the LBP resolves for the vast majority within 2-4 weeks. Sometimes it may complicate with a sciatic nerve inflammation and the healing process takes a little longer. Mechanical or activity-related spinal pain is most often aggravated by static loading of the spine (prolonged sitting or standing), long-lever activities (vacuuming or working with the arms elevated and away from the body, as your case), and levered postures (forward bending of the lumbar spine). Pain is reduced when walking or constantly changing positions, and when the spine is unloaded (reclining). However, a persistent, relenting pain requires further investigation, as follows: evaluation by a physician, imaging studies (MRI, CT scan) and sometimes even functional studies as electromyography. There are several causes of shoulder pain; one of the most common is the Rotator Cuff tendinitis and this seems to correspond with your case. The rotator cuff is a group of tendons that support the shoulder. These tendons can be injured during lifting, when playing sports with a lot of throwing, after repetitive use over a long time or suffer degenerative changes with the aging process. Typically, presents with an activity related dull ache in the upper outer arm and shoulder. Activity is commonly more difficult and painful above the shoulder level (more than 90 degrees). There is little or no discomfort with below-shoulder-level activities (less than 90 degrees) such as golf, bowling, gardening, writing, or typing. But, tennis, baseball/softball, basketball, swimming, and painting are more problematic and painful. The suggested treatment strategy for you should include: keep you weight under strict control in that way you do not overstress your lower back, a physical therapy program aimed to: teach you flexion and extension exercises of the spine to reduce the nerve tension, exercises that improve the muscular strength and endurance of lumbar muscles. Also is very important to keep a good posture at all times and practice low-impact activities such as swimming, walking, and bicycling can increase overall fitness without straining the low back. Standing: While standing, keep your head up and stomach pulled in. If you are required to stand for long periods of time, you should have a small stool on which to rest one foot at a time. The pain control and inflammation reduction can be accomplished with a combination of relative rest, icing (20 min, 3-4 times per day), and anti-inflammatory medication (“Aleve”). You can sleep with a pillow between the trunk and arm to decrease tension on the shoulder (supraspinatus tendon) and to prevent blood flow compromise in its watershed region. It is strongly recommended continue the pain control techniques at home, work, or vacation as part of the exercise program. The home exercise program builds on itself through each phase of the rehabilitation process, and carry-over should be monitored. Corticosteroids injection locally can be considered if there is no significant improvement after follow the conservative treatment.