T Nation

Has anyone ever had an upper back strain?

I hurt my upper back (near my left rhomboid) and it has been excruciating pain. It feels like there is a vice grip and knife in my back. I have not been able to sleep good for 2 weeks. I am taking pain medication (800 mg of ibuprofen) and it does not seem to help. Stretching helps a little and I did receive some ART treatment that gave my back some relief for an hour and then the pain came back. Does anyone have any suggestions? Stretches or treatment?

Anyone?

Hey cjack - Sometimes I strain a rhomboid (or as far as I can tell it’s a rhomboid). I do this from either front squats (apparently underdeveloped rhomboids can fail before the quads) and from heavy deadlifts. I’ve found the best thing is time. Probably not what you wanted to hear, but there it is. My injury isn’t as bad as yours either, so I guess you could hit the Androsol and Tribes in an attempt to get your T up. My thinking is that it would help the muscle heal quicker. Or just take some low dose steroids. But I’m not sure I could personally go that far… [shrug] And I’m also not an authority on this (roid use), so keep researching methods bud. Cheers.

I thought ART was for breaking up chronic problems like restrictions from fascia and scar tissue, not for acute injuries. Hmmmm…but ART did relieve the pain for awhile?

Well, I’d guess that you have either some sort of strain/tear in which case gentle stretching and time are needed until you heal up, or you have some sort of ischemia/trigger point problem. However, you might develop the latter problem as the result of the former, so be on the look out for trigger points either way.

Trigger points: Sometimes a muscle will develop abnormal tone and remain partially contracted. This sustained tension interferes with circulation to the muscle causing dehydration, hypoxia (reduced oxygen), a buildup of metabolic waste and lead to pain. Then, in response to the pain, the muscle develops even more tone! This viscious cycle can continue indefinitely, and if untreated long enough, the fascia over the muscle will shorten to accomodate the shortened lenght of the muscle and prevent the muscle from assuming its normal, healthy length and perpetuate the interference in circulation. I’ve read that there have even been severe cases that led to tissue destruction.

Anyway, muscles in this condition typically develop tremendous soreness and point tenderness at very specific places, with the muscles along the medial border of the scapulae be classic places. There are detailed maps of trigger points available and you might check where your pain is against such a map. (I’ve not checked the web, but heck everything else is on the web so you might do a websearch for a trigger point map.) There is a 70-80 per cent correspondence between trigger point maps and acupuncture maps, so the Chinese seem to have been onto something we are only now recognizing. If pressure on the area of your tenderness sends tingling or pain or some strange sensations to another area, like to the front of your shoulder, up the back of you neck or down your arm, you are probably dealing with an “active” trigger point. Interestingly, many of these “referral patterns” as they are called have no anatomical explanation. In other words, unlike anginal pain, where a common nerve carries pain signals from the heart and the left arm so a heart pain signal is interpreted as arm pain, trigger pain is not explainable by nerve distributions. Research on dermatomes, scleratomes, fetal development, etc. don’t explain why some triggers produce the referral patterns they do. (Pretty cool how the ancient Chinese picked up on this stuff, eh?)

You might see a physical therapist about it, though a DO who does manual therapy or a DC could almost certainly treat this. There are a number of techniques that might help: ischemic compression/acupressure; strain-counter strain; etc., including some stuff I’ve probably never heard of. The idea is to reduce the tension in the muscle and restore the muscle to its normal length. The use of pressure on the trigger point is meant to reset the proproceptive mechanism that maintains muscle tension to a lower/normal level so the muscle will relax and normal circulation, etc., will ensue. However, stimulating acupressure points and trigger points also can lead to endorphin release in the central nervous system and also does something locally to reduce pain, though all the mechanisms are not fully understood. (I’m guessing about this, but I suspect part of the local effect is shifting the pain sensor’s threshold or activating some sort of gating mechanism in the spinal cord at the junction with the interneuron.) I’m guessing that the ART treatment you had done had a similar effect as my understanding is that ART entails placing soft tissue under tremendous sustained compressive force which is exactly what the acupressure/ischemic compression technique does. However, ART is apparently more geared to producing a quick, permanent structural changes primarily in non-contractile tissue whereas acupressure/ischemic compression seeks primarily to produce a quick reduction in contractile tissue tone and only indirectly produces a permanent change in structure. I’d be interested in being set straight about this by anyone more familiar with ART.

Many times treating a trigger point will produce only temporary relief, so numerous treatments are needed. Treatment can also entail ultrasound to stimulate circulation, various types of electrical stimulation, cold packs and even striping the skin with a CFC (the sudden cold causes a decrease in tone, though I've not had any experience with this technique).

You can also treat yourself using a “Theracane.” If you have a Relax the Back store near you, they usually carry these. It is a “J” shaped cane made from fiberglass with handles on its stem that allows you to put pressure on your trigger points. Because you are administering the pressure yourself, you can have greater precision than a practitioner and pain you control is better tolerated. A quick and dirty technique for treating trigger points in your back is to lie on a golf ball! (It works!) Just put the golf ball on the floor and lie on top of it, rolling your body around until the ball is on a trigger point and then “sit” into the ball to produce pressure. After a couple of minutes, you should feel the pain fade somewhat. Then you either increase the pressure until you hit your pain threshold again and wait a couple of more minutes for the pain to fade, repeating the cycle until almost all pain is gone, or roll around a little to see if the pain has shifted slightly. Trigger points are notorious for their precision, i.e. a millimeter shift or shift in angle in pressure on a trigger can make all the difference in the world. Alternatively, have a friend massage your back to find the trigger points and then use their fingers, knuckles or elbows to administer the pressure.

Trigger points are not well understood and most people have them without realizing it. Just occasionally a trigger point becomes active (like after whiplash injuries) and people will complain about “knots” in their muscles and find a massage helps. That inappropriate tension in the muscle is the proprioceptive mechanism in the muscle spindles going awry.

Well, I just vomited a lot of information that may not help you now, but I'd guess somewhere down the road you'll find it helpful. If you do see a PT or massage therapist (I almost forgot about massage therapists!), he or she can train you in how to treat these yourself in a session or two using ischemic compression, stretching, moist heat, ice, etc., but ultrasound, CFC, electrical stimulation and some other stuff would require a professional.

Oh, one other interesting fact. JFK’s personal physician, a lady named Travell, I believe, pioneered research on trigger points, and for man years, her book was the Bible on the subject.

Good luck and I hope this helps.

I have no words of comfort, but I’m really sorry to see this thread. I pulled what I guess is a left rhomboid last week. Yesterday’s deadlifts certainly didn’t help. It does make it uncomfortable to sleep. I’ve hurt for only 5 days; I hope it doesn’t turn into weeks likes yours did. You’ve got my sympathy.

I did what was probably the same thing
to myself about 6 or 7 years ago. It
was stupid. I was using a periodization
scheme, adding weight each week and
dropping a rep, and it was the last
week of the cycle, doing triples. I
was totally psyched because the weight
on top deadlifts had finally gone past
500 lb (was 505) and this really had
me energized.

First rep I felt a pain in my upper back,
but DAMN IT I WAS GOING TO GET MY THREE
REPS.

I did but then I suffered like you are.
I went to a chiropractor but it did no
good.

I just dropped all exercises that hurt
it, and it took a month probably to
get better.

Hang in there! I think you’ll get better.
I don’t know what kind of treatment could
help: the muscle just needs to heal and
pushing it around and so forth won’t
really help that. (Unless adhesions
were forming.)

To the physical therapist, a semi deflated basketball worked for me. I get a better massage rolling onto it. I’m prone to upper back strains. I also know they are quite painful. The best solution for me is to lie down on some ice packs. Have the ice near the affected area. Gently apply pressure. Keep it there for 30-45min. Every time I strain my back, I ice it and it goes away in 1-2 days. Just watch TV while lying on floor or on a couch. Also do some rahab work in that area…feeder sets. Hope this helps.

Thanks for the information and I have always wanted to get one of those J canes but did not know where to get them. The golf ball is also a very innovative idea. I will try it. This is an update, I went to a massage therapist who gave me some trigger point therapy and he did not quite get the spot I needed (I had so much pain I did not know where it was coming from). My wife is also a massage therapist (retired because of carpal tunnel) and she got the spot that was hurting with trigger point therapy last night. Didn’t hurt bad this morning (thank God) but can still feel the pain. Thanks for the help.

Thanks for telling me your experience. Sounds like the same thing and looks like I will have to take off a month. (I am deflating as we speak). It is very depressing to take off a long period of time but maybe this is some well needed rest. My body is telling me something. Will keep getting my wife to give me some trigger point therapy which is my only relief.