Mark is 32yrs old. He came to the clinic complaining of pain in the mid-back, in between his shoulder blades. It had started about six weeks previously, for no obvious reason, and he felt it particularly badly in the morning, when he woke up. The pain seemed to come and go. He did say that he has suffered from indigestion in the past and has had an endoscopy (where they use a camera to look down into your throat and stomach). This had apparently shown some erosions, signs of inflammation) in the oesophagus. Mark said that he had just bought a house, and that his internet company was struggling a bit financially. His partner had had a baby about three months ago. He agreed that he is pretty stressed. 

His mid-back was quite tender with some spasm in the paraspinal muscles. The right side of his neck was also stiff and tender to touch. His sternum was also really tender. 

Mark’s mid-back pain is probably caused by reflux of his acidic stomach contents up his oesophagus creating inflammation in the oesophagus. This is often a problem when we lie down for a while. It is made worse by anti-inflammatory medication, like ibuprofen, and by aspirin, which irritates the stomach. Alcohol and caffeine will also aggravate the condition. He needs to reduce the intake of wine and spirits, and avoid too many cappuccinos! Food and drink that are hot in temperature and spice will also aggravate the problem. He could try taking a medication like Nexium to see if it helped in the short-term, as it reduces stomach acidity. Anything that he can do to reduce his stress levels will help. Going for a regular run is good for this. Maybe Mark should try that!