Client Case Study - What we can do to help!
Client presents with new episode of low back pain.....
Recently we had a client present with a case of new low back pain after reaching forward to put on his shoes. This occurred first thing in the morning and he felt a sharp intense pain on the right hand side of his back. He then could not get up out of this bent over posture without assistance from his wife. Eventually they got him to the sofa lying on his back with his legs bent and he called in sick to work.
This scenario of acute or new back pain presenting first thing in the morning after bending forward or twisting is all too common in society and in our clinic. So Mr X came into the office with 8 out of 10 pain, unable to walk very far and stuck in a forward lean with side bend posture (what we call antalgic posture.
Client History:
First step is to do a thorough history or intake for Mr X. We dive into his medical history, relevant issues, traumas, medications, check for red flags and ask about how his back has been feeling in the previous weeks/months. Once we know his background, history and current pain/dysfunction we then move onto the physical exam.
Physical Examination:
With Mr X of course many movements are not possible or unable to be done but we do what we can in assessing his range of motion, posture and ability to move. We use the Functional Range Assessment on every client to look at joint function along with orthopaedic and neurological testing (tests an orthopaedic surgeon uses) to assess the health of the back.
In the case of Mr X we found significant limitations in his ability to bend forward, side ways and backwards, he had pain upon coughing, sneezing and straining. There was no pain referring into the leg and his neurological status was normal (motor strength, sensation, reflexes). So next we explain to Mr X what is going on specifically with his back.
Report of Findings:
Taking into account Mr X's history, physical examination and any other information he provides including any prior testing we then come to a likely conclusion of what is going on with his back. Most mechanical issues can be determined without advanced testing, a thorough history, examination often provides us all we need to diagnose. If someone has any red flags (neurological changes, night pain, sweats, fever or does not fit a likely diagnosis) we then refer directly to his medical doctor. Rest assured if you should be with someone else or another doctor we will refer you to the right place.
Mr X was suffering from a common irritation of the low back discs or pain arising from the discs of the spine. Specifically at L4-5 disc level with no nerve involvement (sciatica or otherwise). We explained to Mr X that this disc issue has been bubbling under the surface for weeks if not months. Mr X reported that he had been feeling progressive tightness, stiffness and restriction in the lower back (not pain) prior to his back seizing up.
