The following case history involves a fictitious character however it is based on an actual case history I performed.
Nice to see you again Tony, although it’s a shame about the circumstances. Are you going to be comfortable like that?
I’ll manage, thanks.
Can you tell me where your back hurts? Show me, perhaps?
It’s right at the base of my lower back, here (rubbing the spot on his back with his fingers).
Ahhh…okay. Just in that area then?
Yes, it’s just this one little spot but it hurts like hell!
I bet! Have you had any pain in your legs? Buttocks?
Can you describe the pain to me? Is it dull, sharp, burning…?
It feels like someone is stabbing me with a knife…or a large needle!
Ouch! Is that all the time or just sometimes?
It’s mainly when I stand from sitting – as I go to straighten my back. Other than that, it’s pretty unpredictable.
It comes and goes quickly then?
Yep, once I start moving around it seems to get a bit better.
Mmmm… On a scale of 1-10, 1 being mild discomfort and 10 being the worst pain imaginable, what would it be?
9 or 10.
That’s the stabbing pain I take it? What about right now?
To be honest I don’t have that sharp pain at the moment so I’m not really in much pain. There’s some mild discomfort in my back but it’s not bad – I’d give it maybe a 1 or 2 out of 10. But when I get the sharp pain it’s enough to knock the wind out of my sails! Definitely a 9 or 10. I wouldn’t wish it on my worst enemy!
I’m sure they’d be glad to hear that Tony! Okay, so why don’t you tell me when and how this started? What were you doing at the time?
This is the part I don’t really understand. My back had been a bit grumbly for a week or so. Eventually I ended up doing those exercises you gave me, which I have to say helped a lot. I thought I’d fixed it actually and then 2 days later I woke up and my back was quite stiff and sore. I did the exercises again but my back just continued to get more painful. By lunchtime I couldn’t walk!
When was this? Yesterday?
No. It was…Tuesday. So three days ago.
Gotchya. What had you been doing the day before? Had you been exerting yourself?
No, nothing. I mean, I’d done a bit of gardening but it wasn’t much and I didn’t feel anything at the time…or after for that matter. Still, that’s the only thing I can think of that was even remotely physical.
How often do you usually do gardening?
One of the benefits of early retirement is that I can do it more, so probably 3-4 times a week. It’s usually nothing strenuous, just a bit of pottering around.
And how long were you doing it for on Monday?
The usual. Maybe an hour or so.
It’s actually remarkable common for a person to present with LBP with no obvious mechanism of onset. No rhyme or reason whatsoever!
I’m afraid so. Still, at least you can take comfort in that fact. Tell me, how has your back pain changed in the last three days?
Well, as I said when it started it was more like a stiff/sore back, but it didn’t take long to become excruciatingly painful. At that stage it wasn’t just the sharp, stabbing pain either. My whole back was sore (rubbing his back with his hand). It was still quite bad up until last night but I took a couple of ibuprofen before bed and managed to get some decent sleep. This morning I woke up and it’s definitely the best it’s felt. I still have to be careful how I move though to prevent that stabbing pain.
I know you have a history of back troubles Tony. Remind me when it first started?
Ummm…I would have been in my mid-twenties I reckon. I was helping my sister move. My back objected to me lifting her wardrobe!
And how long did that write you off for?
I’m not… exactly… sure. I remember I had to take some time off work – I think only one day. Possibly two. Geesh! That was over 30 years ago now!
Ha ha. Well done Tony. I’m impressed you remembered that much!
Pain has a way of sticking in your mind.
I’d say! So, you didn’t have any back troubles before that, right?
No, none that I can recall. My back has never been the same since that injury. I mean it hasn’t been that bad or anything, but if I did the wrong thing it would always let me know about it!
Mmmm… Any things in particular?
Heavy physical work. Or even driving long distances.
And how many flare-ups would you guess you’ve had over the years?
Possibly 6 or 7 bad ones and maybe twice that for smaller ones.
Is this the worst one you’ve had?
I’d say so. It certainly has felt that way over the last few days. The first episode may have been worse but I was pretty fit back then. My body ain’t what it used to be!
You still look in pretty good nick to me, mate. Moving back to your current pain. Does it have a daily pattern at all? Is it better in the morning or at the end of the day?
Until today the mornings have probably been worse. Actually, I’m not so sure – it’s been bad at night too. Let’s call it a draw.
Ha ha no worries! Have you noticed much stiffness since that first day?
Yeah, especially first thing in the morning and after I’ve been sitting for too long.
Tony, does it hurt when you cough or sneeze?
I reckon at the start but not so much now.
How about straining on the toilet?
Have you noticed any changes to your bowel or bladder habits?
Nope. What’s that about?
Just ruling out any nasties. There’s a serious medical condition called cauda equina syndrome. It’s very rare, but I like to play it safe!
So, you mentioned earlier that standing from sitting elicits that sharp pain. Is there anything else that makes your pain worse?
Hard to tell. Perhaps sitting for too long. Certain back movements.
Bending forward is okay isn’t it?
Seems to be…
Depends. Sometimes just the slightest movement will trigger the sharp pain.
What about rolling in bed at night?
Mostly okay. I mean the first couple of nights my back was really sore and it was hard to get comfortable. But rolling over wasn’t too bad.
You’re a side sleeper?
Any trouble with stairs?
I don’t think I’ve used any actually.
Fair enough. Tell me what makes your pain better? You said you’ve tried ibuprofen which seemed to work…
Yeah ibuprofen helps…a bit. Last night more so. Warm showers have helped too.
Anything else? Ice? Stretching? Other meds?
None of that. Too scared to do more stretching.
Okay. Do you have any numbness or tingling in your legs…or anywhere else in your body?
Good. Any weakness in your legs? Legs haven’t been giving way I hope!
Nope. Guess I have something to be thankful for then after all!
Indeed! Always others who are worse off than you… Do you get any other treatments for your LBP?
Not since I retired. I used to get a massage every couple of weeks but I haven’t needed to since I stopped working!
Ahhh… Plenty of people I treat would love to give up their work so they can give their body a break. You owned an accounting firm, didn’t you?
Yeah, Browne & Associates.
Good stuff! What are you doing to keep yourself busy these days?
Golf. Socialising with friends. Gardening. One of my son’s and daughter have taken over my business so I help them out sometimes. My wife and I also do a fair bit of travel as our other daughter lives in the UK.
How does your back go with the long-haul flights?
Pretty good. We have the luxury of travelling first class these days.
FIRST CLASS!? Should’ve been an accountant! (Winking at him)
(Big laugh) Maybe.
How many times do you play golf?
Twice a week.
With or without a buggy? How many holes?
You legend! Any other exercise?
My wife and I usually walk along the river each week night. Obviously not since this pain started though.
Sounds good. You’ll be doing it again soon! What are your stress levels like these days?
Great. Nothing compared to what they were before! No complaints.
Normally sleep okay?
Like a baby!
You drink plenty of water? How much would you drink a day?
Not enough I’d say. Less than a litre. Beer doesn’t count does it?
I’m afraid not. Alcohol is a diuretic so will only dehydrate you further. How much alcohol would you have per night?
I’d have 3-4 stubbies most nights, plus my wife and I usually share a bottle of wine. More on the weekends, or if we’re entertaining.
Mmmm…good to give the ol’ liver a break for at least a couple of days each week Tony. You may even find by increasing your water intake and cutting back the alcohol it helps with your LBP too.
Perhaps I could. Might help to shed a bit of this extra weight I’m carrying.
Exactly! Okay, what’s your diet like? Lots of fruit and veg. Low in highly processed foods?
Yes, I love eating fruit and my wife and I both like to cook healthy meals. We eat out a fair bit too but they’re usually quality meals.
And finally, no other health events since I saw you last?
Nope. Generally pretty fit and healthy. Only slightly high blood pressure which is well under control.
Great. Is that the only meds you’re taking still?
Okay, we’re done! Let’s take a look at how you’re moving. If you could take off your shoes and belt and stand over here please…
What, no more questions!? (Smiling)
Don’t worry Tony, I’m sure we’ll fit in plenty more during the treatment…
(Laughs) My goodness! You’re gonna know more about me than my wife soon!
(Laughs out loud) You sound like you’re feeling better already! Now let’s see if we can get you moving a little better. 😊