Presentation
“Patient X” presented 3 days after onset of acute lower back pain which was quite severe and getting worse. Pain was being felt on both sides of the back but was worse on the right and there was no referral of symptoms down past the buttock.
“Patient X” was a healthy 27-year-old male with no previous history of lower back pain and no other medical issues. They worked as a dog handler in the K9 unit for Corrective Services. Normally, they were fit and well, enjoying hobbies such as surfing and the gym.
The injury occurred during a basic activity when “Patient X” went to bend down to pick up their dogs toy. Instantly there was pain, and “Patient X” described it as like being stabbed in the back. They were unable to get back up from being bent over for 40 minutes after the incident. From this point, pain was severe, being described as 9.5/10. “Patient X” was struggling to walk and move their legs in any way. They were reliant on strong pain medications to get through their day, unable to work in any capacity and could not even drive due to pain.
Initial Assessment
“Patient X” was unable to initially drive themself to the clinic for their first appointment due to significant pain. When they walked into the clinic they were limping badly. Range of motion of their lower back was significantly restricted in all directions due to pain. We were unable to assess their hips or nerves initially as any movement of the legs caused significant back pain. When feeling through their lower back, there was a lot of muscular spasm on both the left and right sides and the joints of the lower back were also stiff. “Patient X” had an MRI scan taken earlier that day and we reviewed the imaging which showed a bulging disc in the lower back, which was pushing into the spinal column, but not causing any nerve impingement.
Initial treatment
First, we started off by explaining to “Patient X” what was happening in their back. We explained that the MRI showed a disc bulge. However, we know that it’s been found in the literature that 30% of 20 year olds without lower back pain will have a disc bulge on MRI imaging. What this means is that even though there is a disc bulge, it is very possible it isn’t contributing to the symptoms being experienced. Many people in the community will have a disc bulge and not even be aware of it! So, despite all the talk about “slipped discs” and having a “dodgy back” that is damaged forever, we know that this is simply not true. Backs are strong and resilient and will recover with the right management. We also explained our assessment findings including the reduced movement, spasms of the lower back muscles and stiffness of the joints in the lower spine. All these were contributing to “Patient X’s” pain.
We then began hands-on treatment. This involves releasing tightness in the muscles and mobilising the joints of the lower spine that are stiff. Our aim with hands-on treatment is to reduce pain and get the recovery process started.
We then provided “Patient X” with some gentle stretches for the lower back. These aim to restore movement and normal function. “Patient X” was also given advice about pain relief strategies to try at home such as using heat packs and trying to change position regularly to prevent stiffness.
Ongoing treatment
We got “Patient X” back into the clinic 2 days later. We know that it is important for regular treatment early to reduce the pain. “Patient X” reported good relief after the initial session, however symptoms had returned after 3 hours. They were able to reduce the pain relief they were taking by this appointment. Movement of the lower back had started to improve but remained reduced and walking and driving were still painful. During this next session, we continued with hands-on treatment and progressed the stretching exercises. This resulted in both movement and pain improving by the end of the session.
The next appointment was 4 days later, and pain had improved significantly by this session. “Patient X” was now able to tolerate driving and was completing yoga. Movement of the lower back had dramatically improved, now only slightly limited during forward and backwards bending. We completed a lifting assessment, and “Patient X” was able to lift 20kgs without pain. Hands-on treatment continued and we progressed “Patient X’s” exercises to include some strengthening and walking.
Within two more sessions, “Patient X” was able to run 3km, complete their strengthening exercises, and got their work dog back from the kennel where they were staying whilst “Patient X” was recovering. Full movement had been restored and pain was gone. They were able to return to their full work duties without any back issues and have not contacted us regarding any ongoing back pain since discharge.
