Brian was a 58 year old car yardman, and three days ago he slipped on an oil patch at workplace and his left leg went out from under him. To stop himself from falling he reached out to catch himself on a nearby sink and in the process he twisted his back. Brian had avoided a fall but he felt a sudden onset of left sided low back pain. He was able to finish the day at work but when he woke up the next morning, Brian was unable to get out of bed due to the pain that he felt in his lower back when he tried to move. For the rest of that day, Brian found sitting, standing or walking for more than 10 minutes at a time would increase the pain in his back.
Brian took the day off work and went to see his GP, who prescribed him with anti inflammatories and referred him to see a physiotherapist. Brian came to see me a couple of days later, by then, his back pain had already started to improve. He was able to walk although with a limp, but sitting was no longer painful. Standing up from sitting and bending still were uncomfortable. Although Brian was already showing signs of improvement, he was very concerned that he was off work and still experiencing ongoing and unexplainable low back pain.
“Will my back pain go away?”
“Will I be able to get back to work?”
Brian asked both of these questions in our first session. From the way Brian spoke about his back pain and seeing the way he was guarding and apprehensive about moving his back during the assessment, I could see that it was going to be very important to get Brian back to work as soon as possible, even though it would be on reduced hours and duties. Education would also be key, as Brian’s understanding of his diagnosis and his treatment improved, his confidence would too.
Education and specific exercises to improve back flexibility and restore confidence for work and daily activities is the best treatment for non specific low back pain. This is heavily advised by the Agency for Clinical Innovation, that has created treatment guidelines for health professionals for low back pain based on the best scientific research and expert opinion available. To have a closer look at these guidelines, click here.
After assessing how Brian’s back moved and ensuring that there no other contributing factors to his back pain, I explained to Brian that he had non specific low back pain or as I like to call it garden variety low back pain.
"I call it garden variety low back pain as its so common, one of the most regularly treated injuries in our clinic. Because low back pain is so common, we know how to treat it well. With the right advice, some specific exercises and a gradual return to work, in 4-6 weeks you will be back to full time work and and driving your kids to sport on the weekends” I advised Brian.
By the end of our first session, Brian, although he was hesitant and still had an ache in the left side of the back, was now able to bend forward to reach the middle of his shins. I sent him home that night with the advice to continue using anti inflammatories, avoid sitting, standing or walking for more than 15 minutes and to use heat to stop his back being stiff and sore. Most importantly I reassured Brian that his back would improve dramatically over the next couple of weeks and that his type of back pain was very common and there was nothing to be concerned about.
Brian came back to see me at the end of the week. “I feel like I am getting better but I still get pain when I roll in bed and when I walk too far. When do you think I can go to work?”
Looking at Brian move, his back was much more flexible than at his first session but he was still very worried about not being able to work. He was also concerned that his back pain, although now was no longer constant, would spring up on his with certain movements.
In our second session, I could see from a muscle and joint perspective Brian was progressing as expected for someone with acute low back pain. What concerned me more was the amount of worry he was having about the pain in his back and being off work was noticeably upsetting him too.
"It’s not right not going to work, it’s not right being at home” Brian had mentioned on a couple of occasions.
"Brian, your back pain will get better, and you will be back at work by the end of next week, you will be doing less hours to start with and there will be come changes to your work duties, but you will be back to work by the end of next week. For me to be able to let you go back to work though, I need to be happy that you can walk, bend and squat well. To do this you have to stick with the exercises. Your back is improving as I would expect for someone with this type of back pain. Be patient and in 4-6 weeks your life will be back to normal” I reassured Brian
With that bit of reassurance, Brian complied with his prescribed exercises of bending and squatting, and by the end of the second week he was able to bend forward to touch the floor. He also returned to work half a day for 3 days a week.
"I do feel better, I can definitely feel it. I move better in the morning and I am going slowly but work is ok I can sweep and mop” This was Brian 3 weeks after his initial fall and his back pain is continuing to improve and he has returned to full time work.
There are a lot of factors that contribute to back pain, Brian for me was a good reminder that good treatment is not only addressing the mechanical joint and muscle aspect of the injury but to also listen to concerns of your patient and to specifically address those as part of the treatment. With that combination back pain does go away.
Low back pain is a very common injury, something that physiotherapists see a lot of. If you have a question about back pain why not contact someone from the BJC Health physiotherapy team?
