The following is a case study of a patient that presented to my office with a long term history of low back pain. He is a 46 year old gentleman who started experiencing the low back pain after a day of heavy lifting approximately 1 year prior. The pain was described as achy/stiff/restrictive and was particularly was made worse by exertional activities and after periods of being static such as sitting or sleeping for extended periods of time. He also reported it was difficult for him to straighten up after being static. His discomfort seemed to get better as long as he was mobile. His overall health good and he did not report any other health issues.
Prior to his visit at my chiropractic office, he had also sought care from his medical doctor who had diagnosed his lower back condition as a “muscle strain” and was subsequently prescribed muscle relaxant medication as well as instructed to apply heat and rest until the pain subsided. As a result, his pain has only reduced about ten percent from the initial onset and the chronic nature of the discomfort has worried him enough to seek further care. A subsequent x-ray ordered for his lower back was also normal.
Examination: Mr. Back Pain presented with a slight forward bend of his lower back. His range of motion was restricted in all planes but most significantly in extension (bending lower back backwards or straightening up) due to pain. His lower back and gluteal muscles were tense and tender to touch. All other orthopedic and neurological testing was normal.
Diagnosis: Chronic lumbar posterior spinal joint irritation/inflammation with associated paraspinal muscle hypertonicity. In other words, Mr. Back Pain had a significant degree of inflammation in the joints of his lower back with associated muscle tension/spasm. This is a very common diagnosis for sufferers of lower back pain and can be easily treated by focusing the treatment on the correct areas of the spine.
Treatment:
- Chiropractic spinal adjustments to restore lower back spinal range of motion and remove misalignments that exist between vertebrae
- Interferential current therapy to remove muscle tension/spasm
- Soft tissue treatment to restore spinal muscle health
- Passive stretching of the lower back
- Ice therapy to reduce inflammation in the affected areas of the spine
- Complete home care program inclusive of ice application, stretching, mobility exercises,
- and postural re-education
Result: Mr. Back Pain followed his in office treatment schedule and home care program. Within the first week of care head regained his normal range of motion in his lower back and the pain levels had decreased by 80 %. Following the second week of care after his 5th visit at the office, he was also pain free.
Once at the pain free level, Mr. Back pain was also provided further guidance as to continuing his home care program to also include proper nutrition, exercise, and supportive chiropractic care to maintain his spinal and overall body health.
Case Analysis: The simple answer here is that the chronic nature of this case could have been easily prevented by making the correct diagnosis and from there prescribing the correct treatment intervention as well as self care program to further facilitate the healing. This patient had been diagnosed by his medical doctor with a strain of his lower back muscles when in fact, the muscles were actually tense in response to the inflammation in the boney joints of the affected area of his spine. It is imperative to reduce and remove all of the inflammation to restore normal pain free function. Moist ice applied to the affected parts a minimum 2-3 times per day 10 minutes at a time will help reduce inflammation. A common mistake in a case such as this is the prescription of heat application to the spinal area causing the pain. If heat is frequently applied to inflamed areas of the body, the tendency is for that inflammation to persist and the condition to become chronic and get worse.
The other error in this case was to instruct this patient to rest as a measure to combat his lower back issue. Patients are often told not to move and to rest during episodes of back pain. The correct advice however, is to rest from activities that cause increased pain but not sit or lie in bed all day. Of course daily postures such as excessive sitting/standing/sleeping or exertional activity that irritate the injured areas and lead to further pain need to be eliminated. Introduce motion and keep as mobile as possible as soon as possible. Stretching gently and walking for short durations in addition to in-office adjustments and mobilizations of the lower back are key in maintaining your mobility. The idea is to open up the areas that are restricted in the spine to restore function and promote healing.
