Discogenic low back pain
A pleasant, morbidly obese 45-year-old female health care worker was referred to CareChain by her family doctor after complaining for three months of low back pain that began spontaneously. She reported a long history of low back pain with similar episodes but less intense. However, those episodes would resolve usually within a two to four-week period with chiropractic manipulation and over-the-counter medication. She indicated that her low back pain had become quite unmanageable as of late and that it was affecting her ability to perform to her full capacity at work.
Unlike her previous episodes, this current episode had not responded to chiropractic manipulation or over-the-counter medication. She reluctantly continues to work at her job which is comprised mainly of portering patients around the hospital. She has tried modifying her duties but inevitably develops severe low back 20 minutes into her shift. Further, she reports she has been generally inactive throughout her adult life and feels extremely deconditioned as any cardiovascular effort causes her to be out of breath.
With regards to her social life, she has resorted to staying at home as her low back pain symptoms leave her feeling anti-social. To date, she has not been referred for diagnostic imaging or for a surgical consultation.
Her family MD has instead referred her to a CareChain for an advanced back assessment in an effort to get expert answers for her patient, rapid access to spine specialists’ care and an evidence-based personalized plan of management.
Assessment
At her CareChain physiotherapist appointment, the patient underwent a comprehensive low back assessment. During her assessment, the CareChain physiotherapist noted that her symptoms were mainly reproduced with sitting, stooping, and flexing forward. She had no difficulty with toe walking, heel walking and tandem gait. Her passive straight leg raise was negative bilaterally and there was no evidence of lower extremity myotomal weakness or dysesthesia.
Accordingly, she was diagnosed with discogenic low back pain (also known as back dominant pain aggravated by flexion).
Treatment
The patient was provided with a personalized plan of management which included an exercise program emphasizing walking and swimming as well as extension-type exercises and core stability exercises. In addition, the CareChain physiotherapist took the time to educate the patient on the specific aspects of her condition including prognosis, activity limitations and postural advice.
At the end of the consultation, the CareChain physiotherapist sent a consult note to the referring family physician which included an outline of the patient’s personalized plan of management as well as recommendations for ongoing treatment. The patient was advised to touch base with her family physician to discuss non-opioid prescription pain relieving medications and to review her plan of management at her earliest convenience. Additionally, she was advised to find a physiotherapist on CareChain who could support her on her CareChain plan of management.
Over the course of the next twelve weeks the patient attended several physiotherapy sessions. She elected to attend treatment close to her place of work that was recommended by a surgeon friend. She was initially seen three times per week and was instructed to perform her CareChain home exercise program on her off days from the clinic. Each week, her condition was re-evaluated by her treating physiotherapist and her exercises progressed as per her CareChain plan of management. Crucial to her recovery was improving her cardiovascular fitness as well as removing any aggravating factors.
Her physiotherapy sessions were reduced as her symptoms improved. Her tolerance for her work duties steadily increased and she slowly started reintroducing her social and recreational activities.
Results
- 60% improvement of discogenic low back pain
- Improvement of tension and stiffness in lower back
- Mood improvement
- Education on her condition and the importance of staying active
At her follow-up appointment with his CareChain physiotherapist, the patient reported a 60% improvement in her discogenic low back pain (back dominant pain aggravated by flexion) and that her main complaint was primarily related to tension and stiffness in her lower back after prolonged portering. Nonetheless, the patient indicated that this too was improving with the prescribed exercises and activity recommendations. Additionally, she reported that her mood had improved significantly, and she was eager to return to her social activities.
Physical examination at the time of her follow-up was unremarkable. The patient was further educated about her condition and the importance of staying active, avoiding aggravating factors until asymptomatic and the continued importance of managing her condition through cardiovascular fitness, extension-type exercises, stretches and core stability exercises.
Conclusion
As is the case with many back dominant pain patients, this patient’s symptoms resolved through conservative management. Key to this was a comprehensive assessment, rapid access to a network of CareChain physiotherapists and an evidenced-based personalized plan of management.
Had her symptoms persisted or worsened the CareChain physiotherapist would have connected with her family physician to discuss a multidisciplinary approach to managing her symptoms that would have included changes to her medication, motivational interviewing/CBT as well as ongoing physiotherapy. As her symptoms are back dominant and there are no neurological deficits, rapid access to a CareChain spine specialist or advanced imaging would not be warranted.
Nonetheless, her symptoms are now almost resolved, and she has been able to return to most of her activities without having to wait months or years for an appointment with a spine surgeon.
Is your back pain interfering with your daily activities?
CareChain gives you access to qualified physical therapists that will assess your condition and develop a personalized treatment plan. If your treatment plan does not help reduce your back pain, you will be quickly referred to a spine specialist in Montreal or your region. Schedule an assessment of your back pain with one of our physical therapists today and get back to doing what you do best. If you have any questions, or would like book an appointment by phone, reach out to us at CareChain at 1-844-675-2947. Our dedicated staff will be happy to lend a hand, and get you started on your road to recovery today!