Back pain, not in the back?
A new patient, requesting treatment for a sudden onset of back pain was booked into the Corby clinic yesterday evening. When questioned, requesting the description of the lower back pain it seemed simple enough to understand; sharp and burning pain to the left lower back. This is quite a common description of a trapped nerve and also quite easy to treat too.
When I asked what caused this sudden onset of pain the patient was less sure than her description of her pain. “Nothing happened. The pain just came on”.
Not so simple after all…. Pain does not just happen. There is always a cause. A trip and fall to sprain an ankle, or some arthritis causing pain in the hip or knee. Pain does not arise from just nowhere.
I grew more inquisitive when the patient could not tell me what increased or relieved her pain. So I delved further with my questions. Do you feel sick or bloated? Are you constipated? Do you pain anywhere else? Etc. When the answers to these questions returned no further information, I then turned to the physical examination.
As an osteopath, in an examination, we request that the patient performs set movements to see if we can replicate the pain. If we can then that is fantastic, we have more information to work with. If not, then that too, is still positive, as negative results can help to make some issues more or less likely.
When I was unable to replicate the discomfort in the patients lower back, I was about to request that we perform some orthopaedic tests, when, out of the blue a sharp and burning pain gripped the patient and then passed, just a quickly as it appeared. When I questioned the patient about the pain that just occurred, I found out that the pain was not in the lower back at all but in the thorax, at the bottom of the ribs. This started to ring alarm bells, as the thorax is the area where the major organs, apart from the brain, are positioned.
I performed a few orthopaedic tests and was still unable to replicate the pain that the patient had just experienced, so I decided to perform an abdominal examination, much like the doctor would, if presented with the same case.
I could feel nothing untoward within the abdomen and the patient reported that the examination had caused her no pain and I could not find anything that felt unusual. I had a general idea of what I thought it might be, a kidney infection or stones, neither of which a physical therapist is able to treat, so I had no choice but to refer her back to her GP for further consultation.
I called the patient the next day to find out how she was, and discovered that the GP felt much the same as I did. He had the patient perform a urine test which found traces of infection and blood in her sample too, which could indicate stones. The patient was given antibiotics and pain killers, whilst she is referred to a consultant for more tests.