Let us consider a case history to illustrate the problems associated with back pain and physiotherapeutic treatment of the same. This case is based on the problems of one of my patients who is a middle-aged lady suffering from back and neck pain, referred to as Mrs X.
Mrs X was very active in her youth. Her activities in her college time included trekking, dance, drama etc. It was in her college time she suffered from a two-wheeler accident, the accident involved her right knee which swelled up and required to be attended by an orthopaedic doctor. After a heavy dose of antibiotics and a minor surgical procedure, Mrs X could recover from the accident. But, the accident left a pain in the region of the hip which appeared after activity and was relieved by rest. Mrs X was happy to leave her bed and resumed her normal active lifestyle, but she was somewhat limited by the unexplained pain in the hip. Being used to activity and social events she did not let the minor issue of pains in her hip get in the way of her lifestyle. She continued with her normal routine and rested to relive her hip pain occasionally.
Being a strong-minded person, she continued her normal activities. However, her marriage and the birth of her kids placed additional responsibilities on her. A large amount of time was now spent looking after her family. In addition, she also had a fulltime job which required travelling. The lifestyle which Mrs X led did not leave her with much time to pursue her hobbies and active social life. The sedentary job and hectic routine left her with very less time to look after her health. She gained weight and started having more intense and frequent pains in her hip.
Once during her routine chores, she suffered from a severe pain which radiated down her leg in the back as she had bent down to fetch something from the floor. A visit to the orthopaedic doctor confirmed this to be slipped disc. Taking the doctor’s advice she took bedrest, this did seem to relieve her symptoms. But a few years later Mrs X started to have unbearable pain in the back and hip which radiated down the leg.
This left her life disrupted as she was not able to meet the demands of long periods of sitting and travelling which was a feature of her job, and she eventually left her job. Leaving her job and not having an active social circle impacted wider health issues. Mrs X who was used to interact with various people, and cope up with professional demands was forced to spend time passively doing household chores, watching daily soaps etc. And the pains which she suffered made it impossible to do exercise. As Mrs X missed her active lifestyle and was not in favour of surgical treatment she sought a physiotherapy treatment for her problem.
1. A careful investigation of medical history is important to pinpoint the problem. In Mrs X’s case, it was her accident which caused the initial trouble. It is common for accidents which involve other parts of the body to affect the spine. It is thus advisable to seek help at an earlier stage than to let the problem increase. A carefully structured physiotherapeutic examination was used to estimate the impact of her previous accident and the recently acquired slipped disc.
2. The examination revealed latent problems from her previous accident were responsible for her present condition. To avoid further discomfort Mrs X was given pain management treatment in the form of electrotherapy and manual therapy. It was seen that the management of pain itself did help her resume most of the daily activities.
3. To guard against increased aggravation of pain Mrs X was taught some ways in which she could modify her routine activities so that there was maximum efficiency with minimum discomfort.
4. Mrs X was taught a set of exercises to further ease the symptoms of her condition. During the subsequent visits, it was made sure that she was doing the exercises correctly, and if any additional exercises were required were taught to her.
5. To make Mrs X comfortable with an active lifestyle and to regain confidence, she was provided with postural re-education and activity advice to help prevent further discomfort from pain.
At the end of the treatment Mrs X can resume most of the physical activities which she was used to before the onset of her slipped disc. She is now an independently functioning active individual who is satisfied with her treatment.