In treating patients with low back pain, it is not uncommon for me to have them come in with a very well researched, self-made diagnosis. We can thank Google for so much of the information we have at our finger tips today. It is so easy to look up what WebMD or Mayo Clinic says about our condition.
I am going to tell you now that there is no substitute for a skilled medical provider. Physical therapists have a huge asset on our side, TIME. We have time to sit down and let you tell us your story. The reason I say this is because there are clear things that come from the history section of the examination that will point to a more serious condition that may be masking itself as low back pain.
“Dr. Murphy, I am convinced that my low back pain is from a spinal tumor, can you please tell me I am wrong?”
I am now going to go into discussing the possible more serious pathologies that could be related to low back pain. This article is meant to ease your mind about the slim chance of you having one of these more serious issues.
”Brian, how do you know whether I have something more serious? I am convinced that I have cancer!” Some of the things we do include administering a questionnaire about your general health. It could ask questions about your 24 hour pain patterns, previous history of cancer, when you saw your primary care physician last, signs of tingling and numbness, coordination problems and history of any recent trauma. All of these questions clue us into then asking further questions to determine if your pain is of mechanical nature. What I mean by that is basically are you appropriate for physical therapy care because we are mechanical/movement specialists.
The first condition I will discuss is cancer. Spinal cancers are rare and can be picked up quite easily on plain film X rays. If you have not had an X ray performed before you come in to see us we will ask questions about your age, previous history of cancer, any recent weight loss, your pain patterns (what makes it better, worse, 24 hour response). Quite often pain stemming from cancer is constant, there is nothing you can do to make it go away, it will wake you up at night and keep you up for hours.
The next condition that I will discuss is a stress fracture or spinal fracture. There are some clear indicators that this may be a possibility when a patient comes into our clinic. This patient is typically a 50+ year old female, who has a recent history of a fall or motor vehicle accident, she has pain and tenderness in her back and she may have been using corticosteroids. With Arkansas being a direct access state, we may see this patient before they had films in the ER or at their doctors office. In this case, we would refer them out to get X rays of their back to rule out this condition.
The final condition I will discuss today is called Cauda Equina Syndrome. This condition stems from the nerves that come out of your low back. This condition can cause serious damage to those nerves which can be a problem because those nerves give energy to your bowel and bladder! Once again, the history here is critical. One of the hallmark symptoms of this condition is bowel and bladder changes. We ask the patient if they have had issues initiating or voiding their bladder. The patient feels that they did not expel all of their urine. The patient often has saddle paresthesia, tingling and numbness around your anus and genital area. Another thing we do as physical therapists is perform a thorough neurological examination. The nerves that come from your low back give strength to key muscles in your lower legs, it gives sensation to the skin and it also controls your knee jerk and achilles reflexes. We will test all of these things to see if everything is working smoothly. We of course do not want to see a decline in any of the functions of these structures.
In the state of Arkansas you can see your physical therapist directly without seeing a physician first. We are very skilled Doctors with advanced training in neuromusculoskeletal pain and should be at the forefront of your mind when determining who to see concerning your pain and limitations.
At Pinnacle PT, I offer a free 20 minute discovery visit either in my office or over the phone. I listen to your story and ask you relevant questions to see if you are appropriate for my care. I also make appropriate referrals to medical providers I trust in the community if you need to be seen by a physician for something that I am not able to treat. All too often we just ignore our pain because we are scared and think that it is just going to go away. Don’t let your pain get any worse, because often that will lead to compensation and development of pain in other areas and a further decline in your function.