Case study
45yo Male, hurt back over a period of time, building up, no apparent mechanism. Intermittent lumbar spine pain with radicular symptoms down left leg to the thigh. Worse with sitting and lifting/bending, better with rest. GP referred for steroid injection week 1 of injury with no effect. Moderate loss in all planes of motion for the lumbar spine. Repeated extension provided relief and some facet mobilisations helped ease pain on the initial visit. Was advised to continue with graded strengthening and extension bias exercises. Referral for Neurosurgeon from GP scheduled 3 months later.
2 months post initial injury, reporting pain free, returned to work full hours and duties, looking to be signed off after Neurosurgeon review. Neurosurgeon advises that patient requires surgery and on next visit (which initially was going to be discharge), the patient reports back pain same as initial injury.
This patient is an example of how health professionals can affect someone's perception of pain. This patient had no issues for about a month and returned to full duties at work and it was not until another professional advised that surgery was necessary (despite nil pain or symptoms) that pain increased again.
Caneiro, J. P., Bunzli, S., & O'Sullivan, P. (2021). Beliefs about the body and pain: the critical role in musculoskeletal pain management is a perfect paper demonstrating how communication is as valuable as the physical rehabilitation. In fact, the case study used in the paper is similar to our presented case.
Do not fall into the narrative of “If something hurts, it's for a reason, it is your body saying don’t do it” or “I believe in nuts and bolts; if something's worn out, you pull it out and put a new part in”. Explore options before choosing to go under the knife and give rehab a proper go.
Pain does not equal damage!
