A conversation about persistent low back pain

Here we have another patient story that I'm very happy to share. I started working with our patient, a male in his early 40's, six months ago. We worked together for three months, at a frequency of one session per week. We hadn't chatted in a while with COVID-19 and our clinic shut down. I was ecstatic to hear from him this week to say that he was feeling nearly 100%, and has been going entire days without thinking about his back pain while keeping up with his daily home exercise plan.

What stands out very clearly to me when I think back to our initial assessment is how nervous he was. He had a few prior rehab experiences that involved a lot of pain and muscle spasms, and he told me early on that he was afraid of how much physiotherapy was going to hurt. We spent a lot of our session focusing on pain education and how his previous experiences may be influencing his current pain levels.

While we worked heavily on home exercise during our time together, we spent just as much time on the psychological side of pain. It took some time, but once we started to break down some barriers, we began to better understand his pain from a bigger picture than his radiological findings. I asked him to shine a bit of light on what that experience was like from his perspective:

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Can you tell us a bit about your injury journey before starting physiotherapy? For seven months I had off and on debilitating back pain, which also carried down my left leg. During flare ups, I could only stand or sit for 30 minutes at a time. This all followed after an acute episode of severe muscle spasms in my lower back that had me in bed unable to get up, for 4 entire days. This ended with a trip to emergency room for pain killers and a CT scan.  The diagnosis was a bulging disk in my lower spine.  

What were your expectations heading into your initial assessment? I knew it was going to be a journey to repair my back and sciatica. Every attempt to self rehabilitate was met with eventual setback and severe pain.  That's was when I realized I needed professional help and guidance.  I was looking for the best method to safely undo the damage done, and learn the tools to prevent this from happening again.

What was the most important thing you learned during the course of your rehabilitation?  That chronic pain after a certain period can be as much a mental condition as it is physical.  I had to work on my attitude and perception of the pain as much as the physical rehabilitation. After being in pain for so long, my focus on the pain was more to do with the mental aspect of that pain, than the actual spinal injury. 

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His answer to the last question is huge. It's the main reason we've made our progress and that he no longer has to see me. By acting as a facilitator rather than a fixer, I was able to help him to find his own solution. It was tough, but it was extremely rewarding. I hope to reach that level of understanding with each and every one of my patients.

#patientperspective