I am one of those fortunate people who does not have lower back pain. Of course, over my lifetime I’ve had a few moments of lower back pain, more specifically, SI (sacroiliac joint) pain, which I was able to take care of quickly. The SI joint is located at the top of your buttocks where the sacrum and ilium (pelvic bone) come together.
Four years ago on a Monday, I headed out for a run. Much to my surprise, I noticed some left SI pain. Hmmm, I thought, how did that happen? I don’t remember straining myself the past few days. As the running didn’t make it worse, I continued my run.
On Tuesday, I noticed the pain increasing and lasting through the day.
By Wednesday night, the constant, dull, achy pain had begun to spread around my left hip into my lower abdomen, preventing me from sleeping, as I could not find a comfortable position to sleep in.
Thursday morning, I called my friend, Janet, to treat my back. Janet is an excellent physical therapist and we often swap treatments when needed. We can almost always make each other feel better, but not this time – the pain did not shift or change.
By Thursday evening, I told my husband that I needed to go to the ER.
My Emergency Room Experience
The pain was constant, I was not able to find any position to alleviate the pain, and most importantly the pain was not “reproducible”. Meaning, no specific movement or position made the pain worse or better.
We went to the emergency room and I told the staff that my pain was not reproducible so it was not musculoskeletal. They proceeded to work me up for a kidney stone. I had blood work, a CT scan and even an offer of morphine. I turned down the morphine but gladly accepted Vicodin. All the tests were negative, so at 2:30 a.m. the doctor said it must be musculoskeletal and sent me home. I was too wiped out to argue.
Over the next few days the pain became more manageable and I could even sleep.
The following Tuesday, 8 days after first experiencing the back pain, I scratched my back and felt a rash. I had shingles! Apparently, on rare occasions you can have pain before the shingles rash appears, making the ability to diagnose the symptoms difficult.
How is my story relevant to physical therapy?
I knew my pain was not coming from the musculoskeletal system (muscles, bones, ligaments, tendons, etc) because it was not reproducible, meaning there was nothing specific I could do to make the symptoms worse or better. If your pain isn’t reproducible, traditional physical therapy will not help and you should seek out medical care instead.** However, there are many issues that call for a visit to your physical therapist, as explained below.
When should you be evaluated by a physical therapist?
If you have any of the following issues, it’s worth calling your physical therapist to get an appointment as soon as possible:
- Specific activities or movements cause pain (“reproducible”)
- Recent surgery of any joint: shoulder, hip, knee, ankle, foot
- Balance issues
- A recent fall
- A recent injury such as an ankle or knee sprain
- Shoulder or elbow pain when reaching, dressing, washing, sleeping
- Back or neck pain
- Inability to sleep because of pain
- Abdominal pain that is “reproducible”
- Difficulty walking because of pain or balance
- Difficulty functioning because of pain
- Numbness or tingling in your legs or arms
- Pain after workout/exercise that persists for more than 3 days
A physical therapy evaluation will determine if your symptoms are reproducible and, if so, how physical therapy can help. We will ask you questions such as:
What movements cause you pain?
Does pain wake you up?
Which is worse – sitting or standing?
Do specific activities make your pain worse such as doing your hair? Putting dishes away? Squatting? Rolling over in bed?
What is the biggest mistake people make when they are in pain?
The biggest mistake you can make is to ignore your pain, or think you can just rest and it will go away. While a short period of rest may be appropriate, ignoring the pain is often a recipe for pain to become chronic, more difficult to treat, and you may develop other issues while compensating for the original issue.
If you’re experiencing any of the issues described above, we’d be happy to evaluate you and provide you with a personalized physical therapy plan. Give us a call anytime!
** For shingles, I have found non-traditional therapies, such as acupuncture or Integrative Manual Therapy, can be a helpful addition to your medical management.