Tell me about any previous accidents, operations or illnesses, even if they seem irrelevant to your back pain.
This is one of my autopilot questions during a case history. The answer can be brief and fleeting (no, nothing) or absolutely huge (multiple surgeries, hospitalisations and ailments.) Even if it seems irrelevant. I need to include that bit, because people naturally assume that if they have come in with low back pain or neck pain, then surely that’s the only bit we’re looking at? If that back pain only started three days ago, why on earth do I need to know about having their appendix coming out ten years ago? I once had a patient insist that they had no surgeries to report. When they undressed I asked them what the massive scar down their chest was. A triple heart bypass performed two months earlier! Either my questioning wasn’t nearly clear enough (lesson learned) or this person had completely separated the front of their body from the back and deemed it unimportant to their current issue.
So why do we need to know? Why can’t we just look at the sore bit and focus there? The answer is a well coined phrase. The body is a whole and everything is connected. Let’s look at our rather extreme heart surgery example. To get at that heart for surgery meant going in through the breastbone and ribs and leaving them sprung open for a while. Those ribs are attached to the spine at the back which probably didn’t enjoy the unnatural position for all those hours. Muscles at the front of the chest would also have been disturbed and wrap around to the upper back and into the shoulders. While everything up high heals up, the low back is going to work extra hard to do what the upper body can’t. After surgery you tend to be much less mobile than usual while you recover. The spine doesn’t like sitting or lying around without much movement, so seizes up. By understanding what the whole body has been through we can piece together what the pained part has had to adapt to or compensate for.
Here are a few more examples;
That ankle sprain two years ago? For the 6-8 weeks you were recovering and limping your opposite hip took the strain. The ankle has convinced you that it is fully recovered and you’ve kind of forgotten about it but your hip tension has spread to your back and became chronic. Yes, we’re going to treat those bits but, you guessed it, we’re going to be revisiting that ankle too. Is it really, totally better? Or is it skiving off in rigid lockdown while your back does all the work and falls apart?
The awful bout of bronchitis you had last winter? All that coughing for weeks has maybe wrenched your ribs. The muscles in your low back which assist with breathing had to really step up their game too. So, did the ones in your neck. So much so that those muscles in your neck got really tight and started to pinch on the nerves that run from your neck down your arm. Now you have pain and tingling in your hand. Maybe your coughing and your nervy hand pain are connected.
All that dental work you had a few weeks back? Lying with your head tipped back and mouth wide open for long stretches possibly compressed your upper neck which never quite resolved. One end of the spinal chain tends to react to whatever the other end is doing or not doing. So maybe your inexplicable low back pain is secondary to your upper neck compression which happened during your dental work.
Maybe. These conclusions aren’t definite by any means. Maybe something entirely different is causing the low back pain and the dental work is irrelevant. Maybe there’s another reason your arm nerves are pinched, and your body got through bronchitis just fine. But they are big clues and the more information we have the more we can narrow down your unique presentation and get to the best treatment plan quickly. Otherwise we are just going to be rubbing the sore bit for a while and hoping for the best!
If you are reading this, thinking of all the things your body has been through over the years and feel it could do with some TLC then do get in touch. Nothing is irrelevant when it comes to your health!