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There is geometrical increase in our young men suffering from back pain which unwittingly has caused them so much discomfort and distress while studying. This somewhat has affected their class scores remarkably. Pain in the back can be so disabling and discomforting. To students who are in schools, they may not understand the cause of the pain and weakness they experience as they sit to study. Iam a practicing physiotherapist. Physiotherapists are responsible for the non-surgical, non- invasive treatments of conditions that involve the muscles, nerves and joints of the body. We do not perform surgery. Patients either walk up to us or are often referred to us for consideration of rehabilitation procedures when appropriate by physicians.
In the course of treating many patients over the years, I have come upon many instances in which a patient had received unnecessary surgery for conditions that could have either been diagnosed and treated skillfully by physiotherapist or treated without surgery.
It is unfortunately too frequent that we diagnose spondylitis after a patient has already undergone a surgical procedure of the low back.
Spondylitis is one of the most common arthritis conditions that involves the spine, especially in young adults. Spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints. The sacroiliac joints are located in the low back where the sacrum (the bone directly above the tailbone) meets the iliac bones (bones on either side of the upper buttocks). Chronic inflammation in these areas causes pain and stiffness in and around the spine. The tendency to develop ankylosing spondylitis is genetically inherited from the parents and not related to activity.
Back pain in adolescents and young adults is commonly attributed to injury resulting from athletic activities. Why? Because this is the time of life when humans typically are most involved with sports. The fact is, however, that it is very possible that the two events can be true and not related.
A 16 year old boy presented to the emergency department of a highly reputable hospital in Victoria Island (VI), Lagos where I consult as a musculo-skeletal physiotherapist, with a four week history of back pain in the left lower lumbar region. The pain came on suddenly while he was bending over and persisted as a dull ache. The pain was associated with him waking up at night feeling sweaty and feverish. His general practitioner had suspected a urinary tract infection after a urine dipstick tested positive for blood and protein. A course of treatment was started on him but did not improve his symptoms. He presented to the emergency department with difficulty bearing weight on his left leg. He kept his left hip and knee flexed at 45° when lying supine. Systems review was unremarkable. The only positive finding on examination was tenderness over the left paraspinal region at the level of L4-L5, with no associated skin changes.
Reviewing his hospital folder, he had a heart rate of 70 beats/min, respiratory rate of 14 breaths/min, blood pressure of 116/86 mm Hg, and temperature of 36.9ºC. Blood (++) and protein (+) were seen on urinalysis, but no nitrites or leucocytes. Routine blood results were normal except for a C reactive protein >160 mg/L (normal range 0.0-5.0), neutrophils 8.4×109/L (2.0-7.5), and monocytes 1.48×109/L (0.2-1.0). Magnetic resonance imaging (MRI) was performed.
To cut the long story short, I was called to take over the management of the young man’s case. According to the physician, they have done their own side of the case medically. Rehabilitative therapy was performed on his back, thrice weekly for three weeks and his painful back was dramatically relieved. He could now sit properly and longer.
The optimal treatment of ankylosing spondylitis involves medications that reduce inflammation or suppress aspects of the immune that cause inflammation, physical therapy with emphasis on therapeutic exercise and adjuncts. Surgical procedures are not part of the basic management for this condition. Furthermore, the spondylitis condition can also affect the eyes, heart, lungs, and occasionally the kidneys. Therefore, it is particularly important that an accurate diagnosis is made as soon as possible.
“I did not know how I got this pain in the back. It crept into me in the year 2004 when I was reading for WAEC. The pain would come at my upper back the move to the side of my ribs giving me great discomfort. It would not allow me sit to read long and I would always stand even at the class room. In short, I always prefer to lie on the bed than sitting to read. This was the complaint of a young boy of 18yrs who found himself not able to sit on a chair too long in my consulting room. He was always uncomfortable each time he sits and would almost stand after few minutes. He has continuous pain on one side of his ribs and below the abdomen. The problem was that he had nerve compression in upper area of the thoracic spine which radiates to the side. He has obtained various type of treatment in orthodox health centres but to no avail. Through my column in the Sun news papers he located me Owerri where he was treated for 13 days with tremendous relief.
In the effective treatment of chronic back pain, skillfulness is the answer. Stubborn back pain wouldn’t shift grounds with anyhow therapy except some kind of dexterity approach.
Nevertheless, as a Corporate Social Responsibility, the Back Pain Care Foundation shall be partnering the Imo Broadcasting Service to conduct 2-day free intervention physiotherapy for sufferers of neck pain, mid-back pain and low back (waist) pain. The venue is Omega physiotherapy & back pain care clinic, #23 MCC/Uratta road, Owerri. Date is 27th & 28th, 9am-5pm.
