When is low back pain not from the back?
Occasionally patients come along complaining of pain in the low back, with seemingly plausible physical examination findings who do not feel the benefit of treatment long term. They feel a couple of day’s relief from their pain which then returns.
Three possible reasons present themselves for this. Firstly their pain is chronic in nature and their muscles, tendons, ligaments and connective tissues have adapted over time to avoid the pain. Such long term discomfort takes time to unravel. Secondly the diagnosis is simply wrong! Thirdly the pain is referred pain, felt in the body away from the cause. The most well known example of this is Sciatica, where the inch thick Sciatic nerve is irritated as it emerges from the spine, where this irritation that is often caused by a combination of compression and inflammation. The nerve relays bogus nerve signals back into the spinal cord and up into the brain. This bad signal makes you feel that you have pain, typically lancing or stabbing in nature down the back of your thigh and lower leg.
Less known and therefore more difficult to diagnose is visecerosomatic pain, or pain from the organs that are not felt in the abdomen, but rather experienced as pain in the low, mid, upper back pain, shoulder pain, chest or groin pain to name a few. The physiological mechanism whereby pain from one of your kidneys is felt in your lower back has its beginnings when you were an embryo. Then as you grew and developed as an embryo, cells that were embryologically together later took on specialist roles and became separated from each other as they diversified. Now as a fully developed organism if your kidney is damaged, rather than feel the pain in the kidney, which has no pain sensitive nerve cells, you feel the pain into the low back, flank or groin.
How can physical therapists avoid misdiagnosing such referred pain? The correct taking of the case history will supply information about trauma, illness or symptoms of diseased organs. Kidney problems can give pain on urination, nausea, blood in the urine, tiredness and swollen ankles. This process is made further complex when symptoms overlap. Impaired kidney function can allow increased fluid retention and consequentially swollen ankles, that also occurs in right heart failure!
