Mandy Knaap Physiotherapy

General information

MY PERSONAL EXPERIENCE WITH LOWER BACK PAIN
THE SHORT VERSION BY MANDY KNAAP

On 6th September 2014, I developed intense lower back pain without cause. Thinking it was a muscle spasm, I rested, alternating the rest with non-weight bearing exercises, used heat, took medication and had physio. After a few days I went back to work only to exacerbate the pain again. I repeated this regime 3 times, each time adding a few more rest days (1 ½ - 4 - 9 days). After these 3 episodes of rest and treatment my pain was under control and I could go back to work and treat my patients. My lower back was comfortable but I still had to stand and move carefully. I had an odd swelling across my lower back which I had never seen in any patient in 24 years as a physio. This should have sounded alarm bells, but of course it didn’t.

On the insistence of my Mom, colleagues and staff I went for an ultrasound (20 days after the pain and swelling had started).
The radiologist insisted on an MRI after the ultrasound which confirmed that I had an abscess around L3 level spreading into the muscles and between the L3 and L4 spinous processes. It was not a muscle spasm. I was advised to see a neurosurgeon immediately as he was not sure if the infection had spread into the bones.
After admission into hospital, the neurosurgeon said he would first try intravenous antibiotics.
Unfortunately the infection didn’t respond to the antibiotics and I ended up having surgery 6 days after admission. Luckily the surgery was uneventful. The infection was only in the muscles and soft tissue and it could be removed. I was sent home 3 days after surgery with copious antibiotics to continue taking for a further 2 weeks.
I went back to work about 18 days after my surgery. My condition continued to improve over the next 3 weeks but I had to be careful. 5 weeks after surgery I was virtually pain free. I only experienced a prickly sensation around the wound on extreme forward bending.
I was feeling like a normal human being again.

What I have learned from this whole experience:
As a patient who is a physio: (keeping in mind that even though my condition was actually an abscess it behaved the same as a muscle spasm)
- Just because I am a physio and generally pretty healthy doesn’t mean I will respond quicker, the more aggressive and the more regular the treatment is. I demanded deep, aggressive treatment more than twice a week. If I treat an acute lower back patient, I treat the patient lying on their side, usually with rotation type techniques first. These mobilising techniques don’t involve pushing directly on the painful spine area. I would do some local treatment on the joints and muscles, but gently, as the patient’s pain allows. But of course I insisted on deep local mobilising and deep soft tissue massage, thinking: “Oh, I’m tough and I want to get better quicker.” In hindsight though, maybe if we had been less aggressive, the pain may not have been aggravated and I may have taken longer to go for the MRI. Maybe by that time the infection may have spread to the bones.
-A lot of the things I advise patients to do didn’t work for me. E.g. sitting in the car with a lumbar roll at waist level was just too painful and uncomfortable for me. I had to support myself with one half and one full lumbar roll above and below the painful area. Normally the lumbar roll is placed at about waist level to maintain a good posture.
- Sometimes, even though you do all the right things (take meds, do active rest with gentle mobilisation exercises, apply heat, follow good lifting techniques and sitting postures) your body doesn’t always respond and you just have to rest. Even though I did rest it was not long enough so I actually ended up prolonging my own agony. Not very clever. Your body tells you how much and how long you need to rest. You have no control over how your body will respond to treatment. If you keep overdoing it, you only end up causing yourself more pain.

As a physio:
- Not everything you have been taught works on every patient, even if they have the same/similar conditions. You have to adapt your treatment and your advice.
- It is better not to self-diagnose. Even if you have all the knowledge and specialists even have access to special tests like MRI’s etc, we are not always able to diagnose 100% accurately 100% of the time. There are many variables.
- I do empathise with my patients and their pain when I see them in my treatment rooms for physio but I now have a new-found empathy for them from a practical side when they go home.

From a practical side:
-Having back pain is no fun. You have to adapt to so many things or just not do them at all. You can’t bend forward even to brush your teeth. Dressing your bottom half is a nightmare. You can’t put on underwear, pants, socks or shoes. You can’t dry your ankles and your feet. You can’t shave your legs or paint your toe nails.
Luckily I have a good balance so I could balance on one foot and pull my other foot up with my hands and dry each foot. You can also lean against the wall if your balance is poor.
-You can’t sit which also means you can’t drive.
-The heat of the water is great for relief for pain, but it is difficult to get in and out of the bath. Using a heat bag is very helpful.
-You have to stand and eat – if you are too sore to stand, you have to lay down and eat.
- You can’t carry heavy things. It is difficult to shop as you have to bend to put things into the trolley and lift your shopping bags into your boot.
-You can’t sit on the “lavatory”. I had to rest on the back of my left thigh and rest leaning backwards.
-Then you get other side effects like constipation (and this might happen from all the meds you take and from inactivity). Pushing increases your intra-abdominal pressure which increases your pain. So now you have to take laxatives – more pills !
- You can’t just turn over in bed. You move at a snail’s pace – the frustration! In the beginning when you are at your worst, you can’t even do things like stand and pack your kid’s lunch.
- I also can’t believe how many times you drop things. Does this seem to happen a lot more just because you can’t bend to pick things up or do we not notice how often we drop things when our backs are fine? I developed very strong thigh muscles as I had to use my legs to squat down to pick things up. This is the correct way to do it. I also have developed a better posture again as your back reminds you every time you flex or sit incorrectly.
-Luckily I have a good support structure but you also don’t want to impose on other people’s lives all the time.

Remember:
- Listen to your body.
- Don’t be a martyr.
- Ask for help and accept help.
- Do what you are told by your GP/physio and other medical professionals.
- If you are a medical professional don’t listen to yourself and don’t self diagnose – listen to other professionals. From a medical point of view you are not qualified to treat yourself. You only make half of the decisions properly.
- Sometimes it takes a while to find the correct diagnosis.
- If there are things your physio tells you and they don’t help, inform them. There are always alternatives. Different things work for different patients and different conditions.
- Sometimes you just have to be patient.

Practical tips:
- The buoyancy of a deep bath and the heat of the water relieves pain and muscle spasm, but only bath if you can get into and out of the bath on your own or if you have assistance.
- Use heat for the pain of muscle spasms. It gives great relief.
- Wear slip on shoes.
- Do active rest. This means: Lay down as much as possible in as pain free a position as you can (alternate your position between laying on your back and alternate sides). Alternate the laying down with non-weight bearing mobility exercises as prescribed by your physio.
- We have a good strong thigh muscles so use your legs when you pick up or lift things. Do not bend your back.
- If you need to bend forward - either bend your legs or lean onto something to support yourself.
- Ask your GP/pharmacist about medication if necessary (Ask for meds that won’t lead to constipation).
- Listen to your body. Do everything within limits of your pain.
- Ask for assistance when needed.
- Speak to your physio about anything and everything regarding your lower back pain. They can help.

LASTLY : APPRECIATE YOUR HEALTH