From Walker to Freedom: A Veteran Overcoming His Back Pain (Client Story)
How understanding back pain can make the solution so stupidly simple.
I want to begin sharing some examples from real life client interactions.
You may closely identify with the following example, or you may not. Regardless, my aim with sharing the following is to provide back pain sufferers with some hope that more than likely your symptoms and quality of life can improve substantially (and it's often not as complicated as it seems).
I recently received a referral for an older man, a veteran, with a history of lower back pain and decreasing leg strength who had begun using a walker to mobilise over longer distances.
If you are experienced in treating back pain, this referral tells you a lot. From this little piece of background, there is one diagnosis that stands out as the likely cause of this man's pain.
An older man with lower back pain that relies on a walker to mobilise longer distances more often than not has pain caused by stenosis (probably resulting from arthritic changes).
The assessment with this man further confirmed my suspicion. He was able to walk about 50 metres before back pain began to develop. If he continued to walk the pain would get worse. If he stopped and sat down the pain would resolve quite quickly and he could get up and walk another 50 metres. When he used a walker his capacity to walk longer distances was much improved. He also had some occasional radiating pain into his hips and thighs.
This is a classic stenosis presentation. And it stands out like a sore thumb to a therapist who is at least a little bit expertised in treating back pain.
He had a relatively recent MRI report with him, with quite typical changes for a man his age. Nothing that would stand out as a particularly remarkable or of major concern. One finding that was relevant to me was the bilateral foraminal narrowing at L5-S1. This stood out as the likely cause of his pain, as it was a perfect match for his symptoms.
The unfortunate thing about this story is that this man, like many other back pain sufferers, had all but given up on improving his back pain. His main concern was that his legs were getting weaker now that he was relying on the walker to get around, and he wanted help to stay strong and functional so he doesn't struggle to get out of chairs and is able to get up and down from the floor.
The reason he had given up on his back pain is because no one had given him any indication that they understood what was causing his pain or provided treatment to him of any value.
He had seen previous PT's who simply performed some manual therapy (he described massage), which may have felt nice at the time, only for him to walk out the door and be back in the same pain by the time he reached the car.
This PT had no idea what was causing this man's pain and unfortunately probably didn't even bother to try and understand it.
I want to share how stupidly simple it was to make a meaningful difference in this man's life, simply by having an informed indication of what was causing his pain.
The first "treatment" I provided to this man, was simply to tell him to walk with a purpose.
A few additional cues so you understand what I mean by this:
"swing your arms from your shoulders"
"take longer strides"
"take faster steps"
"pick up the feet and lift your knees a little"
This very simply is just walking like you have someplace to be.
Guess what happened?
He walked 168 metres before his back started to hurt. He said he hadn't walked that far in years.
How ridiculous is that?! He just tripled the distance he has been limited to for years. And while 168 metres may not sound like a lot. This simple change makes an enormous difference to this man's life.
He can now go into the grocery store and buy some milk and bread without pain.
He can park the car down the road and walk to the café with his wife without pain.
He can engage in the community, in things outside his own home, without pain.
And he no longer needs to lug a walking frame around with him to do any of these things.
Now that he no longer relies on the walker as much, the declining leg strength he has been concerned about will start to improve again. This will stave off a decline in function that was hurdling him towards a fall in his own home, in which he wouldn't have had the strength to get himself back up. He will likely live a longer, happier and more functional life as a result of something so stupidly simple.
And the benefits of this to his condition are compounding. Walking alone for many with stenosis related pain is therapeutic. The more he walks in tolerable amounts, the more likely his pain will lessen and his capacity to walk even further distances will improve into the future.
I know many of you are perplexed by your pain, leaving you feeling hopeless about your chances of recovery.
What I often try to encourage in discussions with people online, is to find a therapist that makes it simple.
Back pain is complicated. Spines are complicated.
But if the therapist understands what is likely causing your pain and what should be done about it, it won't seem overly obtuse and complicated. They should answer your questions clearly and leave you confident in the actions they want you to take.
When you understand the cause of someone's back pain, the solution is often far more simple than you would think.