My journey with low back pain started, ironically, when I was in physical therapy school. I was 23 years old. That’s right, 23 and in the process of going to school to learn how to treat people with the very condition I was suffering from! Contrary to popular belief, back pain is not an aging problem. It’s actually most common between the ages of 20-40, but can happen at any age. Like most people, I did not have a specific incident where I can remember injuring my back. Although the years have blurred my memory a bit, from what I can recall, my symptoms started as right sided flank pain. I remember initially being worried that something was wrong with my right kidney. I had no reason to think this other than the location of my symptoms was my right flank area at the level of my kidney. Ongoing pain brought me in to see a family medicine physician where labs and X-rays were ordered and, not surprisingly, they were all normal, except for a few small kidney stones on the opposite side of my pain (asymptomatic incidental findings). Having no answers and no referral to a musculoskeletal specialist, the doctor ordered a CT scan of my entire trunk area. I can still remember sitting in the waiting room, full of anxiety, drinking my white, chalky, orange flavored liquid (contrast) convinced I had kidney cancer. It’s amazing how we can start self-diagnosing all sorts of horrible things with ourselves when no one has an answer to why we have pain. Thanks Dr. Google! Not surprisingly, the CT scan came back normal. Whew, what a relief! I was then referred to a urologist who did a bladder scan to make sure my bladder was emptying properly and to do a general exam to rule out any sort of urinary/kidney involvement. The exam and bladder scan were both normal. So there I was, down a rabbit hole of imaging studies, a referral to a urologist and no answers as to why I was in pain. Again, no recommendations to see a physical therapist to perform a musculoskeletal exam given all other tests and labs were normal.
Have you ever found yourself in a similar spot? You’ve seen a dozen medical specialists. You’ve had a handful of imaging studies and still no answer as to why you are in pain? As I look back now, after being a practicing physical therapist for 13 years, I think part of the reason my medical treatment went down a “rabbit hole” is that I had an ABSENCE of low back pain or any symptoms down into my lower extremity. After treating back pain for many years, I now know there is a high percentage of patients who are suffering from low back related symptoms with buttock pain only, thigh pain only, calf pain only, and in my case, flank pain only. The absence of symptoms in a certain area does not mean symptoms may not be originating from there. My story is also a great example of the cautionary approach we should take when using imaging to diagnose musculoskeletal pain. Now, in cases of trauma or if there is a suspicion of “red flag” conditions such as fractures, spinal infection or malignancy, imaging studies are and should be the first line of defense. However, when imaging studies are performed prior to a thorough musculoskeletal exam, they can lead you down a “rabbit hole” of findings and unnecessary treatments for things that may not be causing your problem in the first place. The research is very clear about the high percentage of false positives found on imaging studies for musculoskeletal pain, back pain in particular. (we’ll save this topic for a future blog.
So what did I do? I continued to remain active and, with time, my symptoms slowly went away. It didn’t occur to me until I experienced re-occuring symptoms over the years that this first episode was, in fact, originating from my low back area. Stay tuned for “Part 2” of my story where I will talk about how I have managed my symptoms over the years so I can live my best life!
