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Low Back Pain That Wasn't

I understand filling out paperwork can be a complete pain in the ass. Rarely do people want to take the time to provide a complete history, even when they have the ability to fill it out on their phone while watching old reruns of King of Queens. Unfortunately, the Devil lies in the details and the details matter quite a bit.

Recently I had a runner appear at my office that has had multiple people evaluate him with several months of treatment. Reading through his history, there was a preexisting injury that seemed almost impossible to have been overlooked because it was so obvious it COULD be related to the current complaint.

When he was in the office, he talked about how he had multiple ankle sprains over the last several months and he taped the ankle to help improve the healing.

As the runner stated - the ankle no longer bothered him but his low back became painful about six months later.

Me: “Has anyone looked at your ankle?”

Patient: “No, it doesn’t hurt.”

Me: “What about your hip?”

Patient: “No, we did some xrays on my low back but they didn’t see anything”

Turns out no one had taken the time to evaluation his hip and ankle. He also never thought to bring it up to the doctors. We compared the motion between ankles and hips - no surprise there was a significant difference in motion between the two sides. We spent about 20 minutes performing Active Release Techniques to mobilize the ankle and hip. He performed stability exercises to reinforce the new movement patterns. The low back pain decreased significantly with minimal time spent.

When we steal movement from a highly mobile joint, like an ankle, we will find a new way to move. These new movement patterns can overload other joints and cause pain. This patient’s low back pain was essentially caused by his past ankle sprains. The hip stopped moving because the ankle would not allow hip extension and his low back picked up the slack.

Taking a thorough history and performing a proper exam should be the basis of every patient visit. I would rather spend and extra 30-60 minutes to perform a proper evaluation than throwing a few months of treatment hoping for the best.

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