BLOG: Do You Feel Lucky Today...Well, Do Ya?

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Do You Feel Lucky Today? Well, Do Ya?

You might recall that famous phrase from a Clint Eastwood movie.  I recently had a patient who made me think of that well-remembered saying.  Let me tell you a little about his story.

A number of weeks ago I saw this very nice but distressed gentleman, let's call him Bob.  Bob owned his own business and he was the primary worker...if he wasn't working then he wasn't earning money to pay the bills.  That's a ton of responsibility and a definite source of stress when an injury rears its ugly head and tips over the cart of normal life.  He came in to me with back pain, a shifted trunk (his shoulders were sitting maybe 4-6" shifted off to the left), and significant weakness in one of his legs.  It was a pretty classic presentation for a lumbar disc problem. 

Bob did extremely well with his treatments, even having some relief during the evaluation itself.  He came in two more times and each time had progressively more relief.  We were both excited and encouraged by his terrific improvements.  Bob was doing his home exercise movements like clockwork and he was doing a super job of avoiding the bending type of movements that brought on his pain originally.  But, he did still have that weakness in his foot/ankle (indicative of a nerve root being compromised, most likely by compression from an angry disc). 

As Bob's symptoms improved over those first three visits, it became obvious that his work duties, which required lots of repetitive bending over and some lifting for hours and hours each day, were very likely a huge contributing factor to the back pain and leg weakness that he'd developed.  Short of being hit by a car or falling down the stairs, very often these sorts of "injuries" are not new and sudden-onset problems, though they might feel like they "just started two weeks ago out of the blue." Really they are just the exact opposite.  More likely they're the proverbial "straw that broke the camel's back" scenario. 

Think about it. Day after day, Bob is bending over - his back rounded over, not using his hips very effectively due to tight hamstrings...not able to engage his gluteal (that's BUTT for us simpler folk) and hamstring (back of thigh) muscles very well because the low back has been constantly called to cheat for the hips all those years...a weak core in general, not able to support the spine well.  Remember, we're not talking about bending over wrong just a few times here.  We're talking years and years.  Think of literally thousands of times - that spine bending over to do his job.  You can just imagine the spine and its discs looking down at the hips saying, "Why don't you guys help us out a little - you're killing us up here!"

Well, here's the seemingly good news - Bob is feeling super!  He never even came for his fourth visit.  He called and cancelled because he had no pain.  At his third visit his foot/ankle strength had improved to "only" a 20% deficit, a nice improvement in a short time but still an obvious sign of nerve injury.  But - he had no pain so he felt like he was good to go. 

I am glad that Bob’s symptoms went away, but the concern I share with all of you when you are in Physical Therapy is the same as I shared with Bob that day. Lack of Pain does not equal the presence of function. Pain is only one symptom. To you it seems like the worse symptom possible, but not to us. Bob didn’t allow us to take the time to address the weakness, the poor body mechanics, the loss of nerve function (a huge problem even if no pain), or his repeated forward bending stress. In other words, “probable suspects!”

Bob banked on the fact that when his pain was gone...he was cured! There is more to this story.  Tune in next week and we will see if Bob really was lucky.