Cautionary tales in sports rehabilitation medicine-Case 1
When Low Back Pain is not quite Low Back Pain
A 39 yo RAAF member was referred with low back pain of gradually increasing severity. The pain apparently started after falling from a log in 2004, although he had experienced low back pain since 2000. Analgesic, NSAID medication, physiotherapy had no effect. Clinical examination and MRI of the Lumbosacral spine were unremarkable. The pain was worst in the early morning and the member had dry irritable eyes and constipation. Review of earlier plain
X-rays of the spine revealed fluffy, cystic changes of the upper sacro-iliac joints. A brief review of ankylosing
spondylitis and other seronegative arthropathies will be presented.
Moral: Most low back arises from discs, meninges or facets. A history of trauma may be incidental to the presenting pathology.
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