MISDIAGNOSIS OF BACK PAIN
Back pain is often misdiagnosed & left untreated
The human body is full of surprises, including the way we experience and perceive pain, especially when it comes to back pain. When we feel pain in our back, it can be incredibly misleading. It can mimic other symptoms and even show up in other parts of the body. As a physiotherapist, I’ve learnt to never make assumptions about back pain because we can only truly understand what is happening following a proper assessment.
Some most surprising back pain misdiagnoses that I have seen include:
1. Back pain in the leg – referred pain:
I treated a patient with debilitating pain in his calf. This was preventing him from playing soccer with his kids and the pain became so bad he could barely walk. This patient hobbled into the Elite Akademy clinic. Surprisingly, his calf pain had nothing to do with his calf at all. The true pain source was his upper back – a classic ‘referred pain’ example. By treating the upper back, the patient was soon walking freely and playing soccer again. No more pain. But if we hadn’t identified the underlying back problem, this pain may have easily caused long-term issues.
Referred pain is common.
Think of it as a signal by the brain that something is not working properly in the body, much like the red engine dashboard light in a car suggests something is wrong with the engine. So, when the engine light comes on, we don’t know exactly what is wrong and need a mechanic to examine and identify the problem. It’s the same with the back. My physio team find people are experiencing pain beyond where the actual problem lies, about 75% of the time.
2. Glandular fever:
More than once we have treated patients with aches and pains, including back pain, which ended up being glandular fever. It is not something we see a lot, but because the immune system is working under duress with glandular fever, it often shows up as aches and pains before the patient even knows they are suffering the condition.
3. Psoriasis:
It’s hard to believe a skin condition such as psoriasis may lead to back pain, but around 30% of psoriasis sufferers develop something called psoriatic arthritis, which will manifest as back pain in some cases.
4. ‘Ghost’ sciatica:
It is easy to recognise sciatica’s shooting ‘nerve-like’ pain, which emanates from the back and courses down the leg. Surprisingly, nine times out of 10, sciatica is not the issue. Many problems masquerade as sciatica, including lower back biomechanical issues, hip pain and even knee issues. None will improve while you wrongly mistake these complications for sciatica.
5. Lyme disease:
This infectious disease usually occurs when someone is bitten by a tick. Lyme disease has many nasty symptoms including aches and sore
Properly diagnosing these ailments can relieve sufferers from pain.
joints. But sometimes Lyme disease presents as radicular back pain.
6. Disc bulges
– almost never the problem: A slipped or bulging disc is probably the most common selfdiagnosis that we see at the clinic. Surprisingly, most people, around seven out of 10, if put under an MRI, would show some kind of disc issue. Disc bulges are common yet don’t necessarily cause pain or discomfort. They merely show that our bodies aren’t perfect. With proper analysis we often find what feels like a slipped or bulging disc is something completely different, such as gluteal tightness, nerve spasms, lower spine joint tightness or even stress.
7. Stress fractures:
As with a slipped disc, people are quick to blame their back pain on stress fractures. Unfortunately, people tend to hang onto this misdiagnosis for a long time, because it is assumed stress fractures take a long time to heal. They do, but stress fractures commonly impact sports people and those performing physical manual labour. Yet while people are convinced, they have stress fractures, under closer examination many of them are suffering from persistent shoulder pain, knee problems or neck pain.
Kusal Goonewardena
is an experienced physiotherapist, lecturer, consultant and mentor to thousands of physiotherapy students around the world. Kusal has authored books including: Low Back Pain – 30 Days to Pain Free; 3 Minute Workouts; and co-authored Natural Healing: Quiet and Calm. Kusal consults via his clinic, Elite Akademy.