Lower Back Pain

A Paediatrician with Low Back Pain

Medical History

A 45 year old consultant paediatrician had a 4 week history of low back pain. Pain radiated to the left leg to knee level but no numbness or pins and needles was reported. There was no history of trauma or specific precipitating incident and he was generally well. Pain was worse after standing or sitting in one position for more than 15-20 minutes. No past history of back symptoms. He had seen his GP who prescribed tramadol and diclofenac for pain and gave fit note for 2 weeks stating maybe fit to return to work with adjustments. 

Work History

Full time paediatrician - clinics and ward work including SCBU. Undertakes procedures, e.g. lumbar punctures, central lines, resuscitation. On call rota 1 night a week and 1:7 weekends. Works over 2 sites.

Pain worse bending, standing on ward rounds, undertaking procedures, sitting in clinic. Also difficulty driving and travelling between sites.

Occupational Health Advice and Adjustments

Self referred to occupational health to access physiotherapy as no staff self referral scheme. After examination agreed no need for MRI at this stage. Referral for physiotherapy made.

Agreed he could undertake part time clinic work, some ward work and audit. Agreed would work 3 sessions in clinic/ward and 2 undertaking administrative duties on one site for 3 weeks.

A workstation risk assessment  was arranged and work was restricted to one area with appropriate adjustments. He was advised to alter position regularly and ensure beds were raised high enough when examining children.

He was considered to be unfit for interventional procedures for 4-6 wks, or SCBU work pending the response to physiotherapy.

Review

He had accessed private osteopathy twice weekly as did not feel in house physiotherapy was proactive enough. Had gained confidence that  this was mechanical low back pain and not an indicator of more serious pathology. Pain had resolved in leg and lessened in low back.

His workload was increased to 8 sessions over the next 3 weeks, but he did not work in SCBU or undertake procedures requiring long periods standing or bending.

After a further 3 weeks, the pain had almost resolved and he only required occasional paracetamol. He then resumed full duties. He continued to carry out the exercises on his low back.

Uncomplicated low back pain lasting for more than 6 weeks requires active therapeutic and workplace interventions to optimise recovery.