An 17 year old boy presented to the Pain Clinic with acute onset lower back pain. This started after he picked up a very heavy bag without having his spine straight or bending his legs. In his own words his ‘back went’ and he dropped the bag. He sat down and was unable to move properly for the rest of the day. He was then in significant pain in the lower back for the next few days. Four months later, when he presented to the Pain Clinic, he still had pain which he described as sharp and which could occasionally go on for the entire day. The pain did not radiate and was very localised. It was aggravated by movement and relieved by lying down. He started taking Ibuprofen tablets as required, which gave him some relief. Of note, he had previously had multiple minor injuries to his spine including football injuries and falling off his bicycle. However, none of these had been as severe as this current episode.
On examination, it was noted that flexion, extension and lateral movements of the spine were all completely normal. However, on palpation of the T12/ L1 facet joint there was extreme tenderness, on the right more than the left, on deep manual palpation. The pain was interfering with his activities of daily living. In particular, he was distressed that he was unable to do his football training as he was keen on pursuing a career as a professional football player. He did not feel that the Ibuprofen was greatly helpful and he had had some benefit from Shiatsu.He was also seen by a Physiotherapy colleague in the Pain Clinic who suggested it was likely that he had undergone a recent period of fast growth and had an overdevelopment of his rectae spinae muscles and that he hinged greatly at the thoracolumbar junction. This was most likely because of an imbalance between the development of his skeletal muscles, in particular, he had an underdevelopment of his core muscles. He was given a course of six acupuncture sessions in which he had needles put over the tender facet joints, paravertebral needles, mid-line needles and some regional Acupuncture points. On the sixth session, it was difficult to elicit the previous area of tenderness and the patient felt that the pain had completely resolved. He was then sent to a local Sports Physiotherapist who, with the help of a local fitness instructor, gave him professional guidance as to the form and types of exercise he should undertake in order to strengthen his back and avoid similar injuries in the future. We found it important to take an aggressive approach to his pain management and rehabilitation as at the level of the professional athlete, if even small injuries are not dealt with rapidly, they can potentially lead to damage to future careers.