MONKEYING AROUND WITH BACK PAIN

It’s not uncommon for hard work to lead to pain.  But if you’re not careful, so too can pleasure.  

Supposedly, the most commonly injured joint in the human body is the sacroiliac joint – where the back of the pelvic bone hooks into the tailbone.  We have a right one and a left one.  It acts as the fulcrum point in the center of the body when bending, stooping and climbing.  So it gets a lot of action.  If you lift enough 40-pound sacks of red mulch you can throw one out.  Take it from a singular voice of experience – loading and unloading 15 of them will almost guarantee it.  Mine is out as I pen these lines.  Also, with respect to age, the number of sacks required to throw it out is, I would think, indirectly proportional to the age of the one doing the lifting.

This is the same joint that anthropologists tell us is the reason we
should’ve stayed in the trees --  as in monkeys.  Purportedly, there was an advantage to survival, if you’re a monkey on four legs, in being able to stand up on your hind legs.  Those monkeys that were able to stand and run on their hind legs were also able to run from danger while holding their food, as well as being able to wield weapons while fighting.  A distinct advantage.  So here we
are today, able to lift and roll sacks of mulch with both hands on the wheelbarrow, or walk while carrying our bag of groceries, or if you prefer, stand erect while wielding an AK-47 assault rifle.

Anyway, aside from the lifting, other things like repetitive bending, a twisting motion of the back, or a combination of these can strain the sacroiliac.  Probably not a week goes by that as a physician I don’t see at least one, and usually more than one, patient with a sacroiliac injury, also known as an acute sacroiliac syndrome.

My most memorable and interesting case involving a sacroiliac injury occurred many years ago.  A recently married 32 year old nurse presented with a three-day history of quite severe back pain which she claimed was the result of simply getting out of bed.   According to her, there was no injury, no impact, no bending or lifting.  Supposedly, it started on its own.  Just out of the blue. 
She was unable to comfortably do her work as a nurse, assuming a shuffling gait with shortened strides to minimize pain.  Her exam was remarkable for limited back bending, pain with changing positions, the shuffling gait, and exquisite palpable pain over the right sacroiliac joint.  She failed to respond to any treatment or physical therapy.  Finally, we ordered an x-ray, then an MRI, both
of which was normal.  At her fourth visit I confessed to her that I had never seen anything like this where an SI injury caused such prolonged pain for no reason other than the innocent activity of getting out of bed.  It just didn’t make sense and I guess I sort of belabored the point.

I belabored it enough, I guess, that it caused her to feel guilty over my being so flummoxed.  The conversation paused. She looked to the floor, sighed, turned and said in a slow Southern drawl, “Well, Doc….let me tell you what happened.”  As her face began to turn red, she said, “One night my husband and I were in the shower together and…well, one thing led to another and the next thing you know we both lost our balance and before you know it we were suddenly on the shower floor.  We both fell pretty hard, bending the shower head in the process.  My husband has the same problem.”  The severity and duration of the injury now made sense.  The harder and further a fall, the longer it takes, in
general, to heal.  I asked, “Did either of you lose consciousness or get knocked-out?”  “No, but we damn sure were in pain.  And, to be honest with you, at the time the pain I guess would’ve felt a lot worse if we both hadn’t been laughing so damn hard!” 

Well, she eventually healed.  The stories associated with the physical injuries are almost just as varied as the people who get them.

If any guys reading this are getting notions of – well, monkeying around – I would strongly suggest you consider employing a safety harness.  If you happen to be a fairly big boy then you may want to consider an industrial-strength harness – the kind used for bungee jumping.  On the other hand, you might want to prefer the more nobler and safer, albeit less exhilarating, method of making your wife happy.  Like helping her out in the yard -- maybe even hauling some sacks of mulch around (yeah, right).  This way, if there’s any monkeying around, it won’t result in mutual misery.