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Back Pain/ The other end of the stethocope

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1 Back Pain/ The other end of the stethocope on Sat Nov 19, 2011 12:17 pm


My clinical experience today was very exciting. I had two patients who had gone through back surgery the previous day. One of my patients was a fifty year old male who had undergone back surgery in years past; two disc fusions with a rod and bolts. Another disc had herniated so upon the Dr’s decision the old repairs were taken out and replaced along with the newly diagnosed herniated disc. He had a hemovac placed into his back; I got to take it out upon his discharge. Due to the surgery he had impaired physical mobility and used the assistive devise of a walker; which worked well.


Research revealed that associations between pain, trunk muscle, strength, flexibility and disability in patients with lumbar disc herniation 2 months after surgery. Participants: 172 operated lumbar disc herniation patients. Back and leg pain on Visual Analogue Scale,
Oswestry Disability Index (aka: Oswestry Low Back Pain Disability Questionnaire) is an extremely important tool that researchers and disability evaluators use to measure a patient's permanent functional disability. Also Brief Depression Scale was applied to assess the subjectively perceived outcome. Isometric and dynamic strength of trunk muscles and mobility of the lumbar spine were measured to mirror physical impairment. Two months after the operation median leg pain had decreased by 87% and back pain by 81%, respectively. However, moderate or severe leg pain was still reported by 25% and back pain by 20% of the patients. Approximately 30% of the patients perceived moderate or severe disability measured by the Oswestry index. Decreased muscle strength and spine mobility caused functional disability, especially in older patients and patients with postoperative pain. Furthermore, the ratio of trunk extension/flexion strength had changed in the flexion muscles, being 0.98. Greater age and depression were associated with poorer postoperative recovery.

Conclusion: Pain, decreased trunk muscle strength and decreased mobility still remained in a considerable proportion of patients with lumbar disc herniation 2 months after surgery. Early identification of those patients with restrictions is essential in order to commence rehabilitation.

Key words: lumbar disc surgery, spine mobility, muscle strength, pain, disability. J Rehabil Med 2003; 35: 236–240
Correspondence address: Arja Ha¨kkinen, Department of
Physical Medicine and Rehabilitation, Jyva¨skyla¨ Central
Hospital, Keskussairaalantie 19, FIN - 40620, Jyvaskyla¨,
Finland. E-mail:
Submitted November 12, 2002; accepted March 20, 200Back and leg pain on Visual Analogue Scale,

“The Other End of the Stethoscope”
I know from personal experience how life can give and take away. I love reading or watching stories about hardships that one has overcome. In reading these first 8 chapters, I learned who Marc was and how he wanted to be treated; like the teenager that he was. This story reinforces the fact that we “the caregivers” have such an important role and responsibility to our patients. As he described it in the book, the caregivers are the parents and Marc is one of their children. As nurses we need to realize our patients are autonomous and deserve to be treated with respect and dignity. It also makes it crystal clear how important the works “I’m here” are. You are that person who provides comfort, strength, encouragement and dignity. I learned from the story that I should always be candid with my patients and realize that everything I say is probably being heard. I am excited about reading the rest of Marc's story.

Last edited by avasmorrison on Sat Nov 19, 2011 5:48 pm; edited 1 time in total


Ava, I guess we all need to understand and realize that what we say and how we say it can be taken many ways by patients. Especially if they are not feeling well or are in pain. I know that when I don't feel well I can take things said differently than what they were intended to mean. Just like when we don't feel well we sometimes are not as patient as we should be with others. It's a big responsibility for us as nurses to remember that no matter how we feel, or if our day hasn't been that great that we always make sure it doesn't show in our actions or words. Also we need to remember that if the patient isn't as nice as we would like they most likely have a reason. I believe you can accomplish MUCH with kindness.


I wish I had known you were taking out that Hemovac! I would have loved to have seen it. That is one of the things I have yet to see. Let me know if you get to see or do anything cool on Tuesday. Good job!

4 stethoscope... on Mon Nov 21, 2011 4:58 pm


You are right...we are seen as a parent to a patient, in a way, no matter what the age difference. We are the most accessible to them, not the doctor. So it is vital that we treat patients with the dignity and respect that we would wish to be treated with ourselves.


I can see how the relationship between a patient and caregiver are like a child and parent. As a caregiver or parent you get the good and the bad with a patient or child. You support, care for, and provide comfort to both and hope for the best.

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