Lower back pain and Class 1 medicals

[Wild Weasel]

Hi guys,

I recently sustained a lower back injury in flight (in fast jets), and am grounded. Docs have been unable to pinpoint the cause of the pain so far, however the pain/ache happens during G onset, and I will probably be facing a reassignment due to this.

On the x-rays there seem to be no issue, and the pain doesn't come on in normal everyday life unless I bend backwards at a weird angle. I am still able to exercise/play sports with no issues with the back.

I'm just curious, will this be an issue if I apply for a civillian class 1 medical in the future (FAA/CAA/JAA or otherwise)?

[de facto]

I'm just curious, will this be an issue if I apply for a civillian class 1 medical in the future (FAA/CAA/JAA or otherwise)?

Unless you bend backwards at weired angles during you check:E
Seriously it shouldnt be a problem at all,however if your medical is suspended or revoked,you will need to mention it during the class 1 application.
I wouldnt worry.
Best is go to your local medical caa examiner and ask him/her.

[Radgirl]

I agree with de facto. Lumbar pain is very common and rarely an issue unless it prevents you doing your duties. Leaning back at funny angles might ring alarm bells if it is synonymous with leaning back for an overhead panel or leaning back to get a chart or tea tray.......

Not sure what species of doc you saw, but the definitive investigation is an MRI not an X ray. If a spinal surgeon cannot help after an MRI I would go see a chronic pain specialist. Your symptoms may warrant a standing MRI and may signify facet joint problems but this isn't an area for armchair diagnosis. So make sure you really can't be diagnosed or helped before putting up with your symptoms

[MaximumPete]

See a specialist, possibly one recommended by the CAA, and listen to what he tells you.

Take his/her advice to prevent any possibility of further damage. Prevention is a far better option to cure when it comes to backs.

[gingernut]

Wilde wee, I'm guessing you're young, don't medicalise anything.

[rumour mill]

Having injured my back in the RAF and having had 4 weeks of misdiagnosed physio. Resulting in the physioterrorist pushing on my later discovered pair of permeated discs once a day until tears came out. I would definately push for getting a MRI. Especially if the pain you experience radiates elsewhere. When my back hurt I got pain down one leg into my toes. Even when I suggested that the two pains (back and nerve pain in leg) were associated the RAF doctors insisted they weren't. Long story short- if I had gone to see a specialist who knew what they were talking about and got an MRI done I would have had the surgery I needed earlier and most likely wouldn't still have niggling pain some 5 years on.

Good luck getting it sorted! PS its never caused me any problems getting a class 1 and a civvie job

[BelfastChild]

Not sure that I agree that you should get an MRI. The majority of asymptomatic adults have abnormalities such as "disc bulges" on their MRI. Therefore, it is difficult attribute back pain to any particular abnormality on an MRI. Rarely, an MRI may demonstrate a stress fracture, or spondylolysis, but this should show up on the X-ray you had. An MRI is really only useful if you have pain referred to your legs. Even then, the abnormality, such as a disc prolapse, must correlate with your symptoms. For example, if the MRI shows that you have a disc prolapse compressing the right S1 nerve root, but the pain is in your left shin, then it ain't the cause. Unfortunately lumbar back pain is extremely common, and 80-90% of us experience an acute attack at some point in our lives. The important thing is rule rule out sinister causes, e.g. fracture, infection, cancer - that is what we all worry about, but it almost never is. Pain associated with these problems tend to be constant, unremitting, worse at night, perhaps associated with fever and weight loss. These are the so called red flags.
on a final note, I had acute back pain last year, and it is bloody awful. Good news is the majority of back pain settles spontaneously. Hope it gets better soon.

[Radgirl]

This thread is becoming a synopsis of spinal pathology - a large and rapidly changing area of medicine.

Most spinal pain does resolve spontaneously and indeed pure disc problems eventually settle as the disc dries out. However, in Germany where back pain is actively investigated with MRI and treated within days the number of sufferers returning to work is far far higher than in the UK where treatment is or has historically been conservative. Pilots have the additional problem of poor seating, cramped working conditions and long periods with dehydration. OP asked about the problems of long term pain and the advice was correct - get it investigated.

Personally I would always have an MRI. It is risk free and in the older person eliminates fractures and cancer. It allows early referral to a spinal surgeon who would not simply proceed to surgery for any abnormal finding. Indeed early local anaesthetic and steroid injections almost always are the way to go not surgery, but they terminate the acute pain and muscle spasm that so often results in long term absence from work

The red flags are loss of control urinating or incontinence and the same with bowels. These indicate the need for immediate referral.

[gingernut]

Always good to rule out the nasties such as fracture, cancer, TB and Cauda Equina. Red flags are of course key, I admitted a patient only recently who presented with saddle anaesthesia.

Interestingly our local spinal clinic does the decision making over the phone !

I take your point about the MRI Radgirl, I guess I'm coming from a different perspective, if I sent every patient who attends with back pain, (about 3-5 a day), then I'd probably flood the system. And even if the scan was negative, when would I then re-refer ? If they were in pain still in a month, a year etc. I'm not sure that the results always correlate to the symptoms.

I'm wondering if the German experience is more to do with work ethic rather than intervention ?

Guess the worse thing we could do is send them for a traditional x-ray :-) Can't remember the statistics exactly, but isn't a lumbar x-ray equivalent to about 80 chest x-rays ? And medical radiology (UK) sparks off about 200 cancers a year.

[BelfastChild]

Agree with you gingernut - if we did an MRI on everyone with back pain there would be mile-long queues out the door of every radiology practice!

[gingernut]

and we'd miss some cancers because of that.

[Radgirl]

Gosh Gingernut you see more new patients with back pain than a full time spinal surgeon!!!! I think you hit the nail on the head with the word ethic. My previous post was aimed at people with no previous symptoms who suddenly get lower back pain that prevents them working, and in many cases getting out of bed. Unless you are advertising in the local paper you shouldnt get this number.

Perhaps you are describing patients with a bit of an ache which is quite different, or may be they are after a sickie! I see that in your country the number of A and E attendances has tripled whereas in the rest of the developed world it has fallen by 20 - 30% (except the US where they still shoot each other).

Strange country. Also sorry to see my neighbouring country is struggling with MRIs. Surely we should provide the best level of care and not simply ration it? However, I suspect there is enough capacity to MRI all initial presentations with significant symptoms.

[Doc Savage]

The good news is that most back pain gets better within 4-6 weeks, and your symptoms sound relatively mild. Unless you have radiation of the pain or numbness into your buttocks or legs, it is not clear that an MRI is needed earlier than that.:cool:

[Specaircrew]

I had no trouble getting and renewing a Class 1 despite being A3G4Z1 , unfit bang seats, heavy lifting etc with a disc prolapse for the last 20 years!
Top tip, find a good osteopath or chiropractor as doctors can't 'cure' mechanical lower back pain and it's your posture that needs attention.

[Cruise Zombie]

http://www.naturaljointmobility.info/lowback.pdf

Not sure if this would fix the original poster's maybe rarer problem, but might help people who have the more common condition of lower back pain.

This talks about using exercises in a book called 'Treat your own back' by Robin Mckenzie to fix lower back problems.

After years of worsening pain I found the exercises in Mckenzie's book have removed all my pain.

Have a read, it might help!

I simply found out about the book by surfing the net and reading the reviews on amazon. And honestly it has fixed my problem and a couple of my friends.

P.S. My MRI scan showed two prolapsed discs before I started the exercises.

[Radgirl]

Thanks Cruise Zombie

Here is this little island we call it physiotherapy and offer it to our patients for free. Still, not a bad dissertation from an electrical engineer.

Glad you are better. Take care

[Cruise Zombie]

Thanks Radgirl, I take your point.

But I wonder why there seems to be so much back pain about. My GP never sent me to see a physiotherapist, preferring instead to throw pills at me which did nothing apart from giving me some unpleasant side-effects. Likewise my friends who benefitted from the exercises I mentioned were never sent to a physiotherapist by their GP and the few that did see a chiropractor had little joy. The excercises were a surprise to all the friends of mine that were helped, a surprise to my GP and, it would seem, a surprise to many people who left reviews on Amazon.

Maybe, given the large number of days off work due to back pain mentioned in the media, a study should be done to scientifically check on these exercises and how GP's approach the whole problem of back pain. Treatment may be different in different countries of course.

Although I'm free of pain, I don't know if my prolapsed discs are still prolapsed! They may be because if I stop doing the exercises (like I did one month) the pain gradually comes back.

[Radgirl]

Great points Cruise Zombie

I alluded to differences between countries in an earlier post. As has been said, this is often a self limiting condition as the disc dries out or dessicates. It shrivels up and no longer presses on the nerve root which is the cause of pain. My take on it is that if you have significant symptoms you have a risk of long term immobility which makes it difficult to return to work so treatment is needed. A bit of an ache for a couple of days can be left.

Injections of local anaesthetic and steroids is the most efffective way of terminating symptoms but physiotherapy which reduces the pressure on the nerve also works.

Yes your prolapse cant disappear so it is still there until the disc dessicates but can as you demonstrate be controlled

[Black Sheep One]

I realise this is quite a bit after 'the event', but for those of you interested who have lower back pain, a herniated disc, RSI, tendonitis etc, then take a look at Dr Sarno's work on Healing Back Pain.

I used to fly Fast Jets and soon after my last FJ tour I had surgery on 2 lower back discs around the L5 region. I really thought this would cure my pain, but sadly it did not. Years later (and after a re-herniation of one of the discs) I was once again in pain and was contemplating surgery once more. Doing my research I stumbled upon Dr Sarno's work and decided to read his book. Well, within a week my pain had subsided by 50%, and within a month I was pretty much pain-free. This is not a mind-over-matter issue, but it looks at what the actual cause of the pain is...essentially, a 'bulge' pressing on a nerve doesn't necessarily cause the pain. It does cause some numbness and tingling, but not the pain.

So, here I am another couple of years down the line and I have a very acute episode of sciatica that causes me to call an ambulance and go to emergency. I discharged myself after a few hours once the pain had subsided, and decided to re-visit the Sarno book, despite an MRI showing a massive herniation at the L5/S1 level. After a week, I see a spinal surgeon who is amazed at my recovery, and decides that as long as I'm not in pain there is no need for surgery. I'm now pain-free, off medication a month after the sciatica flared up, and only have some low-level weakness that I am working on with the help of Dr Sarno's methods.

Long story, but worth it if just one person takes a look at the book/Youtube videos/podcasts regarding Tension Myositis Syndrome (TMS). All of this is free online, and could help you get rid of that pain whilst awaiting your MRI...

Good luck!

[Drussjnr]

Do be careful though as it asks if you were medically discharged from the military on your UK CAA Medical form with details. But then again it's up to the AME discretion at that time. It may change by location though.

[Loose rivets]

A rather hurried and badly written note - firstly to spread the word about inflammation. In the OP's post the problem seems to have been caused at a specific time so the first part below is just for general knowledge.

Went through years of thinking most of my pain was spinal. I now seems that a lot of the 'ill feeling' in the L5 area may have been gluten related - despite not being Celiac. One local chap used to lie down on any bed he could use while working. (estate agent) Assumed a very bad back. When he was diagnosed with Celiac ALL back pain went away. My spinal surgeon showed me how close the downpipe is compared to the spine and said, if this is inflamed, of course you'll feel pain around here.

Soooooo frustrating, because so many times I've felt kind of ill when the back pain was at its worst. Now I don't cheat on the diet, and my life was largely transformed. Then I had surgery.

Back on thread.


Radgirl's first post is spot on. MUST know what's going on in there before pulling it around.

Mind you, where there's sudden excruciating pain as in the so-called 'Slipped Disc', a qualified person can put this back in a few moments - if you're lucky. What really happens is the facet joint(s) get locked on full travel - probably jammed by their own encapsulation. The pain comes from huge lock-up signals on major supporting muscles. They do that to save the spinal cord, and relaxing them is the first task. Once that's achieved one can usually get the 'adjustment' to go quite smoothly.


Recently, after 14 years of pestering, I had a [B][one night/B] stay in Ipswich. Got rid of some of the bulge and stuff in the way of the sciatic nerve where it passes through a keyhole.

I had gone from routinely lifting 200 lbs at 60 years old to self-imposed limit of 20. Any more, and I'd be off to my workbench and pressing up while pressing the edge into my tummy just above the nuts. I could feel the facet joints move and I could set about building restoration again for a few more minutes or even hours.

It's amazing what you can achieve by using fulcrums - even one's knee - and dragging stuff. I put three tonnes of tree out for the Texas council to collect. Wish they did that here.

All the time I was living this compromise, I was commuting between Essex and Texas, doing building work and chainsawing trees. The press-up thing and having the Rivetess walk on my back was just part of life. The double attack of Celiac diet and surgery has made a vast difference. My wife said recently, she hadn't seen me so active for years. Being a squeaky wheel, the first to get oil, is hard to do when living in two countries, but for people with normal lives, pestering and pestering is the only way to go. One surgeon at Colchester had his (skilled) chap go through all the tests but would not even see me. Pain control. In other words, writing me off at c 70 years old. Well, f:mad:k him. Compromise is not what I want to do.


One other thought. I've observed another local chap who routinely breaks up concrete as part of his job - all in middle age. He has two Wallis devises and prior to them being fitted, couldn't even stand for half an hours. Wallis devices are more or less shims, but keeping them in place is the hard bit. I don't know why we don't here more about them.

[RatherBeFlying]

Came across a neat book called Aging Backwards by Miranda Esmonde-White. My lower back threw one of its thankfully seldom snits over the holidays and it was quite the enterprise to get on my feet in the morning.

I got working on the posture stretches, recovered nicely in a few days and am continuing as the feeling of well being builds from the stretches.

The real trick is to maintain your musculoskeletal system. Prevention beats cure, but it's never too late to start.

[blue up]

Loose Rivets. Ditto, although I had to have the nasty spinal fusion a year prior to looking into the non-coeliac gluten intolerance. Slice of toast = wind/squirts/back pain. 10 times better on a gluten free diet although the mechanical aspects of the fusion have made flying near impossible. I had no coeliac-esque symptoms until after the 18 months on pain meds.

[Loose rivets]

Again, just for general interest.

I've been right about a few things medical, but this one escaped me totally. The half-dozen times I've just given up on a lovely day out due to back pain, I now realise the feeling has been one of illness rather than sharp mechanical issues.

I knew I'd got a fuzzed up mass of stalactites in me spine, so assumed it must all be down to that. Judo to a silly age probably didn't help. Building work that I didn't have to do kept me strong, but seemingly not fit. One day, nearing 60, I felt a pain down my leg. It was to change my life. Just a nuisance at first, but eventually back pain became tedious enough for my lovely girls to offer to carry my flight bad. Awwwww. :O The big one was I could no longer run. Amazing the psychological difference that makes.

Parallel with this was the allergies to wheat etc,. the soap reaction was to come later. A doctor I was chatting to yesterday was particularly well briefed on anaphylaxis. I know for the first time why I felt so horrifyingly ill - the cause, hospital soap. Thank God I'd finally retired before things got that bad.

The cause of becoming allergic to things seems to get worse with age (discounting adolescence) and while probably due to a breakdown of our 'systems' there might well be issues deep in the mind, kindled at a very young age. In my case I'm sure, due to over-thinking medical issues probably from the age of 6.

Parents. They need to be careful. One PPRuNer friend had healthy and adventurous parents. To this day it doesn't occur to him to think there might be some physical reason not to do whatever he wants to do. My Mom however, used to sit with relatives and they'd all discuss terrifying ailments. It's no wonder I'm so preoccupied with health issues.

She died aged 93 having taken medical books out of the library and correctly diagnosed her ailment. The doctor said, You don't need a doctor, do you? I'm calling an ambulance. It was her last ride.

Probably one of the most important things we can do is pass on healthy mind-set to the next generations, but that may not be as easy as one thought. Smoking is obviously the first issue, but the oddest things come out of the woodwork from time to time. Today it seems, good cholesterol might be a problem. In some cases, as it fights bad cholesterol, the long term affects can be as bad as smoking. Oh, my . . .