Mr.Rajan (name changed), 34 year old, automobile worker was referred for physiotherapy treatment. He came to the OPD on the wheel chair and when asked to stand he complained of severe nagging and irksome pain at the back radiating down to the right side leg. After making him comfortable in supine lying position I started taking the history of the current back pain. He gave the history that, the problem came suddenly while he lifted the tyre of a truck to repair a puncture. The pain aggravates while coughing and sneezing. He told he was admitted two days before and taking medicines but has found no improvement. By that time I understood that Rajan’s pain was due to acute disc prolapse for the reason I am mentioning here.

A. It was of sudden onset  B. Rajan was in flexion, bit rotation and there was compression as he lifted the tyre  C. The pain used to aggravate with coughing. D. While attempt to stand there was kyphosis at the lumbar region.

As he was the sole bread winner he was very much in agony whether he can go back to the work and he asked me with trepidation and consternation “can I ever stand up” and “walk normally” saying so he looked at his wife who was accompanying him who equally looked remorse. I just had a simple answer “I will try and I am hopeful”.

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