Ureteral calculi as a source of low back pain- a case report

This case report describes a 49 year old male with complaints of back pain that was diagnosed as degenerative low back pain and referred to the physical therapist. The mode of onset was insidious and the pain was intermittent with no relief from specific intervention as in rest, heat or analgesics. There was no report of changes in urinary frequency or color, and any vomiting sensation. This patient was appropriately screened by a physical therapist who suspected a pain origin that could potentially be of a viscerogenic origin. He was referred back to the primary care physician who ordered an ultrasound and a CT-KUB (Computerized Tomography-Kidney, Ureter, Bladder) which revealed a 10.5 mm calculi in the left upper ureter. The patient was then referred to a urologist who confirmed the findings and performed a ureterorenoscopy (URS) lithoclast fragmentation and J-J stenting under spinal anaesthesia. The result was an excellent symptomatic and functional outcome. The need for lateral thinking in the evaluation of non specific low back pain is enumerated. The treatment based classification system is a referenced model. The emerging role of the physical therapist in screening of back pain as a first contact practitioner and the responsibility therein, is described.