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Soldiering on may not be smart


SOMETIMES A SYMPTOM  Pain can be a sign of an underlying issue that needs attention.

‘It can be hard to know when pain, regardless of how severe it is, is just pain and when it’s time to act fast’

Andrew O'Brien

‘Keep Calm and Carry On’. By now the old British war-propaganda posters have been tweaked by every advertising agency in the Western world. I’ve seen ‘Keep calm and clean your hands’ posters in hospitals and ‘Keep calm and eat more pies’ posters in, well, pie shops.
The original posters were produced in preparation for World War II to raise morale, given that Britain was under serious threat of airstrikes. The understated, stiff-upper-lip approach is brilliant. ‘Sure, London could be bombed to smithereens, but don’t panic old chap’.
In many ways it’s a motto that physiotherapists use for patients. We typically spend our days with people who are in pain, whether it be due to an acute injury after an operation, or some chronic complaint. When you look at the research around treatment modalities for most musculoskeletal problems, the best evidence is always for ‘early return to normal activity’. In other words, even if it hurts, get moving as quickly as possible. Keep calm and carry on.
A late-night text message from a good friend in Australia during the week reminded me that sometimes keeping calm and carrying on isn’t the best option. My friend’s wife had just that day developed back pain and a set of symptoms that required urgent medical attention and surgery within the week. It’s a frightening thought, but there are times when ‘keep calm but leap into action’ is a much better rule of thumb.
From a patient’s perspective it can be hard to know when pain, regardless of how severe it is, is just pain and when it’s time to act fast. In my friend’s case, it was less about the actual pain and more about the associated neurological symptoms.
Another case springs to mind. I met a man once who, when I asked what his problem was, said: “I look like I’m drunk when I walk.” He had no pain, but he did genuinely move like a man who’d been sitting on a high stool all day. After a consultation with a specialist, he was taken in for surgery shortly after and had a large tumour removed from his spine – following which he happily returned to walking like you and I.
Are there specific symptoms that should have you running to your GP or chartered physiotherapist for advice? Yes there are, and while I sometimes wonder if telling folks what to worry about is a good idea for fear that the hypochondriacs of the community suddenly convince themselves they are dying, I will list a few.
If you have back pain combined with numbness in the ‘saddle’ area around your groin and inner thighs and/or impaired bowel or bladder function, you may have what is known as cauda equina syndrome, where the lower end of the spinal cord is compressed. In most cases these patients will need surgery and may suffer ongoing problems.
Unexplained pain and swelling of the calf and ankle can be suggestive of deep vein thrombosis, a blot clot deep in the leg, which needs to be diagnosed and treated quickly and can cause a heart attack, stroke or pulmonary embolism.
Rapid, unexplained weight loss should be investigated as it can be a sign of a number of different disease processes, all of which need swift medical attention.  
You will likely have seen the television ads warning of stroke symptoms using the FAST acronym. FAST stands for Face, Arms, Speech and Time. If somebody is unable to smile evenly (face), lift their both arms evenly and keep them there (arms) or is slurring when they talk (speech), they may be having a stroke and it is time to call an ambulance (fast).
Feeling pressure, tightness or pain in the chest, feelings of severe indigestion or breathlessness and cold sweats can be indicative of a heart attack. Often it is said that someone suffering a heart attack has an impending sense of doom; they don’t know exactly what’s wrong, but they know they feel very unwell.
It should be noted that this list is far from exhaustive, and also that the symptoms described and the conditions they point to are not that common and in most cases treatable.
Sometimes what appears sinister isn’t really, but when in doubt it’s best to get the opinion of a health professional. If however you ‘just’ have a sore back, well, you know what to do old chap.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at