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A 60yr old lady with back pain


Fiona came to us back in the summer with back pain. She had hurt her back when getting a large lasagne out of the oven. What was causing her back pain?

When she was examined, her right pelvic (sacroiliac) joint was pretty tender, and her hip on the same side was quite stiff. Her back had quite a lot of muscle spasm and she was tender round her waist (flank). When we tested her urine, there was blood in it, and ultrasound scanning showed a small stone in her right kidney [1]. It seemed like there were a few things going on, all layered up, a bit like lasagne!

What could be done, apart from taking painkillers, which her GP had already prescribed?

Firstly, her sacroiliac joint was manipulated [2], and she was instructed how to use an ice-pack on it at home. Secondly she was asked to drink more water, as dehydration increases the risk of kidney stone formation [3] [4] . Thirdly her right hip joint was mobilised, as hip stiffness would increase the mechanical loading on her back.

Her back pain improved, thank goodness. In order to help stop it recurring, she will benefit from on-going exercises to keep her hip mobile and legs strong. She also needs to avoid getting dehydrated. There is some suggestion that keeping her animal protein intake down may also be helpful in preventing kidney stone formation [5]. Perhaps she should replace the beef mince in the lasagne with lentils and soy mince? Now you’re talking!…..

Fiona is not her real name, of course (but you knew that).


  1. Bhojani, N., et al., UPDATE – Canadian Urological Association guideline: Evaluation and medical management of kidney stones. Can Urol Assoc J. 2022 Jun;16(6):175-188. doi: 10.5489/cuaj.7872.
  2. Bussières, A.E., et al., Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative. J Manipulative Physiol Ther, 2018. 41(4): p. 265-293.
  3. Morgan, M.S.C. and M.S. Pearle, Medical management of renal stones. BMJ, 2016. 352: p. i52.
  4. Gamage, K.N., et al., The role of fluid intake in the prevention of kidney stone disease: A systematic review over the last two decades. Turk J Urol, 2020. 46(Supp. 1): p. S92-S103.
  5. Siener, R. and A. Hesse, The effect of a vegetarian and different omnivorous diets on urinary risk factors for uric acid stone formation. Eur J Nutr. 2003 Dec;42(6):332-7. doi: 10.1007/s00394-003-0428-0.

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