Back Pain is one of the commonest conditions for the people who indulged this current corporate lifestyle and also by mingling into this robotic life. So, to rule out this Back Pain we suppose to take several factors into consideration as our ICD & ICF proposed. But still sometimes we not able to find the cause and we say it’s a Low Back Pain with cognitive tendencies or Generalized Pain. Of course, we do agree about those concepts but if we look into it in detail can’t we find the triggering point for certain type of Back Pains? So, are we missing something while assessing Back Pain? Yes, it’s a WALLET.
This is not the new thing where Clinicians come across or something. In August 25th, 1978 “Elmer. G. Lutz (M.D)” published 2 case reports with the title of “CREDIT CARD- WALLET-SCIATICA” in JAMA (Journal of American Medical Association) where extra thick wallets caused the sciatica pain.(1)
But the question is HOW?
As we all know our Human body is one of the superb Complex Design in this known Universe, whatever the hurdle or whatever the challenge it faces, it overcome that by modifying themselves according to it. Same way, when a person sitting on his/her Wallet which is in the rear pocket of their pants, the symmetrical orientation of pelvis get change and which alters the adjacent structures from Joint level to Fascial level according to it.
In sitting posture, both pelvic bones will come in contact with the surface to make you have even posture. But, when a wallet comes in between as a wedge it creates an asymmetrical alignment of both pelvises, which have the impact on the spine where it has amazing ability to adapt and compensate for imbalances, but after effects of this will costs you a lot.
To accomplish the proper alignment of body, spine tries to adjust as mentioned above. So, as spinal movements are most complex and more of coupled movements, spinal rotators and Quadratus Lumborum have to work abundantly to maintain the posture and they end up with overuse injuries. All global stabilizers of the spine will be weak by over time of period where local mobilizers of the spine over activated and leads to muscular imbalances.
Sitting on Wallet is causing the issues not only at spinal level but also at the Gluteal level too. When you sat on Wallet, it compresses the soft structures beneath it and put at the utmost strain. In February 2017 European Journal of Orthopaedic Surgery and Traumatology published a scientific review on 31 Bangladeshi people done by Siddiq AB et.al,., which giving information that putting a Wallet in the rare pocket might cause Piriformis Syndrome as well.(3)
One more study in 2014 gives the results that sitting on a Wallet of 32mm thickness for the period of 15mins causes postural deviations from neutral spine positions and also increases the gluteal discomfort.(4) Even sitting for long durations with Wallet might put a strain on gluteal muscles as we discussed above and also put a strain on the Sciatic nerve(5). Peripheral Sensitization of the nerve will cause serious issues that mimic like Disc prolapses and all.
Interventions for this condition seeks restoration of mobility deficit first by doing Postural Correction and avoiding rare pocket Wallet while sitting for long duration and also to reduce the inflammation which ever caused by the compression. Physical Therapists / Physiotherapists can typically treat the condition by taking the patient through a variety of Stretching Exercises, Strengthening Exercises and also Peripheral Desensitization methods for pain relief.
As former Football player Johan Cruyff said –
“I don’t want to be thief of my own wallet – Johan Cruyff”.
But, now we have to think like “I don’t want to be the victim of my own wallet”……
Head Of the Branch
Spectrum Physio Pvt Ltd (Kaggadasapura Branch)