A Bad Situation Made Worse

  • Daniel Bruns
  • Thomas J. Lynch

It has been said that even the longest journey begins with a single step. In some cases, such a journey can also begin with a single misstep.

Sarah was 39-year-old woman who had worked as an administrative assistant at a company for 8 years. One day at work, while walking between buildings, Sarah had the misfortune to slip on some ice. She twisted her left ankle and fell, landing on her left side and wrenching her lower back. This accident was not witnessed however, and when she reported her injury, her employer was skeptical that she had really injured herself at work. Her employer initially resisted filing a worker compensation claim, and suggested that she was actually injured at home. She was directed to see her personal physician. When she presented for examination by her personal physician though, she was told that this was a work-related injury, and her physician referred her to her company’s occupational medicine physician. Some days later, Sarah was told that her worker’s compensation claim had been approved provisionally, although she was also told that the claim was being investigated by her insurer.

Physical examination by the occupational medicine physician revealed some tenderness around the left ankle, but the radiographs found a normal left ankle. Physical examination also revealed a considerable tenderness in the musculature of the lumbar back, primarily on the left, with the patient reacting to even a light touch. Although the neurological examination was normal, radiographs revealed some minimal lumbar degenerative disk disease and a normal left ankle. Sarah denied any past history of injuries to her back or lower extremities. She reported occasional low-back pain in the past, but no lost-time injuries and no surgeries. Sarah reported being otherwise healthy, with no chronic medical conditions, and she was not taking any medication on a regular basis. She reported a family history of diabetes and heart disease on her father’s side, and she was a nonsmoker.


Chronic Pain Lumbar Fusion Lumbar Discectomy Lumbar Disc Surgery Lumbar Intervertebral Disc Herniation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Daniel Bruns
    • 1
  • Thomas J. Lynch
    • 2
  1. 1.Health Psychology AssociatesGreeleyUSA
  2. 2.Greeley Medical ClinicGreeleyUSA

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