Why my husband’s howl over back pain could happen 4 million times around Australia

My husband, Dylan, lay on our bathroom floor, wedged between our shower door and the sink. Our two children were in the bath with tepid water up to their navels.

“Dad made a really loud noise,” our three-year-old told me when I returned home and appeared in the doorway.

Kate Aubusson with her husband Dylan and their children at their Annandale home.Credit: Louise Kennerley

“Daddy, never make that noise again,” he scolded. Our 22-month-old daughter wailed in anger at her incapacitated father, who was wincing on the damp floor, breathing in all manner of bathroom particulates.

The noise was a howl of pain when the muscles in Dylan’s lower back violently spasmed as he turned away from our unsympathetic progeny in the bath.

“It felt like someone suddenly hit me with a hammer,” he later told me. “All I could do was hit the floor, and once I was there, I couldn’t move.”

At the time, I had no idea. It was about 8.30am, and I was on a metro train headed for work.

With all the speed and agility of his favourite action hero, Spider-Man, our son climbed out of the bath and ran down our stairs, dripping wet, to find Dylan’s phone. (I imagine the webbed crusader would have refrained from climbing back into the bath in such a crisis, but he has Spidey Sense™ and a fully developed frontal lobe.)

I was about to walk into the newsroom when Dylan called. I thought of the Sex and the City episode when Carrie abandons Miranda with a wry neck, naked on her bathroom floor, until Carrie’s boyfriend, Aidan, arrives to rescue her.

I am no Carrie. I caught a taxi home. Dylan was, thankfully, wearing pants.

An estimated 4 million Australians have back problems, and rising numbers are calling triple zero for ambulances to take them to emergency departments.

Back pain was the fifth-most common presentation to Australian EDs in 2023-24 (almost 155,000).

But most people with sudden onset back pain don’t need emergency care, which could lead to unnecessary and potentially harmful complications.

“There’s something deeply primal about our response to sudden onset back pain,” Sydney GP and addiction specialist Dr Hester Wilson said.

“It’s very common, but it can be incredibly frightening,” she said. “All those large muscles protecting the spinal cord suddenly seize up, and the emotional message this sends is ‘danger!’.

“The problem is, they don’t know where to go for help.”

Some 38 per cent of back pain patients admitted to hospital via three Sydney EDs for further investigation were found to have a serious underlying cause, such as an infection or a fracture, an analysis of medical records showed. They needed to be in hospital.

But 57 per cent of admitted patients had no serious underlying causes for their back pain.

Associate Professor Gustavo Machado at the Institute for Musculoskeletal Health at the University of Sydney said current approaches to managing back pain in emergency settings often escalated interventions without clinical justification, leading to unnecessary hospital admissions, imaging and opioid use.

Almost one in five patients developed a hospital-acquired complication, most commonly a medication-related adverse effect.

Dr Simon Vella, a postdoctoral research fellow at the institute, analysed data from one major Sydney ED and found 46 per cent of people with back pain transported by ambulance received opioids, 59 per cent received imaging, and 50 per cent were admitted.

“Emergency staff and paramedics are often pressed for time,” Vella said. “They need to make fast decisions about people they’ve just met, which makes it challenging to determine which patients need emergency care and which do not.”

An analysis of more than 73,000 NSW Ambulance patients with back pain found 97 per cent of spinal pain was categorised as non-serious, and 81 per cent were transported to EDs.

Associate Professor Gustavo Machado at the Institute for Musculoskeletal Health at the University of Sydney and postdoctoral fellow Simon Vella have investigated the number of people presenting to emergency departments over back pain in Sydney.Credit: Janie Barrett

A NSW Health spokesman said in most cases, back pain could be appropriately assessed and treated by a GP and allied health services, and that scans were unnecessary.

NSW Health recommended people with back pain seek urgent care if they cannot pass urine or they lose bowel control, have progressive loss of feeling or movement, or their symptoms get worse, despite following back pain management advice.

How to self-manage lower back pain

• Stay active: do as much usual activity as possible – a little more each day. 
• Avoid bed rest. Too much rest can slow recovery. 
• Protecting your back too much by tensing or avoiding movement can make things worse.
• Use simple pain relief: Heat wraps or heat packs, distraction techniques and relaxed breathing. 
• Medication: Your doctor may recommend short-term over-the-counter or prescription medications to help you stay active while you recover.

Source: NSW Agency for Clinical Innovation’s advice for managing lower back pain 

Vella said fever or unexplained weight loss with back pain could also be a medical emergency.

“Ambulance services are there to be used when needed,” he said. “If a person is living alone, if they’re elderly, they’re unable to drive or transport themselves to a medical centre or pharmacy, then calling an ambulance is extremely reasonable.”

Clare Beech, NSW Ambulance executive director of clinical capability, safety, and quality, said a call to triple zero did not necessarily lead to an ambulance transfer to hospital.

“We’re increasingly equipped to understand the patient’s needs and potentially refer them to someone more appropriate,” Beech said, including via the service’s Virtual Clinical Care Centre.

“For people with severe back pain [who] we are unable to manage in their home … there is a likelihood that they would end up being transported to an emergency department.”

Wilson said GPs were trained to exclude serious causes of back pain and reassure their patients.

“It usually takes about six weeks to resolve, and in that time, we can put a strategy in place,” Wilson said.

Dr Hester Wilson is a GP and an addiction specialist.Credit: Louise Kennerley

But long wait times for underfunded GP practices and few after-hours services are major barriers to seeking care.

Urgent Care Clinics may divert people from EDs, and Healthdirect’s virtualADULTS offers 24/7 urgent telehealth consultations with clinicians.

Dylan called Healthdirect. A triage nurse said he would probably need an ambulance. Instead, they put him through to an emergency physician at RPA Hospital, who assessed him, prescribed pain relief and recommended he see a GP and physiotherapist.

After he had spent about six hours on the bathroom floor, I wedged a towel under his torso and dragged him by his left leg to our bedroom. A singularly bonding experience.

He’s fine now. Don’t ask him about it. He’ll tell you I yanked his leg the wrong way on purpose. It was an honest mistake.

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