There are several situations that may cause back pain in a Progressive supranuclear palsy patient. (1) lower back pain; (2) middle back pain; (3) a slip and a fall in the bathroom onto the bathroom floor; (4) mishap by the caretaker.
(1) Relatively more common is the lower back pain from sitting in a wheelchair for a very long time without exercise. Progressive supranuclear palsy patients cannot stand and do not have balance but they still require physical exercise.
(2) Middle back pain in Progressive supranuclear palsy patients is often due to pushing the walker. The patient pushes the walker with the torso and arm strength, not the strength from the waist or the legs.
(3) Back pain may result from a slip or a fall in the bathroom on the wet bathroom floor.
(4) Mishap by the caretaker usually occurs when the caretaker pushing the wheelchair tries to “push” the wheelchair over a ledge forcing a forward “dump” and the patient falls out of the wheelchair onto the floor or rough ground. The patient would usually fall face down and hit the ground “face first and chest second” with arms outstretched. This “arches” the back and the spine and may twist the back muscles, thus resulting in back pain.
During my lengthy sessions with the Progressive supranuclear palsy patient, many half hours were spent training the patient how to fall and impact the floor on the side and roll. The training was successful when one time the patient tripped and landed on a hard surface cement floor on the shoulders rather than “face down”.