John’s Story – Low Back Pain

John is a 42 year old man who developed pain in his lower back immediately after moving house. He couldn’t recall any specific injury but did quite a lot of lifting, carrying and bending down during the move. At the time he felt a few twinges but didn’t think anything of it. However over the subsequent few days the pain increased steadily and became very severe and began radiating down the back of his thigh at times.

He was otherwise well apart from being a bit overweight. He had a few episodes of back pain in the past but it was never severe enough for him to seek treatment. He did no regular sports or exercise apart from chasing after his two children who are both under 4. His job is office based and he sits for most of the day.

When I first assessed John, he was quite worried about his back pain – particularly the fact that it was shooting down into his thigh at times and he wondered whether he needed an MRI scan.

I did a thorough assessment of his spine. Perhaps the most important part of this examination is the neurological assessment. This involves testing the sensation, muscle strength and reflexes in the legs. The reason why this is so important is that if there is any significant pressure on one of the nerves in the low back that supply the muscles and skin and tissues of the legs, this will be identified with these tests. It is important to always do the neurological assessment in people with spinal pain – particularly if the pain radiates into a limb. This together with other tests helps us to determine if further investigation like an MRI scan is necessary.

In John’s case, the neurological examination demonstrated no abnormalities thus indicating that the pain shooting down his leg was not due to compression of a nerve. Other elements of the examination indicated that there was transient or minor / temporary pressure on one of the nerves – common in the acute low back pain. Crucially, when I looked at how he bent down and lifted and assessed his control of movement from the spine, there were obvious problems. His core muscles were weak and therefore were unable to protect and control the movements of his spine when his activity levels increased (when moving house).

He underwent treatment in key phases:

1)     Settling down the acute pain

When someone is in acute pain, it is not possible for them to make any real improvements with exercises. Therefore we prioritised reducing the pain with medications prescribed by his GP, gentle manual therapy to the joints and soft tissues of the lumbar spine and advice on helpful positions and postures to adopt. The spine likes movement therefore he took regular breaks from sitting at his computer at work and I taught him gentle mobilisation exercises.

This brought about a marked improvement in his pain levels and after 3 sessions he had virtually no pain.

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2)     Improving posture and movement control of the spine

The next phase involved improving John’s posture and control of movement. I coached him on the best way of maintaining correct sitting and standing posture and commenced re-education of the core muscles – those small muscles that help control movement and keep the spine in a good stable position when we move our limbs.

John carried out his exercises regularly and after 2 sessions had improved the activation of his core muscles.

3)     Functional rehabilitation

The next phase involved higher level exercises to improve the strength of the core muscles in functional positions such as when bending and lifting.

After 2 more sessions John was completely pain-free on all everyday activities and was demonstrating hugely improved strength, stamina and control when lifting.

4)     Fitness and prevention of recurrence

We know from research that people who exercise regularly get less recurrence of back pain. Therefore one of the key components of John’s treatment was a plan to improve his general fitness, lose weight and maintain the core strength improvements that he had made from the physiotherapy exercises. John used to play football and go swimming regularly. However since having children, he found it difficult to prioritise the time to exercise. However this episode of low back pain was enough of a warning sign for him to realise that it was vital for him to get back to a healthier lifestyle.

He decided to start jogging as this was easiest to fit around his busy home and work life. He also started cycling to and from work every day. I helped him devise an incremental running programme to compliment his physiotherapy exercises. He also started attending a Pilates class once per week to continue his core stability training. The last I heard from John he had completed a 10 K race and was planning on doing a half marathon. Crucially he had had no further episodes of back pain.