Gus, our Physio Lead, talks us through how he treated his recent client – a 46 year old man who works as a security officer at the Houses of Parliament, who came to him with debilitating lower back pain.
The problem: persistent debilitating back pain
My client first experienced lower back pain after standing for long periods of time, which he does daily for his work. Although starting small, this pain cumulated, forcing him to take time off work.
In light of this, he visited an osteopath who informed him that his pelvis was slighted rotated and advised him to avoid exercise.
This persistent back pain was causing him significant distress.
Unable to work, he was worried that his employer was going to make him redundant. He also felt low, as he was unable to do things he enjoyed, such as working out and going for walks. This was exacerbated by a lack of sleep, as his back pain prevented him from getting a good eight hours.
The diagnosis: a disk-related issue, and no belief in getting better
Due to his persistent pain, he was eventually referred to Technique by his employer’s Occupational Health team.
I conducted a thorough assessment of his back by asking him to do a series of movements and exercises.
The assessment confirmed the Osteopath’s original diagnosis that he had a disk-related issue.
However, it also revealed another issue: that his muscular endurance was very low. This was shown by comparing his exercise results to his cohort’s average (same in sex, age and weight).
hold a sit up for 27 seconds (the average, 90 seconds)
do prone hold for 29 seconds (the average, 97 seconds)
left side plank for 18 seconds and right side plank for 7 seconds (the average, 94 seconds)
As we spoke more I noticed that he was very anxious about his situation. The osteopath had previously told him to stop working out completely otherwise it would make his problem worse. He felt like he was at his wits end because he had no control over the situation and there was nothing that he could do to resolve his pain.
The Solution: a grounded discussion about lower back pain, and a back strength programme
In light of this diagnosis, I started by firmly demystifying common misconceptions around lower back pain.
You may be surprised, but lower back pain is a very common injury. You may be even more surprised to know that there is a very good prognosis for recovery.
Structurally, our backs are very robust and resilient. Of course, each case needs to be individually judged, but unless you’ve experienced significant trauma, such as being hit by a car, exercise shouldn’t be avoided (although I advise seeking a qualified professional’s assessment and guidance before doing so).
Regarding his herniated disk, I clarified that it is extremely rare to have a misaligned pelvis without experiencing a severe trauma like a car crash. So, as his pain had slowly onset, his rotated pelvis wasn’t the problem, but a natural variance (which, in fact, many people have).
The problem was his back’s lack of endurance. Weak back muscles mean extra force is placed on the spine, inevitably causing pain.
In light of this, I prescribed him a physio programme that aimed to increase his trunk strength.
Specifically, this meant a series of home exercises to improve his muscular endurance.
In turn, to ensure his safety, I devised a pain guide – a list of criteria which specified when he was experiencing acceptable and unacceptable back pain. When he was experiencing unacceptable back pain he was to stop and report what caused it.
The results: significant recovery within just three months
I’m proud to say that after three months, my client’s back pain has reduced.
My client reports feeling 80% better, saying he now only experiences some morning pain and stiffness, which eases once he gets up.
This is backed up when reviewing his muscular endurance stats, which have improved, but are still below average:
He can now:
hold a sit up for 65 seconds (previously 27 seconds, average 90 seconds)
hold a prone hold for 106 seconds (previously 29 seconds, the average 97 seconds)
left side plank for 43 seconds and right side plank 66 seconds (previously left side plank for 18 seconds and right side plank for 7 seconds; the average, 94 seconds)
This is positive news. If he’s already experiencing reduced back pain from partially improved back strength, if he achieves the normal values, the pain should continue to lessen.
The benefit: returning to work and peace of mind
In light of this recovery, my client is now back at work full time (and hasn’t had any unplanned time off work since we started working together).
In turn, he is also able to work out with reduced pain, and go for a two hour walk at the weekend, pain-free.
Furthermore, his sleep has improved, he feels less anxious and he’s a lot happier.
Interestingly, he reported that being reassured that lower back pain was very common, and his issue was solvable, was the main reason that his outlook improved.
This may explain how he feels 80% en route to recovery, when the data shows that he’s still only half way. Dispelling limiting beliefs about back pain may have enabled his positive outlook.
What’s next: continued strength programme and tweaking his job role
Going forward, the plan is simple: to continue his upper body strength and endurance exercises.
As a few exercises (repetitive sit ups) still typically aggravate him, I’ve set him some variations to prevent this. I will then monitor these to see if he can transition into the full exercises.
We’ve also made some small tweaks to his work schedule including some more sitting breaks which allows him to work his full number of hours, do his home workouts and go for his weekend walks without worrying about his pain.
As he progresses we will remove these small changes and get him back to his normal duties at work.