Phit Phorum – My Friend’s Back Pain

phit lifting boxesYou’re probably tired of hearing about all my injuries so this month I’m going to tell you about my “friend” Gherk. Gherk is a 42 year old pickle who developed pain in his lower back immediately after moving to a new house. He couldn’t recall any specific injury but did quite a lot of lifting, carrying and bending down during the move. (I supervised all his work, because that’s the kind of friend I am.) 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 pickled-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 didn’t do regular sports because he was so busy with his gherkins and his office based job.

When Gherk was first assessed, 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.

His PT did a thorough assessment of his spine. Perhaps the most important part of this examination was the neurological assessment. It involved testing the sensation, muscle strength and reflexes in the legs. If there was any significant pressure on one of the nerves in the low back that supply the muscles and skin and tissues of the legs, this would be identified. (Neurological assessment in people with spinal pain – particularly if the pain radiates into a limb, is important.) This together with other tests helps determine if further investigation like an MRI scan is necessary.

In Gherk’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. When his PT looked at how he bent down and lifted and assessed his control of movement from the spine, there were obvious problems. Gherk’s 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).

Gherk’s treatment plan was 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. His PT reducing the pain with 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 so Gherk needed to take regular breaks from sitting at his computer at work and do gentle mobilization exercises.

Gherk had marked improvement in his pain levels and after 3 sessions he had virtually no pain.

2)     Improving posture and movement control of the spine

The next phase involved improving Gherk’s posture and control of movement. His PT 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.

Gherk 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 Gherk 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 Gerk’s treatment was a plan to improve his general fitness, lose weight and maintain the core strength improvements that he had made from the physical therapy exercises. Gherk used to play football and go swimming regularly. However since having gherkins, 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.

Gherk 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. His PT helped him devise an incremental running program to compliment his physical therapy exercises. He also started attending a Pilates class once per week to continue his core stability training. The last time I talked to Gherk he had completed a 10 K race and was planning on doing a half marathon. And the best part, Gherk had no further episodes of back pain.

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