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Lower back pain case study- How we helped Mr X* overcome his chronic lower back pain.

*We have changed the name of the patient to Mr X to keep confidentiality.

Mr X was one of our patients who presented with the very typical story of a gradual worsening of his lower back pain. He used to enjoy playing golf, football and playing with his kids in the park. His lower back pain used to be an inconvenience, but over the years it got to the point where he felt he could no longer play with his kids, and he hadn’t enjoyed football or golf for years due to the pain. This kind of chronic pain has a real effect physically and emotionally and I empathize so much with people who have yet to find a solution to their pain.

He had tried Chiropractors, Physiotherapy, Osteopaths and Acupuncture, all of which seemed to give relief for a while, maybe a few days, maybe if Mr X was lucky he would be able to have a good week or so. He had also tried supplements to improve his pain. However, the pain would inevitably return and Mr X had wondered whether he would just have to accept his pain. When quizzed in more detail, it seemed that all of his previous treatments were passive - this means he was never given anything to address his symptoms in the long term. Furthermore, whilst there is good evidence that certain supplements can be beneficial for pain, such as Tumeric, addressing the underlying cause of the issue must remain at the forefront of how to solve back pain.

He had an MRI which showed degenerative disc disease. His Chiropractor had told Mr X that his spine was ‘breaking down’ which is an incredibly scary thing to be told. When I explained that over 80% of lower backs without pain have degenerative changes in people over 50 years old, Mr X felt perhaps he had been explained things previously in a way that was intentionally harmful- I agree. Normal, age related changes should be explained in a way that reassures rather than intimidates. It is easy as a healthcare professional to scare patients in pain. Doing this is unacceptable. Our job is to be optimists and use positive language to help break down the barrier of fear, which is proven to contribute to chronic pain.

Then Mr X found Azzurro Physiotherapy. We only use evidence based Physiotherapy techniques at Azzurro. We spent a lot of the first session working out what had been tried before, and a comprehensive assessment was then performed to work out why the pain continued to return.

What was found was clear weakness in the spine. Mr X had been losing a lot of the muscle strength in his lower back due to his fear of normal movement and activity. The other thing that is often missed was the fact Mr X was moving with a very guarded movement pattern. Someone who has encountered lower pain for a long time and has been told it is ‘breaking down’ can often learn counter-productive ways of moving, where they brace their core and when bending or reaching the lower back stays rigid. This can lead to stiffness and more pain in the long term. The spine, like every joint in the body is designed to bend. If you lose the ability to bend the spine it will become painful. Imagine not moving your knee for a prolonged period of time- the joint becomes stiff and painful. The joints in the lower back are no different.

So for treatment we started with some soft tissue mobilisation to help loosen the muscles and reduce the stiffness in the spine. This gave immediate relief but because it was not going to solve the underlying problem, I gave Mr X a few simple exercises to keep the spine more flexible and begin the strengthening process. Strengthening takes around 6 weeks to kick in and so regular appointments were not necessary. I reassured him, maintained regular contact to help support him and then he returned few weeks later. Mr X had reported an immediate benefit after his first treatment session, and the exercises had meant that the pain stayed better. He also demonstrated a good understanding of the kind of guarding movements that are detrimental to lower back pain, and had started to address this too.

After 4 sessions, Mr X was playing golf 3 times per week and reporting very little pain. He decided to come back to be given a long term management plan because he joined a gym and wanted to know what exercise could be used to help whilst also improving general health and fitness too.

I drew up a plan which Mr X followed and whilst I explained that there are plenty of ways to keep pain away that don’t involve the gym, if this is what he wanted to do the gym can be a great way to help address pain. I created and we completed in detail together a gym programme designed to help him to rediscover all the things he was previously feeling like he could not cope with. He then took this with him without needing me.

I checked in with Mr X recently. His lower back pain is yet to return and he has not had to return for his lower back. He no longer feels he has to fork out regularly for expensive treatments that were clearly not solving the underlying problem.

At Azzurro, our Chartered Physiotherapists only use evidence based practice. We help people solve problems rather than mask them and educate our patients so they don’t feel like they have to rely on us every time they get an issue. Our job as Physiotherapists should be to give power to our patients. If you feel reliant on us at the end of a treatment, we have not done our job properly.

Mr X transformed his life and you can too.

Pain Photo by Raj Eiamworakul

Golf Photo by Court Prather

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