Back Pain Case Study 3
Lower Back
I had a long term problem with low back pain, which involved acute muscle spasm and as a result I was unable to walk normally, sit/drive or go to work, often for several weeks at a time. The problem occurred at regular intervals and despite treatment by various professionals, seemed to be getting more frequent.
When I first saw Val at the Physio & Sports Clinic near Newcastle, I was unable to stand up straight or take full weight through my left leg. She assessed me and said that the most likely cause of the problem was a bulging disc which was blocking my movement. The muscles of the back had gone into spasm to try and protect the spine. The problem was that the muscle spasm itself was very painful
I now have far less problems with my back and have been taught how to recognise early warning signs
I was given treatment that involved ‘straightening me up' and then acupuncture. I was also given exercises that I had to do, 2 hourly initially, to keep me straight. This treatment sorted out the problem much quicker than previously.
I now have far less back pain and have been taught how to recognise early warning signs and am able to deal with it myself using specific exercises. My back is also much stronger.Rachel (teacher)
Physiotherapist's Comments
Rachel presented to me with a marked shift (shoulders to left, hips to right, unable to straighten up). Questioning during her assessment revealed that this is a recurring problem, occurring more frequently as she gets older. It was usually brought on by periods of prolonged sitting, this time following a touring holiday in a sports car. I identified that, before her back goes “out”, she usually experiences several days of niggling back pain.
The physical examination revealed a major loss of movement with a physical block to correcting the shift. There was also protective muscle spasm that was adding to her pain.
This combination of signs and symptoms for a person in Rachel's age group (50 year olds) is frequently due to a disc prolapse. My priorities after the assessment were to reduce the disc bulge, pain and muscle spasm. Once this was achieved we would move on to restoring movement in all directions and strengthen the core muscles that support the spine.
Initially I used a specific McKenzie technique to correct the shift and gave Rachel an exercise to perform, 2 hourly, to maintain the improved movement and prevent the disc bulging again. I also used some acupuncture which can be very effective for reducing pain and muscle spasm.
Rachel responded really well to both and was religious about doing her exercises so that by the second treatment she could stand upright and move more freely. Over several treatment sessions we gradually restored full range pain free movement.
My concern then was that her recurrent back pain had left her with weak ‘core' muscles despite attending a regular Yoga class.
I also needed to restore Rachel's confidence in her back as she felt it was weak and vulnerable. In addition I wanted to teach her how to identify early warning signs in the future and what to do about them, to prevent this problem recurring.
We achieved this with a maintenance exercise programme that she does whether she has pain or not. (It takes less than 10 minutes a day) When she recognises early warning signs that the disc may bulge, she increases the frequency of one specific exercise to 2 hourly for a couple of days which usually settles it down.
Members of the Chartered Society of Physiotherapy