25 years after a funky dance move David needs chronic back pain treatment

 

There are often common themes when someone attends the clinic for chronic back pain treatment. In the case of David K of Bellevue Hill in Sydney, he ticked several of those boxes:

  1. He had been receiving back pain treatment over many years (in this case from Chiropractors and Osteopaths) but to date no one had given him a logical, cohesive self-management program.
  2. Despite recurrent and worsening episodes of pain over a 25+ year period he had never had an x-ray or other radiological investigation.
  3. It appeared that very little attention had been paid to the posture of his low back, the rapidly diminishing flexibility of his low back or the effect that was having on his posture overall.

 

In brief David is in his late 40s with a wife and 3 children, has a sedentary job, practices yoga on a regular basis, plays golf every couple of weeks and quite possibly caused his original injury whilst throwing a funky, high impact dance move whilst in his early 20s. Since then he has been getting several episodes of low back pain per year to the point where he now has a painful episode about every 3 months.

 

Just from his history alone David was in the categories of both a ‘chronic’ and a ‘recurrent’ low back pain sufferer.

 

The big physical findings from the first assessment were:

  1. There was a significant sideways shift to the left in Davids lumbar spine (Low back)
  2. There was an extensive loss of lumbar spine range of movement.

Both of these findings are common with long term back problems as the spine tries to make adjustments around the unresolved, underlying problem, and in Davids case the extent of both of these issues suggested that they had been developing over many years.

 

The other significant finding came after I referred David for an x-ray. The x-ray showed an old anterior crush fracture of one of his vertebrae. This means that the front of one vertebra was permanently collapsed. This was certainly consistent with the high impact dance move from his early 20s that David described, and would also contribute significantly to his progressive loss of spinal flexibility and deteriorating posture. David was a clear candidate for chronic lower back pain treatment.

 

So what to do? Here we are 25+ years after the original injury and with a spine that was permanently injured, listing badly to one side and that was stiffening up with every passing day.

 

First David needed to be informed both about the underlying cause and also given some clear strategies that he could be doing to start reversing the chronic changes that were already in place.

Second we needed to see if the lateral shift in his spine was reversible. After 2 sessions of strong joint mobilization and with David instigating a regular self-mobilisation routine in between treatment sessions, the lateral shift remained unmoved. I was starting to think that the shift had become permanent. Then on the 3rd session we saw it move – and over the next few weeks it loosened up until David could correct the shift himself without my help.

 

Bingo!!

 

This was a pivotal moment because it demonstrated clearly to David that:

  1. His wonky posture was not yet permanently fixed.
  2. With diligence and repetition of the correcting movements he could correct the posture himself and
  3. If he could self-correct now then he should also be able to self-correct should the problem re-occur in the future.

The final point is crucial to a genuine long term ‘fix’ for chronic and recurrent back problems. In the past Davids only option when his back ‘went out’ was to visit a therapist (his Chiropractor or Osteopath) because he did not know how to apply a correction for himself. Now that he has experienced how to self-correct then that will be his first strategy should an episode of back pain re-occur.

 

It took 5 treatment sessions over a 6-week period to get to that point.

 

At the time of writing we are still working on Davids long term posture and flexibility, and as David is doing 90% of the work himself with a structured exercise program he is now only coming in for a treatment session once every 2 weeks. To date David has had 7 treatment sessions and my guesstimate is that we might need another 2 or 3.

The ultimate goals are:

  1. Not to need to see David for hands on therapy in the future.
  2. For Davids home exercise routine to stop future episodes from re-occuring.
  3. That David understands how to manage any future episode and that he has the tools to self-treat without the need for any therapist.

 

And we have achieved this by addressing the 3 main failings of the prior treatments. Namely:-

  1. David has a logical understanding of his problem and a specifically targeted exercise program that he has now added to his regular yoga routine.
  2. We have radiological evidence that both explains what the underlying cause is and that also rules out anything more complex.
  3. David is very aware of his posture and flexibility and is working on them assiduously every day. He also knows that, with the crush fracture in his spine, attention to his posture needs to be a lifelong commitment. And he is up for the challenge!

 

Hopefully once we have completed his course of treatment the only time I see David again will be on the golf course.

Get back pain relief Sydney! Look at your chair

As humans evolved we were primarily walking and running creatures. We didnt sit, we squatted. As such our spines are designed to be active and to move. Our spines certainly weren’t designed to be static for long periods and they really werent designed to sit much at all.

 

So it is no surprise that in the clinic we nearly always have to manage seating choices and sitting postures if we are going to have a successful outcome. This is particularly true in chronic back pain treatment.

 

Here is a summary of the most common ways you can reduce pressure on your low back due to sitting

  1. Dont sit! That sounds both too simplistic, too unreasonable and completely impractical. But stop and think a moment – there are genuine alternatives to prolonged sitting. Standing desks and walking desks are becoming more commonplace and more affordable. And as more administrative/office jobs are now being done from home it is also very easy to spend some of the working day lying prone on your tummy, propped up on your elbows and with a couple of pillows under your chest.
  2. Use a seat that allows your knees to drop below the level of your hips. With your knees and hips at the same level it is difficult to sustain good low back posture for any length of time. As soon as you drop your knees below hip height the mechanics of the low back change and good posture is easier to sustain. Types of seats that are designed specifically for this purpose include kneeling chairs, saddle seats and some well designed office chairs that allow the seat to be tilted downwards at the front.
  3. Make simple adjustments to your existing lousy chair. The two simplest options are a) to place a sitting wedge on the chair seat – this raises your bum and drops your knees below hip height, and b) to use a lumbar roll in your low back. Or  better still do both.

 

And dont be fooled by the word ‘ergonomic’ when used to describe office chairs.

 

The final piece of advice is to be like our ancestors and move regularly. Even if you are at work in an office you can find lots of reasons to get up out of your seat on a regular basis. Going to the photocopier, walking to a colleagues desk instead of phoning them, be the coffee monitor and walk to the local cafe twice a day, walking at lunchtime, making and taking phone calls whilst strolling in the corridoor rather than sitting at your desk.

 

In the long run you are far better making some simple changes to your sitting habits than having to spend time and money seeing someone like me because you have developed a disc bulge in your low back.

Get back pain relief Sydney! – Look at your chair and your sitting habits.

The Mckenzie method in complex back pain

Chronic Lower back pain treatment?

Treat yourself

The broad philosophy underlying the McKenzie method is that the patient must be active in their own treatment and recovery. The therapists role is to correctly diagnose the problem, educate the patient on the underlying cause and teach the patient what they need to do themselves to self-manage and to self-treat. The therapist may well need to apply chronic lower back pain treatment but then, over time, the therapist gradually withdraws from having an active role in treatment.

 

A successful outcome from a McKenzie therapists view point is when the patient is so well informed about their problem that they can resolve their own problems both now and in the future.

 

Two significant advantages

The Mckenzie method works on a number of levels. As a method of assessment and treatment it has two important advantages. These are:-
1. It gives both your therapist and yourself a way of thinking about chronic lower back pain treatment that is very practical and which simplifies the decision making process.
2. It allows you, the patient, to have a very active role in your own healing. Once you know what to do you can carry out a lot of the treatment yourself. This reduces the amount of time and money that you need to spend with the therapist.

 

The therapists role

During the McKenzie assessment the therapist is looking at very specific movements, repeated movements and positions of your spine. By taking note of how your symptoms behave during this assessment process your therapist will be able to allocate your condition into one of 4 syndromes. This process is crucial to successful treatment as each syndrome requires a different treatment approach.

 

It is vital that the therapist allocates sufficient time in the first two or three sessions to ensure that the assessment process doesnt cut any corners and doesnt miss any important information. In the case of chronic, complex or recurrent back pain at least 1-hour of one-on-one time should be allocated for the first few appointments.

 

Your role

Once the therapist is confident which syndrome is underlying your particular problem they can explain to you what is causing your problem and also exactly what you can do to help resolve it yourself.

 

You then need to be an active part in your recovery. In other words you need to be prepared to do exactly as instructed. This is particularly important in cases of recurrent or complex lower back pain or in chronic back pain treatment.