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:
- 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.
- Despite recurrent and worsening episodes of pain over a 25+ year period he had never had an x-ray or other radiological investigation.
- 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:
- There was a significant sideways shift to the left in Davids lumbar spine (Low back)
- 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.
This was a pivotal moment because it demonstrated clearly to David that:
- His wonky posture was not yet permanently fixed.
- With diligence and repetition of the correcting movements he could correct the posture himself and
- 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:
- Not to need to see David for hands on therapy in the future.
- For Davids home exercise routine to stop future episodes from re-occuring.
- 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:-
- David has a logical understanding of his problem and a specifically targeted exercise program that he has now added to his regular yoga routine.
- We have radiological evidence that both explains what the underlying cause is and that also rules out anything more complex.
- 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.