Back pain is one of the most common things seen in a physiotherapy clinic. There are so many stats that show how much it affects the economy, but to be honest, non of that really matters when you have back pain, you just want to get rid of it! And so I wont start off with any stats or thoughts on how these issues se the scene. Lets just start to look at a practical situation.

Earlier this week I had someone come into my clinic room with back pain. It sounded quite routine for them – this was something that regularly happened. They would be doing their regular lifting in the gym, no increase in weight or funny movement, but afterwards felt pain in their back. They had seen lots of people in the past and the pain always gets better after a couple of weeks. However, it seems that every time it comes back it is a bit worse than it was the time before or lasts a bit longer.

It’s a story I think that everyone has heard before? Not just physios.

So we spent some time going back through their history. The client said something to me that always triggers me; ‘you know, ever since I had a hamstring injury when I was playing football when I was 20, It was one injury after another and I always felt I was injured more than I was on the pitch’.

Ah!

Hearing this is always a trigger for me and is said so frequently. Even if not in so many words.

So when assessing, actually the back wasn’t moving too badly. Sure there were some muscular pains when moving in certain directions – it was still quite acute, but nothing too awful. So then we moved onto the hamstrings. Here we found that the left hamstring (the side of their back pain) was able to produce 20% less force than the other side. This was the same hamstring that was injured in their 20s!

So, instead of diving straight to the back, and giving some traditional stretches and mobility exercises on hands on work, we worked on the hamstring.

Your body has to work together to facilitate movement, and everything has to do its part. If one area isn’t doing what it should, then another area has to do more to make up for it. In this instance, the hamstring isn’t doing it’s job and so the back does more. This clearly isn’t the backs fault, and so making the back stronger or more flexible is not the long term solution.

Increasing strength of a tissue or area of your body will allow you to take more strain through it, but I see 2 issues with this:

1. What happens if you get your back stronger but naturally your gym weights get higher too, eventually you end up with the same overload issue occurring.
2. What if you are already really strong in the area and getting improvements in strength will take months?

I’m not saying we shouldn’t strengthen areas, but sometimes it’s not just about strength. Sometimes it’s about getting your body working together. And in the example I am giving today, the back is likely the symptom of the hamstring issue, so if we want to get this client better we need to focus on the cause rather than the symptom.

So what did we do?

We gave some focussed lower limb exercises, mainly looking at hamstring exercises to offload their lower back to do at home. We also started some bending based exercises focussing on getting the hamstring to do more work, and this gave an improvement in the clients ability to bend in the session. Finally, we did some manual therapy to the hamstrings to desensitise the tissues to make them ‘happier’ to work. The hands on treatment will only ever have a short term effect but it does give us reassurance and proof that things can feel better.

So if you keep getting back pain, just think of some of your previous injuries. Were these really dealt with or were the just rested? It may be these things that are causing your back pain to keep coming back.

Josh