Case Study 1: Chronic Lower Back Pain


Does this sound familiar?

You have long-standing lower back issues; mostly it’s there as a niggle, but periodically the pain ‘locks’ you & interferes with daily life and activities.  When that happens you seek treatment relief which might involve manipulations. These can both free you temporarily, and sometimes make you feel temporarily worse.  The symptoms are rarely absent, but you’ve learned to ‘live with’ them, and seek help only when ‘necessary’.  This picture may or may not include ‘sciatica’ (nerve impingement symptoms down the back of the thigh, and sometimes even as far as the calf or heel).  You may or may not have been given advice to do some ‘core exercises’ e.g. abdominal crunches and/or back mobilisations e.g. MacKenzie push-ups.  You may even have been told that ‘this is as good as it’s going to get’ and you’ll have to ‘live with it’.  Sound familiar?

Mr Chatterbox with Chronic Back Pain

Mr Chatterbox with Chronic Back Pain

Where is the ‘Why’?

The problem here is that the immediate ‘why’ isn’t being dealt with.  If the spine/pelvis is ‘out’, then it’s likely that muscle tension somewhere is pulling and keeping it there.  Joint manipulation success can’t last long, without first finding and releasing those muscles which are pulling.   And if muscles on one side of a joint are short and tight, then the muscles on the other side of the joint are probably long and weak, allowing the imbalance to continue.  The treatment eases the immediate problem, but the problem isn’t actually solved.  The pain cycle continues and your imbalances become chronic.

Are there ‘knock-on’ effects now compounding the initial problem?

Is there anything else going on which would inhibit progressive healing?

  • What if the lower back ‘condition’ is caused by your head (which represents roughly 8% of your total weight) sitting forward of the spine, with each ‘forward inch’ adding another ‘head weight’ to the load of neck, shoulders, spine & pelvis?  Just to be very clear, a head sitting 3” forward means just about an extra 1/4 of your bodyweight is hanging from your neck/shoulder muscles … next time you sit at your lap-top, or text on your mobile, think about that … I’ve just leaned away from the desk even typing it!  If the treatment focuses on the lower back, and the position of the head isn’t corrected, the ‘stressor’ remains and the pain cycle continues.
  • What if your lower back ‘condition’ is related to the ‘shape’ of your spinal curves?  If you have a ‘lordotic’ spinal curve, e.g. a lumbar exaggerated curve (which looks like a ‘sticking-out’ bum), then a MacKenzie push-up will exacerbate the issue, but regular abdominal crunches would probably be an appropriate rehab exercise.
  • On the other hand, what if you have well-developed gluteal muscles, making you look as if your bum is sticking out, but the reality is you haven’t got enough curve in your lumbar spine? In this situation, regular ‘crunches’ prescribed to encourage core conditioning, will continue to flatten the lumbar curve and will exacerbate the issue, but MacKenzie push-ups to help generate a lumbar curve would be positively useful.  If the treatment focuses on the pain site, and the lumbar curve isn’t measured and corrected appropriately, the ‘stressor’ remains and the pain cycle continues.

As Paul Chek says:

“If you can’t measure it, you can’t manage it.”

In this scenario, the only safe, corrective treatment regime would be preceded by a full CHEK assessment.  This involves static posture and stability assessments, spinal curve measurements, flexibility checks and assessment of abdominal wall function.  This statistical information is then coupled with a physiological load assessment via a comprehensive health appraisal questionnaire and the combined data form the basis of a customised corrective exercise programme.  Regular re-assessments are scheduled to ensure the programme is both user-friendly and having the desired progressive conditioning results.

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