Lower back pain/stiffness some suggestions please

[makaveli1]

Hello all this is my first post here so I hope Im posting in the right place. About 4 months ago hurt my lower back deadlifting. And now my back aches, its a dull pain sometimes when sitting for long periods which travels into my ass, so I cant sit for to long without adjusting my postion. I have real problems bending down

I finally saw a physiotherapist on Monday on the nhs who said that I have lost range of motion in my 4th and 5th lumbar of and recommend the following exercise to regain range of motion 3 times a day:

Knee rolls
Single leg to chest
Cat stretches
Hamstring stretch

I cant touch my toes with straight legs and my hands are about 12 inches from the floor. He said to carry on weight training but avoid heavy stuff involving the lower back.

Has anyone had any experience with this type of problem? Is there any other exercise or things I could or should do to speed up my rehab???

Im considering getting/ doing foam roller exercises Worth doing?:
http://www.t-nation.com/readTopic.do?id=475832

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[alophysio]

Hi,

Thanks for posting on the website...I am guessing that you aren't a physio.

First of all, it seems like the diagnosis given to you (as told to us by you) is a little simplistic. Sometimes this is because the physio doesn't want to "scare" you with something that sounds bad. I would personally ask if you have hurt something in your back. The reason why is that decreased motion at L4 and L5 is merely an observation and you haven't really given the reason why this has happened. I am sure your physio can give a good clear explanation why.

Secondly, there is plenty more you can be doing. I often give similar exercises to my patients during their first visit for a number of reasons - one of them is to see if they are "compliant". That is, if they can't do these simple exercises regularly, then they probably won't do harder ones either. Another reason why is to see how you respond to these simple exercises.

Thirdly, we can only go by what you tell us. Did the physio do anything else? Did he/she say anything else?

Fourth, it is hard to recommend you to do something like foam roller exercises without knowing what is wrong with you. The fact that you wrote a post like you did suggests to me you are quite keen and "searching" for answers. It might be because you don't trust or like what your physio has told you or it was not what you expected. Or it could be that the physio didn't explain it in a way that made sense to you. Whatever reason it is, you need to find someone who can help you and deal with you in a way that works best for you - the physio that you saw might be quite a good physio but not a good personality match - who knows?!?

Lastly, If it were my back and I couldn't sit properly for 4 months, i would spend the money required to get the best advice i could. Now it is easy for me to say that but i can appreciate that not all people can afford this. But if you think about it, can you afford NOT to do it? If this person can give you all the information you need to understand your problem and fix it quickly, you often don't need to see them often, especially if you do your exercises. I can often help people in less than 5 sessions. Even if you went for one or two sessions and told them upfront you need a diagnosis and treatment plan so a NHS physio can follow you up, then i would consider it. Especially if i lost money by NOT working. But you don't sound that bad.

I hope the above helps. There are so many things that you could have wrong with you like a disc injury, twisted pelvis or lower spine, sprained back joint, overactive muscles in the back, poor core stability, etc etc.

Good luck!

[makaveli1]

Hey thanks for the reply I appreicate it, You're right I'm not a physio. I got the phsyio on the nhs. I asked him what he thought could have initially happened to me and he said it could of been a number of things (which I cant remember).
I asked what happened exactly and he said not to worry about it and gave me the loss of motion explanation. I really wanted a title to my problem so I know what it was.
Im desperate to fix this problem.

I have been doing all the exercises as instructed.

First the physio asked a serious of questions of how it happened, when does it hurt, could you rate the pain on a 1 to 10 scale.
He then told me to take off my top asked where it hurt from and made me so some stretches like touch your toes, hamstring stretch, side bends and putting both legs to my chest. I did all this and then made me lie on my front and really pushed hard on parts of my spine and said that L4 and L5 didn't go down as much as the others.
As I told him that I had trouble bending over and had avoiding doing this rather squatting down, he said I should be bending down more as the more I do this the better my range of motion would become.

I asked if it was serious and he said no.. but Im not convinced to be honest.
I am really seriously considering going to see someone, I live in Coventry could someone recommend whether I need to see a physio or chiropractor? I really don't know the difference

[alophysio]

Ok,

thanks for replying.

First of all, sometimes you don't need to know exactly what is wrong. Having said that, I too would be unhappy if i didn't get clearly told what was wrong.

Secondly, your physio has performed a fairly standard examination. However, i personally feel it was either 1. an incomplete description of what he did or 2. inadequate - i can't tell because i am not sure what actually went on.

Thirdly, I am glad to hear you are doing the exercises - are they helping your pain?

Next, it doesn't sound like you completely trust this physio. I would give him another go to explain again what is wrong. Ask him if he understands how the SIJ works. Does he know the work of Peter O'Sullivan or Paul Hodges or Diane Lee or LJ Lee in motor control retraining?

Again, as i wrote earlier, if it were me, I would pay money to see the best. I will try to find out the name of a physio in the UK who you can see who might know some of this stuff.

Lastly, I would not personally recommend you see a chiropractor. I think in your particular condition you have a movement control problem. The solution usually lies in retraining how your body moves. It is not simple and most physios have not studied this stuff at university, esp outside of australia or canada. I don't think you have something where it needs to be "cracked" back into place like a chiro would do. Physiotherapists are supposed to be the experts at muscles and your problem sounds like a muscle control problem.

I understand your desperation. I will get back to you soon...

[makaveli1]

Again thanks for the reply, I would like to know what is wring also, just so I have a name for it.

He was a nhs physio and quite young so I doubt he knows any work by them guys u mentioned, Im going to see him again next Monday and will ask him for a full diagnosis and mention the names you told me.

On saturday I was doing some light training and kind of hurt my back again, it is better today so I cant really tell if the exercises are working but I live in hope. Im going to give this guy one more chance and then Im going to find another physio. I found this one which looks really good:
http://www.coventryphysio.co.uk/index.htm

Again thanks for your help

[alophysio]

Hi,

I asked a very well respected physio who they would send to in England, and they only gave me ONE name - Leanna Burney at Covent Garden Physiotherapy - Endell Street LONDON ph = 02074978974.

I don't know her personally but maybe give her a call and ask if she can help you. I don't even know where coventry is so she might be next door to you or across the other side of england.

Explain to her your problem and that you want someone who can assess the spine like Diane Lee, LJ Lee, Barb Hungerford, Peter O'Sullivan etc. You will have to speak to her personally i would say.

Hope that helps!

[chunkypuffin]

Dear alophysio,

hi, just wanted to clarify a couple of points. You state in your last post the respected physio you know could only recommend one physio in England - not really surprising as you are in Australia!! I understand that you are attempting to provide as much assistance as possible but a remark like that can easily be misconstrued to imply a lack of expertise in the native physios over here.
You report that you feel it is a motor control problem - why? Without observing movement patterns this is impossible to tell. I know that many a McKenzie therapist would read this case report and claim it is blatant discogenic pain. I understand your stance regarding the motor control issue, having been on a Peter O,Sullivan course recently. But again, he emphasises the importance of observation, clinical assessment and sound clinical reasoning. It is too easy to diagnose remotely and equally easy to be wide of the mark.
Hope these comments are not taken as aggressive, just feel that as makaveli1 is not a physio some of the comments may be misconstrued.
Makaveli, as regards a physio, may I suggest you look at this website
http://www.macpweb.org/home/ if you are going to seek private treatment. All the physios on this site are specialists in musculoskeletal physio and have undertaken post-graduate training and exams to prove a minimum level of advanced competence.

All the best with your rehab.

[chunkypuffin]

Dear alophysio,

forgot to ask, did you start on a masters course? Replied to one of your threads about a year ago re; studying and you were talking about starting a manips masters. Where did you decide on if you did enrol? I've taken the leap and enrolled on the UWA course - Master of Manual Therapy. Different to other masters, as it is a masters by coursework, but this means that everything undertaken is clinically oriented. Really looking forward to coming over next summer for my 3 month residential, although expecting a lot of stick with the way the Ashes are going
Anyway, hope your studies are going well if you have started.
Best regards

Craig

[alophysio]

Hi Craig,

Thank you for the post. Your point is well made and I appreciate the post linking to musculoskeletal physiotherapists. You are right, being in Australia has its limitations. By listing the other physio, i was hoping to provide a contact point for makaveli1 to phone her to find out where some other physios are near his area... Her name was given to me by a phyio that runs courses over there in England. I also emphasised the ONE in perhaps the wrong way. Now i reread it, it looks like the ONLY physio to see - not my intention and i am sorry about that. I was hoping to mention that i only had one name to give.

As for why i don't think it is discogenic pain...The pain has been there for 4 months now. It is therefore chronic and given that makaveli1 didn't report reinjury, i assumed that any perpetuation of his pain was more likely to be from a motor control issue that the disc injury itself - as in the disc is sustaining some form of stress on it causing the pain. It could also be simply a case for the pain psychologist but i think most people won't think so. Also, the NHS physio would probably have given Mackenzie extension exercises if he felt that it was a disc problem...In fact, if PA in prone was stiff, wouldn't that mean decreased extension ROM anyway??? So therefore, i thought that the diagnosis was non-specific low back pain with probably issues in controlling movement.

It will be interesting to see how Makaveli1 goes...

So to recap, thank you for the extra reference and I am sorry if i offended anyone. And yes, it is hard to provide advice without seeing the person (something that i thought i said but didn't).

BTW Craig, check you messages...

[neurospast]

After having read all the responses I am wondering how it is possible to give such a precise answer with so little information In a way like chunkypuffin said. The problem which arises is that a answer is given on "hear say". The physiotherapist said that.... he did..... After my experience the majority of patients are so stressed at first contact that they have no clue what is said, what is done and what exercises are given. Therefor it is a good idea to give indeed simple exercises and maybe only one or none. This patient could be a problem because he is to keen to get better and therefor impatient and could hurt himself again and again. (I asume after reading his comments. maybe Makaveli1 could reply to see if my assumption is right)
And yes I make the same mistake, I assume on the little information given but wouldn't it be good practice to assume as little as possible?

[makaveli1]

thanks for the replys everyone just a quick update. As far as I know I havent reinjured the area to the point it was before but have strained my back on a few occasions.

I went to the NHS physio last week and he check my flexiblity by making me bend forward, to the side, and backwards. He said these had improved, but still couldn't give me any real diagnosis, he suggested I strip my training right back to the bare minimum. So I basically stopped for 2 weeks, the pain is still there after a while when I sit. I have been doing the same exercises as before written in the thread 2 or 3 times a day. I know my flexibility has increased as am closer to touching my toes.

I just felt like the guy blew me off I told him the pain was still there, but he said it is still "early", made another appointment with him but feel like its a waste of time.

So Im going to go private to in the next few days, hoping I can get more of an insight to what is wrong with me, and how I can fix it faster. Will let everyone know how it goes