A case study: How did this client overcome their low back pain with one consultation?

Wondering about the process we’ll follow if you sign up for the How to Overcome Lower Back Pain consultation and the online course? Here I’ll go through the process in detail and explain how it worked for one recent client, Beth (not her real name.)

An overview

1. Questionnaires are filled out so I can get an idea of what’s been going on.
2. Consultation over Zoom or similar to allow me to find out more.
3. Advice and recommendations to help overcome your lower back pain.
4. Online support for 2 weeks to answer any questions or clarify understanding.
5. Results and discussion about next steps if required.

Let’s take a look in more detail.

The initial questionnaires

Click through here, enter your email address and you’ll be sent an email with the initial and consultation questionnaires.  I’ll be in touch by email, within 24-hours, to book in your 45-minute online consultation.

The consultation questionnaire provides the information I need to know about your lower back pain, so I’ve got a good understanding and have had a chance to do some research before we first meet. This means I can provide the best advice possible.  

In Beth’s case, she explained she had had an MRI. She had a herniated disk (L5) pressing on her nerve root, and a bulging disk with annular tear at L4. The pain she estimated to be a 6 out of 10, 7 days per week, and she said it worsened as the day went on.

She went on to say:

“I hurt my back at the gym. I have intense sciatica that seems to be getting worse. I am unable to lie on either side of my body because of the nerve pain that radiates down both legs and I find ease of symptoms laying on my tummy. I cannot sit or drive. When I stretch my legs just by standing my sciatica flares up which is why by the afternoon it is unbearable. My largest pain is sciatica but it does not hurt my back to walk.”

She also provided more information about how everyday postures and positions impact her. Things that made her pain worse were house cleaning, carrying groceries, too much walking – that’s all useful information that can help me build a picture or what’s triggering and what’s relieving her pain.

Beth had actually been to a physio before, but the pain was getting worse, this suggests to me that they had not listened to her whole story, therefore they did not provide the right advice. Disc bulges and herniations are not caused by a one-off action, they build up over time. So while she says she hurt her back at the gym, it is more likely that this was ‘the straw that broke the camel’s back’ so to speak.

Consultation

After reading Beth’s questionnaire answers, we held a 45-minute online consultation. We covered a lot of information and worked out the timelines that had led to her current condition.

We spoke in April 2021. Her MRI L4 / L5 had taken place in December 2020, a herniation was picked up with the pain travelling down her right leg. She saw the physio for 6 weeks but the pain had returned by February 2 weeks later.  She repeated the MRI in March to find that a new herniation was going down both legs.

Beth explained that the physio had given her exercises such as nerve flossing / gliding, the McKenzie press up, and core tensing and squat. I felt that these were relatively generic exercises that were not given in response to an understanding of her specific condition. Unless you also remove the triggers there is risk the pain will come straight back in the future.

Beth explained that she couldn’t sit. In a chair at home she would suffer tingling and numbness after 10 minutes, while in the car it was painful after 5 minutes.

It’s always useful to be able to measure progress so we talked about what time the pain began to build up. She explained that it was about 1pm that the pain would really come on. She would lie down for about 30 minutes to reduce the pain. We discussed the fact that if we could work out ways to push this time back or reduce the level of pain this may be a good first step to regaining quality of life. It can’t always be about removing all pain instantly.

Advice and recommendations

From all the information gathered I was able to make an informed analysis that was entirely specific to Beth’s lower back pain.

I set my advice out in 4 parts and signposted Beth to information from within my online course and beyond. There are several workshops that were of use to her as well as explanatory videos and other bespoke information provided via email.

Core skills

With regards to disk bulge, a flexed spine is part of trigger in creating the bulge. That’s why it’s vital to bring the spine into a neutral posture to create that gentle inward curve. This helps to minimise risk and spread the load around the disk. A neutral posture puts the spine in position, while a brace holds it in that position, stabilising the spine.

Beth also mentioned painful ‘catches’ with certain movements, so we looked at ways to slow and smooth out movements and work to prevent this.  We also talked about hinging from the hip rather than the spine when it comes to lifting, bending, gardening etc. This helps to reduce the risk of the nerves being irritated and therefore pain shooting down the legs.

Sitting and standing

We discussed that sitting and standing are static positions but that our bodies prefer to move, this is why changing posture and position regularly can help. Beth was able to sit 10-15 minutes without pain at home, so I advised on ways we could begin to build that up. I suggested she sit for 8 miinutes pain free, then get up and walk or lay on her stomach for 2 before sitting again for 8.  This would give her 16 minutes of pain-free sitting with a 2-minute break in between. This could then gradually be extended and tweaked.

We also added a cushion to position her pelvis and spine to reduce the risk of nerve irritation from slouching or flexing.  We had to work out how big cushion needed to be to find optimal position but understanding this gave Beth some control over what she could try.

Lifting

Supported by videos and workshops from the online course I sent information about different options for lowering the risk of pain when lifting. Beth was able to watch these in her own time and begin to work on this skill.

Decompression

Initially decompression (spinal stretches) would aggravate Beth, but she was eventually able to neutralise her spine and minimise the bulge. She was finding her pelvis moving when she did decompressions, so in a workshop I was able to talk her through how to decompress while maintaining position.

 2 weeks support

Once I’ve sent over the advice and recommendations, I’ll follow up a few days later to see how everything is going. This process is not about me telling you I’m right, it’s about giving you the tools and information to try things and see how your body responds. Some things might not be as effective as others, but this is how we work out what works best for you.

At this point, Beth was doing well with postures and trying to make them habits and she was already starting to feel a difference in the way she moved and sat. There were a couple of days where she didn’t even lie down in the afternoon which is significant. So we had improvement in terms of reducing and possibly even releasing pain.

She had bought the lumbar cushion and was starting to practise sitting for periods throughout the day. The decompressions had been an incredible benefit (once we got the position worked out!) – it was only after watching the video that she realised she’d previously been doing them wrong.

She asked some questions, and I was able to answer them. So she continued with what she was doing as it seemed to be working.

A week and a half later Beth asked about how she could begin to get back into exercise and try to build an idea of when she’ll be able to go from rehab back into fitness training. It can be hard to decipher when that time should be. It’s a combination of when you feel ready and when your body is ready to respond, but ultimately you will only know once you start trying.  I describe it as starting at shallow end and walk into deep end - finding the right balance and sweet spot between too much and not enough effort.

In Beth’s case we discussed the fact that one indicator of disk bulge in the future is a disk bulge in the past, so she would need to remember to continue with exercises and good habits to lower her risk.

Over the two weeks I answered lots of questions and sent through relevant videos as part of the online course. She gets to keep that online course for life so can keep readdressing / relearning as and when she needs to.

Results

A week after the online support had finished, we talked results.

Beth reported her pain now hovers around a 1-3 out of 10. She still experiences some degree of pain daily, with more intensity later in the day but she describes it as ‘significantly improved’ If she has continued to do the right things, she may now be pain free – it is entirely possible.

She said she finds it helpful to rest for about 30 minutes in the afternoon to make it through the remainder of the day, but she can now sit for about 30 minutes before she feels any need to stand – that’s at least double the original time and is a much better place to be. Sitting for driving has increased to 10-15 minutes pain-free instead of 5 minutes, so again doubling or trebling that capacity. The best bit is Beth says the pain no longer ruins her whole day like it once did.

She says:

“Overall I’m doing much better. While I still hurt, the intensity is manageable and for the first time in months I feel hopeful that it will eventually heal. I have learned that posture is everything. If my posture is perfect, I can actually have zero pain. I can see how having a stronger core is essential to maintaining this posture and currently I find it difficult to maintain it because my core is weak. I am anxious to begin core work to help reduce fatigue during the day.

“Because I can tell my pain is winding down, I’m no longer plagued by nerve spasms when I sleep. I can go the whole night without one, which is tremendous. When I first contacted you, I was getting sometimes 3 hours a night. The decompressions throughout the day have also helped.“

Beth is still working on and building on my advice and recommendations to help wind down her pain, she now understands better how to manage and improve it over time, she doesn’t feel she needs me to help her with this stage. If she has new questions in the future or wants to understand how to move from rehab into fitness work, she may feel it’s the perfect time to come back.

Meanwhile, I’m delighted to see how much progress she has made. 

If you feel I could help with your lower back pain, click the link below to download the questionnaires and get started today:

LBP Consultation & Coaching (christopherholetraining.com)