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Back’s back

Jan 12th, 2014

Sarjeet asked The Guru for the following Physiotherapy Advice:

Hi Guru!

I’ve had ‘lower back pain’ on and off for over a decade. It was always localised to the lower right hand side of my lumbar region.

Then suddenly a few months ago during a really painful flare up, the pain jumped to my left buttock and all down my left leg to my foot (indicative of sciatica). I couldn’t sit, stand or walk because of the pain. An MRI revealed a disc herniation, which was operated on just over a month ago. The sciatica pain in my left leg and buttock disappeared instantly! The wound, and inflammation around the surgery have pretty much healed now too!

However, the original pain in my the lower right hand side of my back returned (with a vengeance) about a week after surgery!

After doing some research online, i’ve identified that the pain is actually (and has always been) on my posterior iliac crest, and in my gluteus medius! The area is so painful, that once again standing, sitting, walking, and now even sleeping are a struggle!! I’ve tried doing ‘clamshell’ exercises, and myofascial release with a tennis ball, but no such luck.

I’d be amazingly grateful for any advice or guidance you may have!

Hope this message meets you well, (sorry it was a bit long-winded!)

Kindest regards,

Sarj

Jan 12th, 2014

The Guru Responded:

Hi Sarj

Great post – all sounds very normal, above board and incredibly frustrating.

The surgery has dealt with the structural issue (the disc) but you haven’t changed the functional one. This is what you need to do next….

The pain you feel, is not where the pain is. It’s referred pain from your back and not necessarily you disc. All the things you are doing can be good pain relievers, but they will never get rid of the problem.

The most common cause, and you fit the profile, is having a really stiff but painless thoracic spine. The lack of mobility here means that your lumbar spine has to compensate for the lack of movement in your thoracic spine and therefore move more. Unless you can control this excessive movement in your lumbar spine it will irritate discs, joints, ligaments….take your choice!

So, leave your lumbar spine alone. No stretching but try to work on stability and small, subtle control of how this bit moves. The most important bit is to get your thoracic spine moving, without changing the stability of your lumbar spine. Posture, sitting at work are really, really important. Don’t slouch or don’t become a sergeant major and stiffen everything up. Lift your chest up, not your shoulders and don’t lean backwards.

Try stretching your thoracic spine by rolling up a towel – like your heading off to the pool. Put this on the floor and put a pillow at the top of it – like a “T” shape. The pillow should be slightly higher than the towel. Now lie on the towel so your head is on the pillow and the towel runs down your back from the nape of your neck to just below bra strap level. Bend you knees up and hang out for 10 minutes. Try this twice a day, and it mustn’t be painful – if it is your doing it wrong!

Change how you move rather than what you move…

Good Luck

The Guru

Six Physio

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