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30 year old male with 2 years of low back pain

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This entry is part 1 of 1 in the series The Pain Detectives Series

At Errol St Osteo we are constantly dealing with all different types of injuries.

On a daily basis we see back pain, neck pain, headaches, locked jaws, frozen shoulders, carpal tunnel, ankle sprains, knee injuries and many other conditions.

As we have been around longer and longer we have started to see more and more complex cases.

Injuries that have been lingering and loitering like barflies searching for one more drink after last drinks were called hours earlier.

Which is great. Acute injuries are relatively simple. Satisfying to help people with but not particularly stimulating.

And so we really enjoy the challenge of diagnosing and determining why certain injuries linger longer than others.

As a method to determine the cause we run through thorough case histories, search for psychological factors such as predetermined ideas and assess movement patterns.

In the last year or so one of the things we have really been looking for is habits.

People’s habits are fascinating.

And they often have absolutely no idea they have them.

Two weeks ago we had a patient in, a thirty year old male with a two year history of right lower back pain. He’d seen numerous practitioners, all had provided some relief but it kept coming back.

We went through his history searching for reasons, was there any acute trauma, car accidents, lifting too many weights, poor squat technique, was he inactive and just slouching too much, how much did he get up from his desk?

Nothing was leaping out.

The questioning went on and on and the patient was clearly starting to get frustrated until the right question was asked.

“How often do you sit like that?”

“Like what?”

The patient, who had been getting visibly agitated that we weren’t actively taking his pain away, had been sitting with his right leg in a frog leg position on his left.

That is right ankle on left thigh, right knee at right angles and away from the body and the right hip externally rotated.

He had been sat like that through the previous 30min of my interrogation.

“I don’t know, a bit I guess.”

My guess as the practitioner was that if he could sit in a position like that for 30min unflinchingly then he probably would be sitting like that throughout the day.

Treatment wise

We worked to undo that position. So we massaged, pushed and stretched the muscles that would be shortening to hold the patient in that position, cracked a few things and stood him back up.

He felt great, but he had felt great after previous more broad brushed type treatments.

However his homework was different from anything he had been given. No specific exercises, no core work, no stretches.

All he had to do was pay attention to the position he spent the majority of his day in.

And when he figured out what that position was he was to invent an exercise or a movement that was the opposite to that position. I didn’t mind what it was.

And the result?

He came back in swearing that I was a genius. His back pain of two years was gone.

Why?

Every single time he sat anywhere, whether he was at work, at a cafe, at a bar, watching tv, his first instinct was to raise his right leg and frog leg it across his left thigh.

How would this have caused his pain?

The body adjusts to positions we hold. Certain muscles must contract and shorten to hold us there. Other muscles must lengthen to allow for that positioning.

In this guy’s case the hip was held in external rotation, so the external rotators of he right hip were shortened and contracted.

This created a stretching moment arm on the joints (or more particularly: one specific, two year painful joint) of the right low back.

Not only that but the patient had been told numerous times by different practitioners to stretch his right low back.

Which if we place in the context that his right low back was being stretched every time he sat would have perpetuated and prolonged the his low back pain.

What’s the moral of this story?

Aches and pains are complex, it’s important that you think about what it is that you do.

Generally speaking an injury that has been around for a long time doesn’t just stay injured.

Things heal, no matter if they are ligaments, joints, muscles, discs, tendons, given the right stimuli or the right amount of rest or when they are taken off load, they heal.

If you’re practitioner doesn’t seem to be thinking through what is going on with you but instead applying a broad brush to your injury, get a second opinion.

Errol St Osteo: Apologies For The Self Modelling, Googling Cross-legged Positions Does Not Provide Health Relevant Material

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Posted in : The Body Detective Series
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