John is a 35 year old male office worker with a history of niggling low back pain. Yesterday John noticed his back pain building while out running a particularly hard run. The pain developed into severe low back pain that night and was even worse in the morning when he woke up. How can Beyond help John?
We would suggest John makes an appointment with one of our Osteopaths. Our Osteopath would begin by taking a full and detailed history to try and determine not only the cause and nature of John’s pain, but also any lifestyle factors that may have contributed to it. This would be followed by a thorough assessment. They would look at how John’s back and lower limbs are moving and would assess how his muscles are activating. Once the root of Johns pain has been identified, our Osteopath would treat John’s muscles and joints to try to reduce his pain levels. Techniques commonly used by Osteopaths include soft tissue or massage, articulation, which target the movement of the joints, manipulation or even dry needling. At the end of his appointment, John would be provided with a detailed plan to help him manage his pain. This may include anything from follow up treatments required, advice regarding stretches or exercises or even ergonomic advice for his work station.
While taking John’s history, the Osteopath noted that John has been running in well worn shoes with particularly poor support. Their assessment showed that John had excessive pronation in his feet, commonly referred to as flat feet, that was causing increased rotation through his lower limbs during running. This results in tilting through the pelvis and increased curvature of the spine, which places strain on the muscles and ligaments of the back. The Osteopath feels that this may have been contributing to John’s long history of low back niggles and so once John’s acute pain has settled, they refer him to one of our podiatrists for their opinion.
Our Podiatrist assesses the function of John’s feet. This involves an initial examination, including a history of symptoms and current footwear, a biomechanical assessment of John’s feet and an evaluation of John’s gait. Our Podiatrist advises John on more appropriate running shoes and provides him with some strength exercises to improve the posture of his feet. Our Podiatrist has also strapped up John’s feet to provide them with additional support and will look at the possibility of orthotics further down the track if John’s lower limb biomechanics can’t be corrected with more conservative measures.
The Podiatrist is now happy with the support through John’s feet however believes that more work needs to be done to correct the ongoing biomechanics through his back and lower limbs. At rest John’s lower limb biomechanics are great. Once John is out running and starts to fatigue he struggles to maintain the stability through his hips and pelvis. This increases the load through his lower back and makes him more susceptible to back pain. The podiatrist chats with John’s Osteopath who agrees. They decide that John would benefit from improved stability through his low back and improved muscle control, especially when out running. They suggest John tries Clinical Pilates.
John makes an appointment with one of Beyond’s Clinical Pilates instructors. During the first assessment, the instructor reviews Johns history and assesses John’s goals and expectations. They do a full assessment on the strength of John’s muscles and look at how his joints move. A real time ultrasound is used to see how John is activating his deep core muscles. The Clinical Pilates Instructor discusses this with John and they run through some basic Pilates exercises with him to get him started. John has never done Clinical Pilates before so he has a follow up one on one session to learn how to use the equipment and to get a full understanding on how to activate his muscles correctly. He is now ready to start group classes which he attends on a weekly basis. Over the next few weeks John starts noticing his strength improving and is more aware of how his body is moving.
John’s severe back pain has eased and he feels that his niggling pain is now under control and well managed. His body is now feeling so good he has decided to increase his running and train for a half marathon! He discusses this with his clinical Pilates instructor and although his stability is feeling good, they both feel that he needs more strength and power to be able to run the time he is setting out to achieve without re aggravating his back pain. The Pilates instructor feels that he could supplement his Pilates with some specific strength work and refers him on to the Exercise Physiologist.
Our Exercise Physiologist reviews Johns history, then sits down with John to discuss his running goals and current exercise program. They then run John through an individualised program for him to do at home and set out a suitable running program aimed at getting John through his half marathon pain free. These programs are reviewed and adapted every 4 weeks. John also begins a small group exercise class with the Exercise Physiologist once a week. This class focuses on strengthening the specific muscles and movement patterns John needs for his running.
John is now running a lot more than he has in the past and his running times are looking great! Although he is feeling strong, the extra k’s are causing his legs and back to feel tired and achy. The Exercise Physiologist suggests he could improve his recovery between runs. An option they suggest to John is Myotherapy.
John books an appointment with our Myotherapist. Our Myotherapist takes a detailed history of John’s low back pain as well as assessing his current exercise program. They treat John’s back and legs using a variety of soft tissue techniques including massage, stretching and dry needling. This loosens the muscles and helps minimise any aching and tiredness through John’s back and legs and enables him to run more frequently and without discomfort.
John completes his half marathon in a great time and feels his low back pain is now manageable and under control. The team at Beyond love being able to work together to help patients like John achieve their goals and MOVE THROUGH LIFE. Not every patient that walks through our doors will need to see practitioners from every different service like John did, but the team are here to support you should the need arise in the future.