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Low back pain fixed with shoulder release

10 Nov 2015 by Graham Nelson

Mr B, a 36 year old keen runner, presented with a several month history of left lower back and hip pain, which he was noticing with bending, lifting, prolonged sitting and running distances greater than 6-8km.

  
Mr B’s main goals: (self rated as 10/10 being pain free and full function)

1. To sit and drive for greater than an hour without pain (6/10)

2. To bend painfree (currently 5/10)

3. To run greater than 8km without hip pain.  Ultimately to complete a half marathon (21km) 


We performed a systematic assessment of Mr B's musculoskeletal system and found the following imbalances:

1. Neurodynamic tension in the left lower limb

2. Significant restriction in flexibility of hamstrings bilaterally: Left – 60 degrees; right – 45 degrees.

3. Widespread muscle tension and guarding, particularly of left gluteals, quadratus lumborum and calf, and left and right subscapularis, infrapsinatus and pectorals

4. Stiffness in the anterior portion of disc at L2 segment, right worse than left. 

5. Stiff lumbar and thoracic segments at T6-8 and L1-3. 

6. Significant muscle guarding with lumbar flexion and extension movements. 


Through a clinical reasoning approach, we worked out together that Mr B's left hamstring flexibility was a good test to measure changes in his condition. Through a process of treatment directed testing, we found the biggest and quickest change in this test occurred with a release of his left subscapularis muscle (underneath shoulder blade). It increased his left hamstring flexibility by more than 40% and even improved his right hamstring flexibility by 30%. When re-testing the main dysfunctions in his body, most of them had improved (decreased muscle tension around his back, lower limbs and shoulder and increased movements in his hip and back (lumbar and thoracic).


Following the reassessment, we were confident that we had found the main driver of his left hip and low back condition.  With only a further 2 sessions of treatment directed to the left subscapularis muscle, hamstring, hip, lumbar and thoracic movements all returned to approximately 80%. A secondary contributing factor was identified in the right L2 anterior disc and with 2 treatment sessions directed to this segment, we restored all of his movements to 100%. 


In line with these objective improvements, Mr B had achieved his goals of sitting and driving for greater than an hour without pain and bending without pain.  He was also now running greater than 10km without pain and limitation and feeling much more confident in his ability to achieve his ultimate goal of running the half marathon. 


Mr B was taught postural and motor control strategies to look after his primary and secondary contributing factors in order to prevent aggravation in the future.  He managed well with this and
integrated these into both his daily tasks and exercise regime.  Following the initial 5 sessions of treatment which achieved these goals, Mr B was able to maintain these gains with a tune-up approximately every 6-8 weeks. 


This is another case which demonstrates how other areas in the body can affect the overall condition and without a thorough assessment, we can’t be sure we are treating the main driver of the condition.
If you would like to learn 
 more about the neuroscience behind the approach we used with Mr B, please click here.

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