Hi sharing an interesting case of forward neck and continual back pain.A 35year old software professional presented with repeated episodes of low back pain and stiffness making sitting, standing or even lying down painful . His first episode was 3 years ago and have been repeating since then ,each time with increasing severity every 4-6 weeks. He had consulted many doctors and physios . He would feel better with prescription 10 day courses of anti inflammatory and muscle relaxants with physical therapy till the next episode hit and the cycle started again.Multiple MRI scans had shown that the lumbar architecture was fine and the lordosis aka the curve in the low back had flattened out.
A detailed history and observation showed that he was a workaholic in long periods of chair sitting and screen time. Both of these had not been kind to the back. He had a visible Forward head position, rounded shoulders and flattened out low back
Pic courtesy physioqinesis.com
Chain of events
His habitual positioning had caused a weakening of the spinal muscles. This was made worse with the weak neck musculature.All of these had lead to poor core strength and a flat back. A flattened back is like a stretched out rubber band with poor shock absorption and flexibility. This caused repetitive microtrauma to the structures and tissue damage over a period of time. At this stage the body would respond to pain meds and passive pain management techniques like IFT and TENs but as the original faulty pattern was not addressed the tissues had never healed fully . Their ability to bear the loads in day to day life had come down and thus started another pain spasm episode. Repeated pain cycles had caused the brain to freeze or inhibit the painful part even now without actual tissue damage. This explained the constant stiffness without pain.
Phase 1( Repositioning forward head and strengthen upper back)
We started with these
Standing arm reach
Once he was comfortable repeating each movement 30 times per day painless we moved on to phase 2
Phase 2( Functional core muscle activation and improving hip flexibility)
Chair squat- stand facing the back of a sturdy chair. Place your palms on the back of the chair . Keeping the knee caps forward and bend the knee 5-8 cms keeping the weight on the heels . Breathe in as you go down and out as you come up. Repeat 3 to 5 times each hour. Make sure to keep the ribs in line with the hips .
Toe raises with belly breathing
Stand with the feet shoulder width distance and the outer border parallel to each other. Breathe in and lift yourself up on the toes. Breathe out engaging the core and come down without touching the heels to the ground . Repeat this movement 3- 5 times each hour.
Over a period of 8 weeks he reported no pain flare up. His pain at rest had gone down by 50 percent of the original reported and he had started walking at a comfortable pace outdoors for 60 min everyday.
To sum it all I’m quoting one of the foremost pain clinicians Dr Greg Lehman BKin ,Msc,DC,MscPT
The body is more of an Ecosystem and less of a car that needs aligning. Our treatment should reflect this
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Sitting posture of subjects with postural backache