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Back Pain Treatment at Sports Injury Clinic Marylebone London

Back Pain Treatment

Do you like to keep fit and active, but back pain is holding you back? Find out more about back pain treatment we offer on our Martin Higgins Clinic, Marylebone.

"I help fit and active men and women get straight to the cause of their back pain problem and address it quickly, so you can be free from back pain and start getting back to your usual activities."

THIS IS A CASE STUDY OF SUCCESSFUL TREATMENT OF SPONDYLOLISTHESIS LOW BACK PAIN USING A NEUROLOGICAL APPROACH (INCLUDING POSTURAL RESTORATION TECHNIQUES)

Case Study: Back Pain Treatment

INITIAL ASSESSMENT

Karen had been suffering with low back pain for 10 years. 

A recent MRI and X-ray had confirmed bilateral pars defects at the L5 vertebral level & her
 spinal consultant had given her the diagnosis of grade 2 spondylolisthesis low back pain. 

[Spondylolisthesis – where a bone in the spine (vertebra) slips out of position, either forwards or backwards – see image below]

Usual Activities: walking, gardening and yoga.  

Main Problem: Pain with usual activities, periods of prolonged standing and when lying on back


Clinical Testing: 
1.  On lying: pain in low back, excessive range of movement (120 degrees) in both legs before she felt any restriction in her hamstring muscles on a straight leg raise test (see image below). 

2. On standing: weight bearing through the front of the feet and unable to sense heel (calcaneal) bones. Able to place her palms flat on the floor on a when doing the toe touch test
3. On walking: weight bearing on the outside of her foot (not her arches). In the past all her walking boots and trainers would wear out on the outside of her footwear (supinated – see image below).

Assessment: 

1. Too much flexibility – Contrary to popular belief having too much flexibility suggests pelvis instability and is often a cause of pain & injury

2. Foot in an incorrect (supinated) position – Without being able to sense your arches and big toe when walking, it indicates your foot is not pronating (the normal transfer of weight through the foot during the normal walking cycle) and you will be unable to shift your hips (pelvis) from left to right and vice versa, which is required for a normal walking (gait) cycle.

Karen had been trying to maintain “good posture” by standing up tall and keeping her chest up and shoulders back. In sitting she was using a lumbar roll to maintain a deep arch in her lower back.

I commonly see this problem, in patients who come for Back Pain Treatment. They are standing & sitting too straight and they are extended through their back. This places the upper lumbar spine in excessive lordosis (see image below). I refer to this with my patients as being “over posturised”.

By maintaining this over-posturised position it creates compression in the lower (lumbar) spine. This excessive arching (lordosis) will often increase symptoms in patients suffering with spinal stenosis, spondylosis, spondylolisthesis and facet joint problems.

The influence of Malocclusion and teeth grinding

 

This patient also had a significant malocclusion and also had a long history of teeth grinding. Teeth play a significant role in fine control of jaw function. This malocclusion can cause faulty muscle patterning of the muscles used for chewing and swallowing and around the cranium, neck and thorax.

From my clinical experience I decided to use an occlusal appliance (bite splint) to change the sensory neural input from the patient’s teeth. It is well documented that malocclusion can influence the muscles in the cervical spine and entire thorax.

I worked with a dentist to fabricate a flat plane occlusal mandibular appliance. It is made with hard acrylic and is constructed to achieve balanced contacts with all opposing supporting teeth.

 

 

BACK PAIN TREATMENT APPROACH

1. Bite ‘mouthguard’ appliance: to balance her teeth contact and improve muscle position around the jaw and neck
2. Manual therapy in clinic to correct her ribcage and pelvis position
3. Home exercise programme to ‘re-train’ her muscles to maintain pelvic stability and good ribcage and spine position
4. Postural Advice: remove the lumbar roll she was using when sitting, adopt more relaxed sitting posture by bringing ribcage down. 

Following treatment to correct her pelvis and ribcage position, karen felt more ‘grounded’ and stable in the standing position and she could sense her heels and arches when walking. Karen lost the excessive arch in her back and no longer experienced pain on lying down.

Her hamstring muscle function around the pelvis improved: 
1. In the toe touch test, the patient could no longer place her hands flat on the floor and felt restriction in her hamstring muscles. 
2. Her straight leg raise testing also changed, in that the patient now felt restriction at 90 degrees compared to 120 degrees. 

My treatment then focused on restoring optimum ribcage and diaphragm position. Strong emphasis was placed on facilitation of the hamstring and abdominal (stomach) muscle groups. 

With the occlusal appliance in place on the mandibular teeth (lower teeth), the normal sensory information that the brain received from the patient’s bite had been altered.

The appliance balanced the patient’s occlusion. The use of the splint shifted the patient’s centre of mass back and with the splint in situ the patient could now sense her heel (calcaneal) bones and her arches in standing.

 

The patient used the bite splint whilst performing her home exercises, walking and during the night. This allowed her to facilitate the muscles around the pelvis more easily with the splint in place whilst performing her exercises.

 

Improving the control of the pelvis to restore optimum diaphragm position.

Strong emphasis was placed on facilitation of the hamstring and abdominal muscle groups to take the spine out of excessive lordosis and reduce compression in the patient’s lumbar spine.

I removed the lumbar roll she was using when sitting and taught the patient to achieve a more relaxed sitting posture by bringing her ribcage down. Specific exercises developed by Ron Hruska at the Postural Restoration Institute in Nebraska were then used to improve activation of the hamstrings, abdominals and adductor muscle groups.

Back Pain Treatment Result

This patient had a very good outcome with the use of the flat plane bite splint and home exercises to improve her pelvis and lumbar spine position and reduce symptoms of lower back pain.

This case study of a patient with grade 2 spondylolisthesis highlights how changes in the neurological system can significantly impact the musculoskeletal system. In this case the patient’s occlusion had a profound effect on her pelvis position and where she perceived herself in space.

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