Mr H, a 45-year-old male, made an appointment and came to the clinic with lower back pain that had started a month prior, and while he had been getting some therapy, it wasn’t improving. He usually enjoyed his work and, up until his injury, had been doing boxing training for a year. Suddenly, when he injured his lower back, it all had to stop. He was keen to get back to work but was frustrated because he could no longer do his job for long before his back and the pain spreading to his buttocks became increasingly sore. Not only that, but he could feel his fitness slipping away now that boxing was making his back worse.

Mr H had consulted with his medical doctor, who had ordered an MRI, which revealed that his lowest spinal disk was injured and there was a bulge that was pressing on his nerves, causing radiation into both hips.

He was frustrated, suspecting that allowing it to continue could worsen it. Deep down, he knew he needed to seek a different opinion and course of action. He was suffering at work and was advised not to attend boxing lessons. He was understandably worried about his future.

I saw that Mr H was keen to return to driving work and boxing. It can be frustrating when you have pain affecting parts of your body, and you don’t seem to be progressing. It’s like you have a blockage, putting your life on hold. It would be challenging to break things down into small actions that would get the ball rolling for him, but he could build on these to generate better movements and less pain.
With a 30-year career in helping patients overcome muscle, joint, and spinal pain, I approach each new patient with an open mind, endeavouring to discover what the issue is, which steps to take, and which to avoid to improve their condition.

As an osteopathic doctor, I needed to find out what he was feeling, how it affected him, and how much he could stand, sit, and move during his usual daily activities. Mr H was unable to sit to do his normal forklift driving for more than an hour without lower back pain and getting referred pain in his buttocks. Bearing in mind that a lot of shock loading affected his back while driving a forklift. Fortunately, his work allowed him to mix things up and work in the office, which gave him relative rest, and he could get up and down when he needed to get some movement and provide some relief.

To determine which part of his body is injured and where it is in the healing process. Having had an MRI made it more apparent that he had a small disc protrusion at the L4-5 region of the spine (lower back). It was placing pressure on the left fourth nerve root, which seemed to cause pain radiation to his left buttock. This led to his diagnosis. There were also knock-on effects on the areas surrounding this. His lower thoracic and upper lumbar (lower back) and below the injured section, as well as his hips and buttocks, were also under increased workload. It had disrupted his normal activities for a month before he came to the clinic.

We are developing a strategy to do what you can to help and then progress. The plan is to start by improving the mobility of the joints above and below the area of injury so that they can take up the movement and reduce the strain on the injured area. This means loosening the muscles and tendon tensions and moving the joints in pain-free ranges of motion.

Activities outside of the clinic were modified to the point where there could be some pain but not overly so. This is done on a trial-and-error basis and relies on the patient giving feedback to work out which way(s) the activities should be adjusted. Over time, the activities will gradually be increased with a proportionate period of rest to allow good recovery before participating in them again.

As an Osteopath, I work out the types of therapy that will help to loosen the muscles and tendons and mobilise the joints in a way that won’t result in excessive pain on the day after treatment. This requires working out the correct dosage of physical input. Sometimes, this can only be done with feedback from the patient in the following two to four days. That is why we send an email on those days after treatment to get an idea of how the body has taken on board the energy input from the treatment and how long it takes to recover. This can vary depending on your level of fitness and rate of metabolism.

When I agreed to help Mr H, I asked that he provide honest feedback on the effects of treatment and exercise after each session. This would let me know what had and hadn’t worked. This information helps me, as the therapist, to decide which aspects of therapy to continue, adjust, or stop. This leads to a refinement process and moves things towards Mr H’s goals.

Getting the ball rolling…

In Mr H’s case, he booked an appointment online. If he was unsure or had questions that needed clarification, he could schedule a call. Sometimes, people are unsure whether osteopathy can help them, so we offer the opportunity to book a no-obligation 10-minute chat to answer any questions.
Here is a link:

• The feeling of significant improvement.
• He restored his confidence in his ability to perform normal duties at work as a forklift driver and work for as long as he wanted by taking breaks should he feel fatigue setting in.
• The ability to gradually and progressively return to boxing training helps keep him mentally and physically fit.
• Increasingly active and able to take on and train two new puppies.
• Able to work and earn as much as he was before the injury.
• He has less pain in the lower back and fewer periods of pain in his buttocks. And if he does have any pain, it is more like the delayed-onset muscular soreness that he would usually feel the day after a workout.

• The continued frustration of not getting any better.
• The inability to return to his regular role at work and home.
• The risk of becoming much less fit and losing strength.

Mr H’s injury is serious. The journey and transformation have taken over four months. He was highly motivated to get better, and it is so gratifying to see how he took advice, implemented, and monitored the changes that needed to happen.