Heather (54-years) came to see me with a 7 year history of lower back pain. It had started with an MRI confirmed L5/S1 Disc Herniation with Sciatica. She initially responded well to physical therapy, involving manual therapy and core stabilization exercises and she was told to avoid spine flexion (bending forwards).

She told me that initially her back pain was provoked by sitting and spine flexion which was causing her a lot of issues at work. She had also experienced a couple of painful episodes when bending down to pick up objects from the floor and simply putting the leash on her dog or bending to pet him. As a result of these severe episodes from bending forwards and her physical therapist telling her not to flex her spine she had become scared of this movement and had done her best to limit this motion in day to day activities for the last 7 years.

At the time of our initial appointment, her symptoms were very different to what she had experienced 7 years prior when her lower back pain started. She described a sensation of her lower back feeling constantly tight, achey, and compressed, especially when standing, laying on her front and walking. Sitting provided some minor relief.

I wanted to test her spinal motion, but as she had a fear of flexing forward whilst standing we assed this using the cat/cow, and childs pose. During these moments she found it very difficult to flex her spine, and it felt very foreign and awkward to her.

Her back was so stiff that she experienced a massive stretch just laying on top of a large gym ball and after a couple of 60 second stretches, she felt much better.

Her case history and physical assessment suggested that her reduced ability to perform and the avoidance of spinal flexion had led to the tissues of her back being overly tight.

We discussed that although types of disc herniation can be irritated with flexion in the acute phase, the body is excellent at healing, it lays down tissue in the direction of the force it experiences, a process termed “mechanotransduction”. By gradually reintroducing and exposing her spine to flexion, the body adapts and becomes more resilient to this movement. By avoiding it completely, when you have to flex, your tissues will not be resilient in this motion and you’re more likely to get an injury. Additionally and pertinent to her case, we needed to stretch the tissues of her back through flexion.

We provided her with a progressive mobility program and a course of Osteopathic Manual Therapy to encourage her mobility.

Conclusion
She had an excellent response to this treatment plan and was feeling much better after just 4 weeks. She was grateful that in our sessions we took the time to talk about the WHY of her pain so she had a better understanding of how to manage her symptoms, preventing acute outbreaks in the future.

Limiting spinal flexion can be very beneficial in the short term, however, we run into problems if we don’t re-introduce flexion in a progressive manner.  Flexion is a natural and fundamental movement of the spine keeping the structures of the back healthy and strong, movement variability is a key component to reducing stress concentrations.