Her back pain started about 4 years ago with slowly worsening symptoms since then, and started to have numbness and tingling down her left arm about 6 months before starting therapy. She had a previous corticosteroid injection and physical therapy – massage and light general exercise – which was minimally helpful. Her physician asked her to try again at a new clinic.
Problem
Her pain, in the lower left thoracic spine, was aggravated by a combination of activities that involved her neck and her low back. Due to the bothersome mechanical factors on both ends of her spine, functional activities – like lifting, carrying, and housework – could be particularly painful and limited.
Examination
She was not found to have any weakness or area of numbness indicative of a pinched nerve. Her posture is slouched and she clearly had a difficult time getting up and down due to her poor hip girdle and low back strength. This lack of stability, when combined with the stiffness of the rest of her spine, left her unsteady and painful.
Treatment
I initially approached it as a general mechanical neck and upper back pain, with manual therapy (joint mobilization) but that was only somewhat helpful. Traction treatments to her neck were also only a little bit helpful, and strength and stability training of the shoulders and upper back were only a little helpful.
Her treatment really turned the corner once we began to address the weakness of her hip girdle and low back. Although exercises to address this are known to be annoying and tedious, her hard work began paying off almost immediately. I was able to also teach her a self-mobilization program, where she could lay on a rolled towel, and position it anywhere on her spine to “lock” one area of her back and then use more forceful rotation and get improved movement and decreased pain.
Outcome
Although not 100% pain free, her worst pain in the past few days, with full return to her usual activities, was rated as 1, on a scale of 0 to 10, where 10 is the worst pain a person could imagine, and 0 is absolutely no pain or discomfort. She has a home program, customized and typed out for her, to address her problems with stability and mobility over the long term, and the State of Texas allows her to return to see me without a physician referral for one year.
