Got an email from Aude yesterday
with a ripper of a question about
managing acute low back pain.
So, thought I would take you through a
quick case to illustrate some strategies.
First up though I have to say this:
Pre AFS I would be dreading the super
acute low back pain patients
Like the one I describe next
I would be thinking
“you’d probably have been better
off staying at home than making your way
in to see me.”
–> the usual course of events.
-the struggle to get them to lie down on
-Hoping the yelps of pain wouldn’t be
heard in the waiting room.
-Then the relief when they are finally
lying down and somewhat more comfortable
-Proceeding with the standard soft
tissues, foraminal gapping, traction
-But with the dread of getting them back
to their feet looming over me.
So when you can actually start helping
these patients without all
it’s a seriously practice changing
One of my early experiences which
convinced me that a functional approach
was the way forward was a lovely lady in
her mid forties.
Long history of intermittent grumbly LBP
with a few acute episodes thrown
in for good measure
When I walked out to reception to meet
her she was bent double over the back of
one of the chairs
shifting around trying to find any
position that would be slightly more
So to keep things brief.
This is the process I used from the
*First find a comfortable position in
standing if at all possible.
(No need to go through the whole painful
process of lying down.)
*2nd use hands to add stability
(the plinth is a good option here)
*3 Use simple drivers to create
movements that reduce the level of pain.
the pelvis is a good local choice
Head might be better if pelvis is too
*As pain reduces and movement increases
—-> Tweak towards a gradually more upright
and less supported position.
In this particular case
Using the EXACT process above
Within 5 mins pain was down to 1-2/10
and she was standing upright
And then I messed up.
And this is perhaps the most important
part of the process
(Beside the communication skills to
support the movement. But that’s for
I got greedy
tried to get even more progress
added more tweaks and
Almost back to square 1
Took the next 20 mins to get back to
where we had been after 5min.
To avoid this:- don’t be afraid to STOP
when you have made good progress.
So, how can you put this into practice?
Well, to be honest you can have a crack
using your own skill set and the content
of this email.
But the truth is, what will probably
happen is this…
…you’ll get stuck and resort to
your old comfort blanket of passive
to really nail this stuff you
have to have a few fundamental
functional skills in your locker
It’s what the guys on the Spine and
Pelvis course next week will be
So if you’re fed up of dreading the acute
patients and your ready to change it up..
Chris ‘don’t get greedy’ Wilkes
PS don’t forget the homework for your
Just use what you did in the session to
get them moving.
That is unless you used passive manips
or soft tissue.
Then you’ll have to make something else