Lower Back Pain Case Study

Case Study for Lower Back Pain

By Darren Macfarlane, Sports Injury & Rehabilitation Specialist

This case study is for a rugby player who came to me with lower back pain which he has been suffering with for the last year. With a reoccurring injury my client needed a full biomechanical functional screening assessment to get to the underlining cause of the problem. I will discuss relevant information he gave me, the assessments I carried out and their results and the treatment and individual corrective exercise programme that I designed for him.

Relevant Information:

• My client broke his left ankle 2yrs ago. Had surgery and had metal pins put in place. Sometimes during training sessions he can experience pain in left ankle.
• He has been suffering from pain in lower back for the last year especially while driving on long journeys or sitting at his desk in work all day.
• Reports after a heavy training session involving squatting or lunging that he experience pain on left side of lower back.
• While running or sprinting he feels his left leg straining out to side.
• Currently trains four times a week and just lives with the chronic pain in the lower back.

Biomechanical Functional Screening Assessment:

I carried out a postural assessment which included measuring the spinal curves and pelvic tilt. I then assessed the local system (core) for any weakness or to see if it was working properly. I carried out a comparative range of motion assessment on the lower leg muscles. I then recorded the client doing a lung and squat to assess his movement.

Assessment results:

Postural Assessment:

• Left lateral view shows an increased curve in Lower Spine. This indicates Lordosis and is consistent with the back pain client is experiencing

• Knees are anterior and that would suggest tight Quads

• Spinal Curve: L5 to S1 is 24, this is very curved which again indicates Lordosis

• Pelvic Tilt: Left is 16 degrees Anterior and Right is 15 degrees Anterior, Normal is 0 degrees. This indicates an anterior Tilted Pelvis which will increase the Curve in the Lower Spine. I suspect this is tiled because of tight Quads, Psoas, Erector Spinae and weak Hamstrings & Lower Obliques

Local System (Core):

• Lower Ab Coordination: This is Poor and confirms weak lower Obliques

Comparative Range of Motion (flexibility & joint movement):

• Measurements showed both Quads to be tight with Left tighter than the right – this backs up the postural assessment findings

• Both Psoas are tight which was also identified in the postural assessment

• Both Calf’s are tight with the left a bit tighter

• Left QL is tight

• Right Piriformis is tight

Assessment of Movement:

• Lunge

• Plane of motion stability: Fell left during lunge due to Left Ankle instability

• Squat

•  Initial movement coordination: chunky movement evident on initiation of decent, knee flexing prior to hip flexion. This means that movement is faulty

•  Plane of motion stability: Saggital instability in the forward position &; frontal instability to the left side. The muscles that stabilise the body during movement are not firing to stop him falling forward and to the left side

•  Full Range of Motion: Client only got ¾ of way and that would indicate tight Calf’s, Quads &Psoas

My Findings:

1. Hyperlordosis in lower back would suspect is leading to is lower back pain. This is caused by his overly tight quadriceps, psoas and erector spinae and by having weak hamstrings and lower Obliques.

2. When you run, sprint or walk, the psoas muscle (hip flexor) fires and tilts the pelvis forward and the lower Obliques fire at the same time to counteract the forward movement to control the movement. The clients lower Obliques are weak, this means the pelvis is tiling forward rapidly shaking it causing a lot of stresses on the lower back which can lead to pain.

3. All the clients muscles in his left leg are tight this was probably a result after the operation. During the lunge he fell to left side this is because muscles are tight on this side and client had some left ankle instability.

4.During the squat I observed faulty movement and instability, he also had hip and ankle mobility restrictions, and this will affect him during his training and during games which can lead to muscles imbalances and injury.

Corrective Exercise programme:

I designed an individual corrective exercise programme from the assessement results to correct any dysfunction the my client had. I went through the exercises to ensure correct form while doing them. My client will follow the programme for the next month and come a for some soft tissues treatment also on his tight muscles.

I will keep you posted on the progress, check out Darren Macfarlane Sports Injury Therapy on FACEBOOK & my blog darrenmacfarlanesportsinjurytherapy.blogspot.com

www.sportsinjurytherapy.ie