Same Disc problem but different pain?

I want to tell you a story about two of our clients who I caught up with this week. I have changed their names and professions as West Byfleet is a small place.

Mrs Jones is a 43-year-old mother of two who works part time as an accountant in West Byfleet. She enjoys Pilates. On her two days off, she likes to take her dog for a walk and meet some girlfriends for coffee in Cicico’s.

She also likes to keep fit in the gym, and when she’s not doing Pilates, she enjoys a spin class. She is out playing tennis with many friends. The kids have lessons on the court next to her. In the last few years she’s been suffering with a lower back issue which always gets worse when she begins to play tennis at the start of the year. Although this year, it is particularly bad, and it started affecting her tennis so much so she’s had to start cancelling games with friends. She’s realised that it wasn’t necessarily the tennis that she loved, it was the social aspect and the fact that the whole family could get involved. Over the past three years, she’s seen various physiotherapists, had massage, taken many forms of medication including naproxen, and also consulted with a spinal surgeon who took an MRI of her spine.

The MRI shows that she has an L5/S1 disc problem putting pressure on her spine. Because tennis is a very dynamic sport and has lots of twisting and turning, this is why the disc has been flared up when she starts the tennis season. The disc is going out to the right-hand side therefore putting pressure on the right sciatic nerve, given her a lightning rod pain going into her right buttock.

Mrs Jones has a friend called Mrs Williams. Mrs Williams has three kids, she works full time, and also enjoys Pilates with Mrs Jones. She sits at a desk all day and works as a PA for a corporate lawyer in the city. She barely finds time to get to the gym as much as Mrs Jones, and it’s always on her mind that she’s sitting for long periods of time during the day.

She also has a back issue that is more consistent and not just seasonal depending on if she is doing more activity or not. She’s conscious of it when she’s sitting at a desk and has had numerous ergonomic assessments provided by her workplace. These have helped if the workload is high. On busy weeks, she is often in the office at eight o’clock and leaves at six some days, spending at least an hour on trains commuting backwards and forwards to London.

She has private medical health with her work and also has had an MRI. Believe it or not, she too has an L5/S1 disc issue. Without giving any confidential information away, it is very similar to Mrs Jones’ disc problem.

They’ve both been around the block and seen many different people. Some things have helped, some haven’t, but the underlying consensus is that nothing has fully resolved the problem.

Mrs Williams has a rare day off and invites Mrs Jones out for a walk and a coffee at Cicico’s. They bump into one of their other friends and get chatting about their backs. The friend in the coffee shop recommends them to see Dr Jeremy at West Chiropractic.

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They make their appointments and are greeted by staff. Jeremy welcomes them into the clinic. An assessment with x-rays, posture analysis, and a full report is given and a detailed treatment program with a rehabilitation programme built in.

It gets to week three and everything is going well. Mrs Jones is feeling much looser and lighter. She has no sciatic pain and is able to get back to full time Pilates. But Mrs Williams still has buttock pain and still has back pain. I was wondering why she’s not feeling like Mrs Jones? She has the same disc issue, the same level, the same symptoms, so why doesn’t she respond the same?

This is all too common and highlights the importance that everybody is different. There is no one size fits all treatment program for lower back pain and disc issues. Discs can take anywhere from nine to twelve months to fully heal and is largely dependent on how long they’ve had the problem for.

Pain affects everybody in different ways. One of the most common things we hear in the clinic is “When I’m stressed or had a long day, my back pain or shoulder pain is much worse.”  We will touch on this more when we discuss what causes back pain, but to make you aware there are not just structural issues causing pain within the spine.

Many of our clients will describe an emotional trauma coupled with a physical trauma, for example a road traffic accident. It is often why a lot of spinal surgeries do not cause full resolution of spinal pain. What this means is you can take the pressure off the spine and still be left with pain.

We dug deeper into why Mrs Williams was taking longer to respond. After we looked at what she was doing outside of the clinic it became apparent that she wasn’t looking after herself as well as Mrs Jones. She was making a couple of minor errors when she was getting home in the evening that were hampering her ability to heal at the rate that we wanted. The problem was how she was sitting at home and also how she was sleeping at night. B

ut often we need to take a check at week 3 or 4 and see where we are with a progress evaluation, check the goals we set and perform a course correction. Like with an aeroplane, it never flies in a straight line as conditions are always variable, but minor course correction along the way ensures it gets to its final destination. 

This also brings in the nature v nurture argument. We often hear “My mum has a really bad back and has done for years and so does her mum, so I was bound to have back pain.” I can’t sit here and argue with that, there is a genetic predisposition to back pain, but there is not much evidence out there, mainly because it is so hard to try and replicate the same conditions and the fact that back pain is so complicated. 

Mrs Jones did say that she has a family history of back pain, but I have also seen clients that have had family members who have had major back operations and they have managed to avoid them with proper care and guidance.  

The nurture of the human body and the way that it is influenced as we grow is more important than a nature or genetic aspect. I believe, with the proper guidance and care, that most genetic issues can be adapted and changed as we grow. 

It is important in this example of the two ladies’ you can have a very similar injury on paper but can present very differently and thus require two completely different programme’s. As I was always told in my time at Bournemouth football club ‘treat the player NOT the scan’.

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If you do know someone who wants more advice, please send them our details. You can send them this assessment as well to diagnose their back pain. It is a great tool to understand where your back pain is coming from, it is free and takes 60 seconds. Click here for assessment

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