If you contact me about your low back pain it's because you've already failed with at least one, sometimes all of the following: physical therapy, chiropractic, osteopathy, yoga, massage, acupuncture, etc.
You've been living with low back pain for months or even years without understanding the cause of your pain. You may have even been told that you'll just have to live with your pain and learn to manage it.
Yet, in the majority of cases this simply isn't true. You've been told this by someone who didn't have the knowledge or skills to identify your individual pain triggers and show you how to avoid them. And, as a result, you've most likely been given a generic program of 'exercises for low back pain', some of which have made your pain worse.
The problem is that you've most likely never undergone a thorough assessment.
The McGill Method low back pain assessment (developed by world renowned low back pain expert, Professor Stuart McGill) that I take my clients through takes 3 hours to complete. It comprises the following:
A 10 minute doctor's consultation, or even a 1 hour physical therapy session don't provide enough time to carry out a thorough, individualised low back pain assessment. This often results in the erroneous diagnosis of 'non-specific low back pain', and the prescription of generic exercises that may or may not help, or even worse, that exacerbate symptoms.
In reality, low back pain is highly individualised and thus requires a highly individualised approach. As Stuart McGill says: 'there is no such thing as non-specific back pain. There are only poor diagnoses resulting from inadequate assessments.'
Nobody had told Daniel that the herniated disc in his back was an indirect consequence of an operation he'd had when he was a baby.
He had been born with club feet and underwent surgery to correct them. Although the surgery was successful it had left him with only about 20% of the normal range of ankle dorsiflexion (the movement where you pull your toes and foot towards your knee).
As a result, when he squatted, instead of his knees coming past his toes, they didn't advance beyond the mid-point of his feet. This forced his lower back to round into flexion every time he sat in a chair or bent down to pick something up.
It isn't usually problematic if you move like this sometimes. But, when this is your default way of moving, the repeated flexion and compression of your lumbar spine can result in the gradual delamination of the fibrous outer layer of your intervertebral discs. Over time, this can lead to a disc bulge or even herniation.
None of the doctors Daniel had seen had made the connection between his lack of ankle mobility and the herniated disc in his back. It was only when I pointed this out to him that he was able to start doing something about it.
Fortunately, by improving his ankle mobility over a period of weeks and adjusting his foot position in accordance with the structure of his hips (another vital part of the assessment) he was able to squat lower while maintaining a neutral spine.
This allowed him to go about his day without unnecessarily stressing the injured disc in his back. This allowed his disc to begin healing itself, with the result that he no longer experienced low back pain.
Again, and again, I see clients who have been prescribed exercises that provoke the exact same pain triggers that I identify during their initial assessment. It's no surprise that they're still in pain.
When Remi laid down on his back and tried to raise his straight left leg as high as possible off the floor, he barely managed to lift it 30º before the tension in the back of his leg and the pain in his lower back stopped him lifting it any higher.
His pain increased when he dorsiflexed his ankle (pulled his toes towards him), which confirmed that the excessive tension in the back of his leg was in fact his sciatic nerve – not tight hamstrings, as his physiotherapist had told him.
This was why the hamstring stretches he had been prescribed were making his pain worse. Every time he did them he was further tensioning and aggravating his sciatic nerve which inevitably provoked his pain.
Further testing revealed that he was able to move his sciatic nerve along its path without provoking his pain by coordinating the movement of his head and his lower leg. This indicated that nerve flossing was an appropriate therapeutic exercise for him.
After only a couple of weeks of daily nerve flossing (in conjunction with a personalised exercise program and consistent spine hygiene) we repeated the leg raise test and Remi could raise his leg to almost 90º. He had tripled his range of motion without ever stretching his hamstrings. He was now able to move more freely without provoking his pain and perform strengthening exercises (which further accelerated his recovery) that he hadn't been able to do for over a year previously.
If we hadn't determined what his pain triggers were via provocative testing, it wouldn't have been possible to adapt Remi's exercise program to him as an individual and successfully wind down his pain.
Once provocative pain testing has revealed your specific pain triggers, you can begin to eliminate them from your daily activities and allow your back to heal.
Manjeet used to begin every single session by thanking me for helping him get to a point where he no longer had any low back pain.
I always appreciated his gratitude but what really struck me was his literal disbelief that he was now able to live his life without the chronic pain that had been a constant unwanted companion for the previous seven years.
He had seen various practitioners during this time, including doctors, physiotherapists and acupuncturists, but he had never been able to get rid of his back pain. He would experience sporadic spasms in the muscles of his lower back without understanding why. The 'experts' he had seen couldn't provide him with a solution so it seemed to him that he was going to have to live with this forever.
However, fortunately for Manjeet, he didn't give up. Whilst scouring the internet for information, he discovered the work of Stuart McGill, and ended up getting referred to me because I was a personal trainer specialised in low back pain rehab who he could work with online.
When I first saw Manjeet move, it was clear to me that he was continually provoking the very same pain triggers that had been identified during his initial assessment. Without realising it, his default movement patterns were keeping him in pain.
He was flexion-intolerant (his pain was provoked when he bent forward), but he had never previously been taught how to avoid this movement. He had never been shown how to move through his hips whilst bracing his abdominal muscles to stabilise his spine.
As a result, every time he sat down in a chair, got out of bed, picked something up off the floor, or walked up a flight of stairs, he was flexing his spine, unknowingly irritating the herniated disc in his back. It wasn't apparent to Manjeet that how he moved was preventing his back from healing. Firstly because his pain usually only appeared several hours after irritating his back, and secondly, because none of the 'experts' he had seen had informed him that the way he moved could influence his pain.
Understanding what his precise pain triggers were, and becoming conscious of how he was provoking them were the first steps in the healing process for Manjeet. I then worked with him to improve his 'spine hygiene' (the removal from his daily routine of movement flaws that cause tissue stress), so that he was able to get through his day without unwittingly triggering his pain.
Manjeet began to see significant improvements during the first weeks he was working with me. He then made consistent progress over the following months as we gradually ingrained new, spine-sparing movement patterns that didn't aggravate his back. We did this while working around concurrent knee and shoulder issues that he had.
Thanks to Manjeet's dedication to his new spine hygiene practices and his persistence with the program, within 6 months he was completely pain-free and able to start working with me on improving his strength, muscle mass and metabolic fitness. We did this by implementing a full body strength training program, something that would have been impossible 6 months previously.
One year later, he was still pain-free.
Manjeet's testimonial:
'After herniating a disc back in 2014 I tried many solutions: physios, acupuncture, other specialists, but nothing helped. Then I started working with Andy about 18 months ago. I've been pain-free now for more than a year. Training with Andy is the best investment I've made in my health. I would definitely recommend working with him.'
—Manjeet Singh
Laurent had suffered what is known as an iatrogenic injury: an injury caused by medical treatment. He entered the osteopath's clinic with low back pain and came out with low back pain plus sciatica (which for him, presented as sharp, shooting pains down the back of his leg).
Without conducting a thorough assessment to try to determine the source of his pain, the osteopath had asked Laurent to lie down on his side, and performed the same manoeuvre as in the video above. The violent application of downward pressure to his pelvis forced his spine into rotation at its most vulnerable link: L5-S1 (where Laurent already had a herniated disc). This created further instability at an articulation that was already unstable, and provoked the shooting pains down the back of his leg.
In the months that followed, Laurent was beginning to get back to normal after working with a physiotherapist. However, his sciatic symptoms resurfaced when the physiotherapist instructed him to do prone scorpions as part of his rehab program.
The twisting of his pelvis in the opposite direction from his ribcage replicated the same pain mechanism that had been inflicted upon him by his osteopath. It reproduced the exact same sciatic symptoms.
This is what happens when generic exercises are prescribed before conducting a thorough assessment to determine what someone's individual pain triggers are.
After training with me for 6 months, Laurent is now pain-free again and stronger than he has ever been. Not only that, but he has a much better understanding of the cause of his back pain and how he can avoid it in the future.
The bottom line is that you'll have a much better chance of getting rid of your low back pain once and for all if you understand its cause, learn how to avoid your individual pain triggers and build resistance to injury via a personalised exercise program.
This is only possible if you get adequately assessed.
Laurent's testimonial:
'After more than a year of having a back injury that prevented me from doing the sports I wanted and after consulting several specialists, I discovered Stuart McGill and his method for rehabilitating people with back pain. I found Andy on the list of certified practitioners on McGill's website and got in touch with him.
After a very complete assessment and sound advice, I began a rehabilitation program with him. I quickly became able to do movements again that I hadn't been able to do previously and my pain gradually faded until it disappeared completely. This was despite me having had some extremely painful episodes! I admit that I'd been beginning to lose hope about whether I would ever find a solution.
For those who are familiar with fitness training: I went from writhing in pain while sneezing to being able to swing a 32 kg kettlebell without pain! I built up to this in a progressive, safe and effective way.
If you want to put an end to your back problems or get back into fitness in a sustainable way, I recommend you contact Andy!'
—Laurent Feraudet
