Dr. Marc Heller Demonstrating How to Diagnose Lower Back Pain to a ClassA 60-something-year-old male comes in with thoracic stiffness and lower back pain. The lower back pain would occur on various motions. He had previously been quite active, living on three acres and taking care of his property.

He had been rear-ended in a vehicle accident several months earlier. His previous chiropractic care and massage had seemed to make him worse rather than better; he would spasm the day after the treatments.

The key findings on exam included stiff hips—he couldn’t internally rotate beyond 10 degrees on both sides. He was very rigid throughout the thoracic spine. It was hard to elicit tenderness in the thoracic spine as his muscles were so tight. His lumbar motion was fairly normal, with some pain at the extremes of motion.

Our Diagnosis

His lumbar pain was coming from excessive movement in the lumbar spine. This was made worse by the fact that he had decreased movement above and below.

Treatment

We focused on teaching him to strengthen his core and stabilize the lower back. We treated the hips and thoracic spine with low force mobilization, trying to increase movement in those areas. We gave him mobilization exercises, including a foam roller for the thoracic spine. He needed to wake up his psoas, both to get the hip moving better and stabilize the lumbar spine.

Outcome

Not quick, not easy, but within a few weeks, he was feeling quite a bit better. As he improved, the rigidity of the thoracic spine decreased, and the more obvious restriction was on the left at T6-7-8. He said that is where he first hurt after the injury.

What Was Unusual

He really did not need treatment in the form of manual therapy or manipulation to the lumbar spine or sacroiliac. The case was all about getting motion into the areas above and below as well as increasing stability in the lumbar spine.

I have appreciated this theoretically but usually find something useful to do, hands-on, in the lumbar spine. For this man, any local work in the lumbar spine just made him worse.