Back pain , where to start .

What do you do when a client comes in complaining of back pain ?

Where does it hurt?

When did it happen?

How did it happen ?

The list is endless and no question is wrong we need to know as much as possible about the situation in order to help and most importantly to let our client verbalise their pain .

It is important to understand the mechanics of the lumbar spine so that we can treat safley and give practical advice to enhance recovery .

From L1 to L5 the lumbar segments can rotate a maxmum distance of 15 degrees . The most movement occurs in flexion or forward bending . Too much rotation causes repetitive stress on the SI joint and lumbar vertabra leading to inflamation and pain .

The disks between the vertabra are squashed with repetitive forward bending and the contents can burst through the disk wall and irritate nerves and allow the facet joints to grind against each other .

  • Now we know that the lumbar spine is not made to rotate very much but is made to flex very easily .
  • Too much rotation and flexion can lead to disk herniation and repetitive stress injuries .

Most of your clients will complain of a tight lower back in which case they will always be bending forward to stretch it ( not a good idea )



Most therapists will want to stretch the hamstrings if they are tight . A poor core will rely on the big muscles like the hamstrings to stabilise the pelvis .

  • We need to test for tightness ( this is quite rare )
  • Test for rotations and correct them
  • Teach how to stabilise the core to improve coordination and endurance .
  • Carry out daily activities like sitting and standing up safley