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Missing the Simple

back pain back pain advice rehab rehabilitation Nov 11, 2022
simple ideas can be very effective with back pain

It’s amazing sometimes how simple solutions are the best, and this is no different in the management of back pain.

Last week, Toby spent time in a private hospital with a spinal surgeon, sitting in on his consultations with patients.

It was a mixed bag. Some patients had responded well to steroid injections, some were in need of surgery, and some were adrift in the world of back pain management.


The phenomenon of self-selection

Generally speaking, you don’t go to see a spinal surgeon unless you think things are fairly serious.

Instead, you might go to a manual therapist if you think your case should respond to some advice, some hands-on work, some exercises – any mixture of these. 

It’s remarkable really how the majority of people present themselves to the right specialist. Self-selection of the appropriate help and guidance.

Surgeons mostly see patients who are really struggling, and manual therapists like Toby and Graeme tend to see those who are perhaps not quite there yet, or at the beginning of their journey.

Frustration arises therefore when surgeons are faced with cases that should have been better managed by other specialists.

What do I mean by that?


Starting by facing the wrong direction

Toby saw two cases in a few hours of observations where there was a clear possibility that their previous management had been off the mark.

Both of the patients in question had seen a manual therapist and had seemingly self-selected the right path.

Both had conditions that perhaps could have been managed and solved without needing the escalation of seeing a spinal surgeon.

Yet here they were, worried about their lack of recovery, and fearing that a surgeon might need to do what a surgeon does...


Case 1:

A fit and healthy young man who plays hockey. He had mid-lower back pain, worse when he bends backwards.

Management so far: lots of exercises in which he was forced to bend backwards.

Toby’s thoughts: not what I would have done…

After the patient had left, Toby and the surgeon questioned why you would give someone exercises that repeat the painful movement. Might that not make things worse? Might a simple case of an irritated spine become a chronic case? The patient probably does now need a surgeon’s input, but perhaps his condition could have improved with better management from the outset.


Case 2:

An elderly gentleman, in decent health, who was experiencing pain and weakness in his legs after 5 minutes of walking, relieved by a minute of sitting.

Management so far: some cracking of his spine by a therapist who twists it to make it pop, and some exercises on all fours lifting legs up behind him to force his spine to bend backwards.

Toby’s thoughts: not what I would have done…

Again, a conversation ensued, querying why a patient who would benefit from curling his spine forwards (this is what he does for relief when he sits) had had his spine twisted around and forced backwards. It looked like his case was going to proceed to surgery taking other factors into account, but again, basic management had been off target and the patient was left powerless to manage his condition himself.



Sometimes there can be moments of great clarity when faced with seemingly complicated problems.

There is a certain elegance to finding solutions that are neat, easily implemented, and that deliver results.

But at other times our thinking can be clouded, and we don’t see the wood for the trees.

Ideas are proposed out of a well-meaning desire to help, but without fully considering the potential consequences.

Patients can be left confused when more and more tasks are piled upon them, and this often reduces their compliance. They give up.

Additionally, too many patients get given exercises that they do not understand the reason for. Guess what? These patients don't engage in the process.


KISS – keep it simple, stupid

Sometimes, less is more. Understand the problem. Make sure your patient has a clear picture of what is happening. Then build a plan that minimises the bad, and maximises the good.

Our programmes at offer simple, yet effective solutions to patient problems. Yes, we could build in more complexity, but we’re confident that at a basic level, we’ve got things right.





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