Clicking and cracking! Men is it beating your back pain?


Earlier on FB I posted how amazing it feels to treat someone for just half an hour and see a change in their pain levels. Well it inspired a blog post… hope you can be bothered to read it, especially if you are a MAN and have BACK PAIN!

Today, the client arrived unable to sit down and tears in his eyes. For a strong bloke, seeing him like that was quite concerning. He started telling me his story. He has a manual job and unsurprisingly a 30-40 year history of intermittent periods of low back pain. This latest episode has stuck around for 5 months and doesn’t seem to be easing, it’s actually getting worse.
He’s not your typical bloke to come to Pilates. You know the type that sit in the pub and in the politest way possible giggle at Pilates saying,

“that’s a girl thing!” and, “ha, what’s that going to do for me?”

Well, after a few hundred pounds spent on private therapy and the pain worsening, he turned up at my door today. He only did that because we are mates in the pub and I think…well…. he just likes me! I am sure, without our drunken conversations about my work, he would never have considered Pilates as a treatment option. Well I am glad that a couple of whiskies and the odd pint of beer later has led him to using my services!
I just had to write about this, because as he left my house, in far less pain than he arrived and able to sit down, I considered why his 1-2-1 intervention had not provided him with relief. It got me thinking about my previous difficulties of treating clients in the standard way. I wanted to share this with you because this story validates the concept behind Phoenix Freedom. Perhaps you are in a similar situation and this story may help you understand what Phoenix Freedom can offer you.

The private intervention he had experienced included some manual therapy (cracking, stretching that sort of thing) and he was issued with some gentle low back flexibility exercises. None of this is wrong, in fact the private therapists have followed the current evidence for treating low back pain. My honest thought when he started explaining his recent input was ….can I help this man?

Then I assessed his posture! Uhhrrrrr well……I would like to say this in a clinically correct way, but the reality is the voice in the back of my head was saying,

“bloody hell this is terrible, crap actually and where the bloody hell do I start here, we’ve got to go so far back to move forward, this is a bloody minefield! I have weeks of work here! He needs a total an utter overhaul of his posture, changes to the way he moves, not to mention improvement in flexibility – crap…”

While that (very non-clinical) voice was muttering in the back of my brain, the clinical voice was fully aware that communicating a positive message is crucial. All the evidence available to us medical professionals’ states that conveying a positive message is vital, this prevents negative associations with pain and positivity may prevent unwanted fear avoidance behaviours. What does that mean? I mean that:

fear > you limit movement more = pain worsening

Makes sense really! So in my smiley, smiley way I tried, in my best, most credible and positive voice to explain how we may be able to move forward.

Now take me back in time when I was offering 1-2-1 therapy alone. Having clinically reasoned (in my very non-professional voice) that I could probably see this guy for a year and still be trying to iron out posture corrections and movement dysfunction patterns – how then am I going to change this guys symptoms in 4-6 sessions?

Firstly, you might ask why only 4-6 sessions? There will always be a limit on how often a private therapist can see someone

1. The NHS commission services based on 6 sessions
2. Insurance companies work on the same basis
3. If you are a self-funder you may pay for more, but 6 sessions gets quite expensive! So unless you are Brad Pitt or David Beckham where money is no concern, 6 sessions will probably set you back £250-£350.

We will come back to why 6 sessions are considered standard in both private practice and the NHS later.

Let us get back to my client!

If I was treating this guy in the standard way (4-6 sessions) I have to consider what my best available treatment options are and think, what will improve this person quickly and effectively in the least amount of time? Trying to change longstanding posture habits and movement behaviours, funnily enough is not at the top of my quick fixes list! I would absolutely turn to manual therapy – it totally has its place. Not for the reasons you are thinking though! Here are the examples I hear from clients ALL THE TIME!

“it puts me back in alignment” or “straightens me up”, or “cracks my back into place…” I love the latter quote the most!
All of that if I’m honest (and the evidence backs me up on this…) is total and utter bollocks! Sorry for my slightly misplaced language, or if I have offended you, but it hits a nerve with me when I hear this type of language, and well, I get angry. People are totally missing the point as to why manual therapy can be of real benefit! They do not understand how to make the most of that crack, snap or pop they have spent their hard-earned cash paying for!

I wont delve into too much detail, but that crack is just air! It’s not bones clicking back together or your pelvis realigning, it’s air, air in your joints being put under pressure and popping when you are manipulated. But, what we do know scientifically is two major things happen:
1. Local tissues release endorphins into the area (happy chemicals for want of a better word)
2. Pain relief via something called the pain gate theory – I’ll blog about this another day!

1+2 = localised pain relief and reduced local muscle spasm – so you feel better

Amazing! Isn’t the body amazing? Unfortunately, this treatment is short lived, hence why your pain comes back!
Instead, what we should do is use this crack to allow us to move better, freely and more normally – well then you are onto a winner! And that, my friend is why exercise alongside manual therapy works better than the “crack” alone!

Why then if this client was cracked and given exercises was he still in pain? The exercises were to some degree appropriate, but I have to say, his back is so screwy, he’s just not able to access any kind of movement into his low back with or without a crack – AT ALL….tricky to treat!

In a private therapy session, which is what? Half an hour? I have now done my crack – let’s say we’re 10—15 minutes into the session. That leaves me with 15 minutes to teach this guy some exercises. Again – I really don’t have time to break down local, small movement dysfunction and teach good control. Plus, is the client really going to be on board with a few tiny little movements into their lower back? There are other reasons this is tricky – he is unlikely on a first session to be able to perceive this movement properly and therefore carry it out well after one session – another blog on this one day too!

As a clinician you are always weighing up how best to spend your time. I would never have spent the full half an hour teaching a very gentle pelvic roll! Especially to this type of character, who let’s face it, had I mentioned Pilates in a different context would have laughed and never have come back! Instead, I would have done a mixed modalities approach of some manual therapy and given 2-3 simple exercises in the hope he would start to free up his lower back. Of course, this approach hasn’t worked for him.

When he turned up at my door today. I had so much freedom. I know that this guy is prepared to come to my sessions on a longer term basis. I have no pressure to “fix” him in 6 sessions. I can go right back to basics and start there. He has no expectation that I might “fix” him with manual therapy and he knows that he is here for that horrible word called EXERCISE!

Well now, his expectations are more aligned to how I might really and truly be able to help him. I have absolutely no pressure to do anything other than teach him some key Pilates principals – the first being the pelvic tilt! We spent half an hour doing this and learning to access his deep abdominals and pelvic floor. These muscles are the ones that actually segmentally attach to the spine. They tend to get a bit lazy when you are in pain – again I can blog about this another day!

I had no expectation he would be in any less pain at the end of our first session. I just wanted his brain to be aware of movement in his lower back. You know what, the funny thing was, just spending this time actually created immediate relief for him! That shocked me! Perhaps all 1-2-1 input should focus just on this! Ha, that’s where Pilates research was back in the 1990s…we’ve moved on since then….activating your tranversus abdominis muscle alone isn’t the quick fix either!

In reality, his pain will return. But, what I can do now is work with this guy over the next 6 months and build on new movement patterns and access muscles he probably has struggled to activate for 30-40 years! I have the freedom to do this under my Phoenix Freedom concept and it’s not costing him any more than the 6 sessions he might have paid for privately. I’d love to say there is a quick manual therapy “fix” but honestly chronic problems take a chronic bit of time to fix, way more than 6 sessions to affect change!

I’m encouraged he got relief so quickly, it’s encouraging because I know I can affect change! As I mentioned earlier he’ll struggle to do that exercise at home without me…his brain right now just wont quite get it….now I’m going to promote myself and the Phoenix Freedom ethos. I’ve asked him to pop back Tuesday (for free) so I can just check he’s got it. And if he hasn’t I’ll probably check again! He’ll be on the floor in the pub doing his exercises under the watchful, beady eye of Rachel! Talk to my other clients and you’ll find out I do this for them all! Why is a good question and I hope I don’t burn out! But I do it because, well, I just care I guess….

Seriously though, I really want people to understand what they are doing, get it and then see the real benefits of Pilates. It’s why I wake up in the middle of the night thinking…what exercise can I put into the class for Mr Bloggs so he really starts to move better and see changes to his pain. All classes are tailored to the group I have in front of me! And I do recognise it isn’t always possible to give 1-2-1 input to everyone all the time. And I have some clients I feel guilty I’ve neglected a bit…I have one in mind actually, I will pull him aside soon! But this method is somewhat affordable and ongoing in a way other interventions aren’t.

Anyway we’ll see how he gets on. Perhaps I’ll write another blog about his progress, or even get a testimonial from him…we’ll see… I’m pretty confident he’ll get there!

Rachel@Phoenix Freedom x

Note: the 6 sessions thing…if you are interested….

Any therapy intervention, you should see some benefit from between 4-6 sessions, if not stop! The body is pliable and we therapists should be able to affect change in soft tissue structures and relieve pain in that time frame. The natural healing process of tissues takes about 6 weeks, hence why services are commissioned in this way. The age old problem for all therapists is we can’t guarantee long term relief because guess what, that requires changing long standing habitual postures and movement patterns that are contributing or are the cause of the injury in the first place. At Phoenix Freedom I’m doing my best to solve this problem!

Hope to see you soon!

Rachel Changer