John, an experienced recreational rower, came to me in a long overdue review complaining of discomfort in his lower back and down his leg specifically when rowing on water. Oddly enough, he didn't experience the same symptoms when using the rowing machine (ergo) in the gym. A perplexing situation, to say the least. He had been doing Pilates for several months with the aim of improving his ability to 'control' his lower trunk area on the water.
The key differentiator between ergo rowing and water rowing was, of course, the water itself. Unlike the stable environment of the ergo, rowing on open water demanded additional stabilisation to navigate the unpredictable currents. Hence the initial course of treatment was to make John better able to control his trunk on water. Reasonable.
However, as I delved into his ongoing issue through a series of questions and assessments, a surprising revelation unfolded. John's problem wasn't rooted in a lack of core stability, as one might assume. In fact, it was quite the opposite. He had over time developed excessive tension and stability around his trunk and spine, leading to compression and in certain situations (such as rowing) the subsequent symptoms.
His original Pilates program had been aimed at enhancing core strength - no wonder he wasn't improving it.
This case emphasises the significance of tailoring rehabilitation approaches to the individual's unique needs and continually tweaking the program as the person works through it to achieve the best long term result.
This experience underscores a broader truth about low back rehabilitation — it's not just about making the core stronger! It's about understanding the individual's biomechanics, movement patterns, and the context in which the pain manifests as well as the whole person and their background and history.
Every person is different, and a personalised approach is crucial for successful rehabilitation.
The takeaway here is clear: the success of rehabilitation lies in the details. Identifying and addressing deficits through a personalised approach is the key to unlocking relief for individuals grappling with back pain and/or sciatica - or in fact, any condition.
It's a shift from the conventional to the bespoke, recognising that no two people are the same, and neither should their paths to recovery be.
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