Conditions · Back
Back pain,
taken seriously.
Back pain is the most common reason people come to see me, and the most commonly rushed. Most of it is mechanical — joints and muscles that have stopped sharing the work properly. Most of it does get better. What decides whether it stays better is usually whether anyone worked out why it happened.
This page is about the everyday kind: the back that seizes up lifting something ordinary, the ache that builds over a working week, the one that has been coming and going for years. Back pain that began with an accident or significant injury is a different matter, and needs medical assessment first.
01 · The differential
Where it usually comes from.
Ordinary mechanical back pain has a few recurring patterns. Most people arrive with a combination rather than just one.
Joints that have stopped moving
The lower back has small joints at each level, and the pelvis has two large ones. When some stiffen, neighbouring segments take more movement than they should — often felt as one specific spot that catches, or a back that is worst first thing.
Muscles guarding
Spasm and guarding are protective rather than the original fault. It is the most painful part and the least useful thing to treat on its own, because the muscle usually relaxes once whatever it is protecting is dealt with.
The hip and pelvis below
The lower back and hips share their workload. A hip that has lost rotation puts the demand somewhere, and the lower back is usually where. It is a common reason a back keeps flaring after it settles.
What your day asks of it
Sitting, driving, lifting, a new training load, or a change in how much you are on your feet. Rarely the whole answer, but frequently the reason it recurs on a schedule.
02 · The chain
Backs, hips and knees travel together.
In practice I see the lower back, hip and knee as one chain rather than three complaints. Restricted movement at one level changes the demand on the others, and the pain often shows up at the end of the chain rather than the start of it.
So a back examination here includes the hips and the pelvis as a matter of routine. If there is a knee on the same side that has also been complaining, that is worth knowing about. The order in which things started is often the most useful thing in the whole history.
03 · The appointment
The first appointment, in full.
Forty-five minutes, and most of it is the history — when it started, what you were doing, what makes it better and worse, whether it travels anywhere, what you have stopped being able to do, and importantly a screen for the symptoms that mean this is not a job for me. Then the examination: how the back moves and what limits it, joint-by-joint assessment, neurological testing where warranted, how the surrounding muscles are firing, and an examination of the hips and pelvis.
Then I tell you what I have found and what I think it means. Where treatment is appropriate it usually starts the same day.
04 · The limits
The symptoms that need a doctor first.
Most back pain is mechanical. A small proportion is not, and telling them apart is the single most important thing that happens at a first appointment.
Go to A&E now
Difficulty controlling your bladder or bowels, numbness around the saddle area or between the legs, or weakness developing in both legs. These are emergency symptoms and need assessment today — not an appointment next week.
See your GP first
Back pain following a significant fall or accident. Back pain with unexplained weight loss, fever, or a history of cancer. Pain that is constant, unrelieved by any position, or that consistently wakes you in the night. New back pain if you are over 50 or under 20.
Where I'd refer
Progressive leg weakness, symptoms spreading over time, or a picture the examination cannot account for. I refer for imaging or a specialist opinion rather than treating around a question I can't answer.
Patients who came in with this
So helpful with finding the cause of the problem, explained it and has helped my back pain, very knowledgeable and friendly
…I have been treated by Richard for the past year in relation to an ongoing back issue and could not recommend him highly enough. Richard is personable and efficient, has an encyclopaedic knowledge of his subject matter and shows genuine care/empathy for his patients.
…I went to Richard for back and side pain and after the first session, already felt better! It will take time to heal. Really appreciate how Richard talks you through what he is doing and what exercises can help in between sessions.
Where to see me
Two London clinics, same practitioner at both. A new patient appointment is 45 minutes and includes your first treatment where that’s appropriate.