Tackling spinal stenosis

I want to tell you about some of the amazing people I’ve met in clinic (with their permission of course!)

18 months ago, when my clinic was in its infancy, I met an amazing family. I’d been at school with V and she asked if I would treat her husband, G. As she explained about his condition, I was personally horrified at what they’d been through and professionally intrigued (and more than a little worried that I wouldn’t be good enough to help!).

G arrived (slowly!) heavily reliant on crutches. Not for the first time I rued my upstairs treatment room, but he matter of factly (as I’ve seen him deal with so much since!) managed.

G explained to me that he had four areas of his spine that were being compressed through the narrowing of the vertebral foramen at C5, C6, L4 and L5. He was in a lot of pain, managed by diazepam, morphine and gabapentin amongst other analgesics.

He’d been made medically redundant but wanted to work. He hadn’t played rugby or attended the gym for several years; as an enthusiast for both this had affected his mental health. He went to Disney land in a wheelchair.

More alarmingly, he’d began to collapse unexpectedly, losing control of his legs, bladder and bowel. Distressingly this happened in front of his young children. As often happens, he had come to me as nothing else was helping; surgery was not an option and he was unable to do exercises through mechanical limitations and pain. Like many who come to me, I was a last resort after being told 'you just have to live with it'. He came wanting some pain relief and a little more movement, and was willing to try anything.

And so our journey began. G’s range of movement was severely restricted through his spine, hips, knees and ankles. It was moderately restricted through cervical spine and shoulders, more especially on the right. Getting G on the couch was a challenge but though communication, humour and inventive bolstering we got there. My first look at G’s back was an education; he had severe hypotrophy of the right erector group, quadratus lumborum, gluteals and lats. His left side showed hypertrophy. There was inflammation, scoliosis to the left in the lumbar spine and rotation through the thorax anti-clockwise. The muscles on the left were hypertonic, and spasmed on touch. Feeling a little overwhelmed I quoted the Jing mantra, work with the head, hands and heart, called up all of my anatomy and physiology knowledge, and began. Basic myofascial work across the whole back with indirect traction work and some proprioceptive neuromuscular facilitation on hip flexors, hamstrings and QL formed the core of the first treatment and helped me assess G’s muscle recruitment and what was going on in the tissues. We found that his left side was jerky in movement and very weak, the right was better but he wasn’t recruiting his glutes or adductors at all. He slept whenever I wasn’t talking to him, obviously needing the relaxation, and on re-test found increased ROM and reduced pain in all areas tested. We grinned at one another and so we committed to our journey together. We had a few bumps and learnt not to treat psoas for example in the early days as it made him feel like he’d lost his prime communication with his legs!

As my skill sets evolved with the progression of my degree, so the treatments grew - G was ever the enthusiastic first client to experience them. He came weekly for 13 months and now I see him fortnightly becoming when he needs treatment which is where we want to be.

6 month after that first massage, G went back to work as a welder and fabricator working on oil pipelines and cooling towers. I cried, but G and V were as cheerful as ever. I was so happy for them!

9 months after he was back in the gym, using body weight exercises that we discussed and tweaked in our sessions alongside light free weights ( G is man and man must LIFT! 🤣).

14 month after our first meeting he bought a motorbike and had reduced is analgesics by half. After 20 months he did his first rugby training session in years. He now plays every week in his clubs second (veteran) team. I see a lot less of him and I couldn’t be happier!

G has worked incredibly hard and has been amazing to work with. A combination of MFR, PNF and trigger point work has become our go to treatment with great results. We are now working more on his neck and shoulder as his lumbar spine is comparatively trouble free. Sure he has stiffness and some neurological pain but it is manageable and he’s out living life again as he wants to and I knew he could. For me, he is the clearest example of how soft tissue work can improve the body’s response to a hard tissue issue. He is also a fantastic example of pain in the brain theories, and psychological response to pain, along with the affect of a positive mental attitude!

We have recently started a programme of exercise based on intrinsic biomechanics to build on his amazing progress. I assessed his movement in a full hour long session, and prescribed anti-spasm exercises (muscle energy techniques) and because it is an area he wants to work on in the gym, we did a core ratio assessment and I have given him core recruitment exercises after identifying a lower than ideal ratio posterior to anterior.

V is another inspiring case study we will look at soon and the pair of them humble me everyday. I’ve worked on their son after a trampolining incident, and both of their parents. They’ve become amazing friends and I probably would have lost faith in me without theirs being so constant. I’m eternally thankful that they’re in my life. This is why I do what I do.



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Kelsall Hill Equestrian Centre, Middlewich Road, Organsdale CW6 0SR

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