u/Dr_JohnP

I work as a personal trainer and I have a client that has struggled with chronic back pain for over 20 years. It usually is the kind that starts at the lumber spine and radiates downward towards the lateral aspect of the thigh. We’ve had really good progress in helping that to get better, but now she’s struggling with something even worse that popped up and I’m having trouble making sense out of it. She’s had many physical therapists in the past and she’s a bit jaded with them because she said none of them have been able to help her with her back pain until she met me and she finally was able to have major progress and experienced relief and so now, after working with many different physical therapists for years with only negative results, she is extremely reticent to return to another (she’s convinced some of them made her pain worse by the time they dismissed her).

I suggested she make a post on Reddit to see if any people had similar issues and could offer their experience but she’s not very tech savvy and asked if I could do it for her and then either show it to her or let her know what people said. I don’t intend to do anything out of my scope of practice with her, I just desperately want to help her get some relief from all this pain she’s been dealing with and since I was able to fix some of her chronic pain through basic exercises like strengthening her posterior chain and stretching out her very tight hip flexors I was hoping we could find some ideas to help this new thing she’s been dealing with. I can offer more detail on the work we’ve done on her initial back pain if that would be helpful, but this new one seems unrelated.

The situation first occurred when she was just reaching down to pull out a plug out of a wall socket and then as soon as she reached forward and down to reach the plug she started feeling unbearable pain around her right quadratus lumborum muscle. She actually seemed to imply it felt deeper than her QL but she pointed to the general area that it was in. She described it as feeling like the muscles in that area were rapidly seizing up, I’m not sure if this was a back spasm or what, but it seemed more serious than one. For the past two weeks after this occurred she’s had a few more incidents with the muscles seizing themselves but mostly she just can’t move her back in a certain way without extreme unbearable pain. She dealt with chronic pain for a long time, so she’s no stranger to pain, but she said this has been truly unbearable like it makes her unable to live a normal life like this. When she’s not dealing with the active “spasms” she feels a strong residual soreness in the area that worsens when she moves in certain positions. This is actually not the first time she’s dealt with this exact pain - it happened first in 2018 and again in 2021 where she explained that it started similarly - doing something extremely innocent like reaching for something or bending over without any load and then having these horrible muscle seizures that are unbearable for her to experience. The other two went away on her own after a few weeks or even months but this seems to come back every few years so I want to understand so she and I can help her to prevent it happening anymore in the future and help her recover from this bout.

When she’s getting up she has to basically lift herself into a full squat position and extend her knees to get up without feeling a ton of pain. Getting into the supine position is initially painful, but once there the pain seems to subside especially if she bends her knees in that position. It isn’t painful to the touch but mostly when she moves her back or engages the muscles to get up or bend over. She also mentioned that when she’s on all fours she can round her back like the cat yoga pose, but when she’s brings her shoulders and and chest up to arch for the cow pose she gets this flinching pain and she physically can not maintain it.

I’m kinda at a loss, I can’t force her to try physical therapy again and she already saw a doctor about this incident who wasn’t helpful to her at all so I just want to do what I can as her trainer to make sure the exercises I do with her are safe, what kinda things to absolutely avoid and what exercises might help. If anyone could shed a light on what this sounds like it actually is that would be super helpful (does this sound like a back spasm?) Any advice for her in general would be greatly appreciated. What I can do with her during our sessions, what she can be doing for herself on her own time (I used to have her stretching multiple times a week with a routine I wrote her but now I’m nervous for her to be doing that) and how does she prevent this happening in the future (what muscles to strengthen, what should maybe be stretched)?

Sorry if this was too long, I just really want her to feel better, she’s worked so hard to get to where she is now. When I met her she was sure her chronic back pain would never get better and in the year and change I’ve worked with her I’ve watched her become a new person - so obviously it hurts seeing her revert back to a pain that’s even worse than what her pain was like when I met her. Happy to provide any additional information needed.