Q+A: My back has stiffened completely. Help!

Q I suffered from pain in my hip and back for about 12 months. Then my back suddenly stiffened completely while I was out running and I had to stop. It has been variously diagnosed as a slipped disc and a trapped L4 nerve, but after treatment and lots of rest, the problem is still there. X-rays show nothing, I haven’t run for 10 months and I need help!

A Happily, I think that a slipped disc is unlikely. You don’t mention having any leg pain, nor that there is any joint narrowing on your x-ray. The two are not always indicative of slipped discs, but combined with your description of your symptoms, and the gradual onset, it seems an unlikely cause.

I think the most likely diagnosis is therefore a trapped L4 nerve, at least in part. However, the L4 problem is usually associated with pelvic problems, such as a rotated sacro-iliac joint in your pelvis, so this needs to be double-checked. Assuming that the joints are now moving well after your treatment, we need to look the muscles and nerves.

You don’t mention whether you’ve been given any exercises for your back or hips, and this is crucial if you’re to make any meaningful progress. You need to find someone who can offer you some specific exercises for both the pelvis and the spine that can re-educate them to work properly again. After a year or so of problems, your muscles will most likely be in so much spasm that they will be unable to work properly to protect and stabilise your spine and pelvis. Hence, whenever you put them under pressure – for instance, by running – the problem will return.

You have to re-educate your muscles, and the best way to do this is by having regular massage to your spine and hips (to teach them to relax), regular re-education exercises for the muscles (to teach them to contract properly) and also mobility exercises for the spine. In addition, you need a full stretching programme for the muscles and nerves that relate to your hips and spine.

Martin Haines, chartered physiotherapist and sports injury specialist