A man in his 40s living in the Kannai area of Yokohama visited Spine Chiropractic after developing sudden acute lower back pain while standing up from his office chair during work.
He arrived at the clinic with severe pain localized to the left side of his lower back and was walking with a noticeable limp.
［Background and Current Condition］
The patient had experienced chronic lower back pain for many years.
Because his work involved prolonged desk work, he had developed the habit of standing up carefully to avoid aggravating his back. Although he did not follow a regular exercise program, he intentionally chose to walk instead of driving whenever possible during weekends and short outings.
He had noticed that light movement usually reduced his back pain, so he frequently tried to get up and move throughout the workday.
However, after transitioning to remote work during the COVID-19 pandemic, his daily activity level decreased considerably. He felt that his episodes of lower back pain had gradually become more frequent over the past several years.
He had previously consulted orthopedic specialists and received anti-inflammatory medication for his chronic back pain, and had also undergone manual therapy. While these treatments provided temporary relief, none addressed the underlying cause of his recurring symptoms.
Following this episode of acute lower back pain, he decided to look for a more comprehensive solution aimed at preventing future recurrences.
After searching online, he chose to visit Spine Chiropractic.
Assessment of Acute Lower Back Pain
Patient History
Because sitting significantly increased his pain, the consultation was performed while the patient remained standing.
He described severe pain localized to the left side of his lower back.
Even slight movements triggered intense pain, making normal movement extremely difficult.
Following the injury, he was unable to continue working and took several days off, spending almost three days resting at home because sitting, standing, and walking were all extremely painful.
Lumbar flexion produced the most severe pain, and he was barely able to bend forward.
Lumbar extension was considerably less painful and remained possible.
He also reported significant difficulty performing routine daily activities, including:
- Getting out of bed
- Putting on trousers or socks
- Washing his face
- Standing up from a chair
These simple activities had become extremely challenging because of the pain.
Postural Assessment
Standing posture revealed a classic antalgic posture.
To avoid loading the painful left side of his lower back, the patient unconsciously shifted most of his body weight onto the right leg.
This protective posture is commonly observed in patients with acute mechanical low back pain.
Static Palpation
Examination in the prone position demonstrated marked asymmetry in muscle tone.
Significant protective muscle spasm was present throughout the lumbar erector spinae and quadratus lumborum, particularly on the left side.
In addition, the normal lumbar lordosis had almost completely disappeared, leaving the lumbar spine noticeably flattened.
Because lying supine produced excessive discomfort, assessment in that position was postponed until the patient’s symptoms improved.
Motion Palpation
Because of the severity of the patient’s pain, only a limited motion assessment was performed.
Even gentle passive movement of the lumbar spine reproduced significant pain throughout the left lower back.
To avoid aggravating the acute injury, a more comprehensive motion examination was deferred until the acute phase had settled.
Orthopedic Examination
A focused orthopedic examination was performed to exclude lumbar disc herniation and significant neurological involvement.
The findings were as follows:
- Adam’s Sign: Positive (left-sided lumbar pain reproduced)
- Neri Bowing Test: Negative
- Straight Leg Raise (SLR): Negative
- Valsalva Maneuver: Negative
The Bechterew’s Sitting Test and Belt Test were not performed because the patient was unable to tolerate the required positions due to pain.
No neurological findings suggested lumbar disc herniation, lumbar radiculopathy, or other serious spinal pathology.
Muscle Strength Examination
Manual muscle testing was not performed during the initial assessment because the patient’s pain was too severe to allow reliable testing.
Muscle strength and functional stability were scheduled to be reassessed after the acute symptoms had improved.
Men have the highest incidence rate of lower back pain.
Chiropractic Treatment for Acute Lower Back Pain
Because the patient’s pain was severe, treatment began on a specialized chiropractic table positioned at a slight incline to reduce gravitational loading on the lumbar spine and allow the patient to remain as comfortable as possible throughout the session.
The initial focus was to reduce the protective muscle spasm affecting the:
- Lumbar erector spinae
- Quadratus lumborum
- Gluteal muscles
Rather than simply relaxing the muscles, treatment was aimed at restoring normal muscle function.
During the acute phase of lower back pain, excessive muscle relaxation may reduce spinal stability because these muscles are acting as a protective mechanism. Therefore, treatment emphasized improving muscle flexibility and functional movement while maintaining adequate support for the lumbar spine.
Further assessment revealed a significant reduction in the patient’s normal lumbar lordosis.
Loss of the natural lumbar curve increases mechanical stress on both the spinal joints and surrounding muscles, often contributing to recurrent episodes of acute lower back pain.
Using principles of Joint Motion Theory, gentle chiropractic mobilization was performed to restore normal lumbar joint mobility and gradually improve the natural curvature of the lumbar spine.
Because this was an acute condition, all treatment was performed carefully and conservatively to minimize discomfort while restoring normal spinal mechanics.
Before leaving the clinic, the patient received detailed instructions regarding:
- Safe techniques for getting out of bed
- Proper methods for standing up from a chair
- Activities to avoid during the acute phase
- Home care strategies for reducing lumbar strain
- Gentle mobility exercises appropriate for the early stage of recovery
The primary objective was to reduce pain while promoting normal spinal function and minimizing the risk of recurrence.
[Treatment Progress]
First Visit
Although some pain remained immediately after treatment, the patient noticed a clear improvement when getting off the treatment table and while walking.
“I can’t believe I can stand up this much more easily already.”
He was provided with advice regarding activity modification and home care, and because of the acute nature of his condition, a follow-up appointment was scheduled three days later.
Second Visit (Three Days Later)
The patient continued to experience significant stiffness and discomfort when getting out of bed in the morning.
However, his daytime symptoms had improved considerably.
Everyday movements, including standing up from a chair and walking, had become much easier than during the initial visit.
Because the acute muscle spasm had begun to settle, the next appointment was scheduled one week later.
Third Visit (One Week Later)
After two chiropractic treatments, the patient’s recovery progressed rapidly.
Daytime pain had almost completely resolved.
Although mild morning stiffness remained, it no longer limited his daily activities.
As long as he stood up carefully after waking, he was able to complete normal daily activities without significant discomfort.
Because his improvement remained stable throughout the week, the interval between treatments was extended to two weeks.
Fourth Visit (Two Weeks Later)
Following his third treatment, the patient’s workload increased substantially, requiring long hours of remote work and prolonged sitting.
Approximately one week later, his lower back became significantly more painful again.
He considered contacting the clinic but instead performed the home stretching program he had been taught during his previous visits.
To his surprise, the exercises reduced his symptoms considerably.
He continued performing the stretches every evening, and by the time of his scheduled appointment two weeks later, his symptoms had largely settled.
Although this response demonstrated that the home exercise program was effective, reassessment revealed that muscle imbalance between the left and right lumbar erector spinae had returned.
The reduction in lumbar lordosis had also become more pronounced.
Treatment therefore focused once again on restoring muscular balance while improving lumbar spinal mobility and curvature.
Because prolonged sitting appeared to be a major contributing factor, we recommended returning to weekly treatment temporarily rather than maintaining two-week intervals.
Fifth Visit (One Week Later)
The patient reported very little pain throughout the week.
He had remained consistent with his home stretching program every evening and was maintaining good lumbar mobility.
As both the patient and clinician were satisfied with his recovery, active chiropractic treatment was concluded.
Sixth Visit (Approximately Six Weeks Later)
Approximately six weeks after completing treatment, the patient returned because his chronic lower back discomfort had gradually returned.
Although he had not experienced another episode of acute lower back pain, he felt that stretching alone was becoming less effective.
Following chiropractic treatment, his symptoms improved significantly once again.
After discussing long-term management, the patient chose to transition to a maintenance chiropractic program focused on preventing future episodes rather than treating active pain.
He has now continued monthly preventive chiropractic care for the past three months while maintaining excellent function and experiencing no recurrence of acute lower back pain.
Clinical Perspective
Acute lower back pain is one of the most common musculoskeletal conditions encountered in clinical practice.
Often referred to in Japan as “the Witch’s Shot”, it is characterized by the sudden onset of severe lower back pain that can significantly restrict movement.
While the pain appears to occur without warning, the underlying mechanical changes within the spine and surrounding soft tissues often develop gradually over months or even years.
Some individuals experience chronic lower back pain before an acute episode occurs, while others develop severe pain without any obvious warning signs.
However, the absence of pain does not necessarily indicate optimal spinal health.
Likewise, persistent stiffness or mild discomfort should not simply be accepted as “normal.”
Lower back pain can arise from many different conditions.
Some disorders—including lumbar disc herniation, spinal stenosis, fractures, infections, inflammatory disease, or other neurological conditions—require medical evaluation and are outside the scope of chiropractic care.
For this reason, a thorough examination is essential to determine whether conservative chiropractic treatment is appropriate.
In this patient’s case, the examination suggested that the primary contributors included:
- Chronic hypertonicity of the lumbar erector spinae
- Tightness of the quadratus lumborum
- Iliopsoas muscle dysfunction
- Loss of normal lumbar lordosis
- Reduced lumbar and pelvic joint mobility
Together, these factors gradually increased mechanical stress throughout the lower back until a relatively simple movement—standing up from a chair—triggered an episode of acute lower back pain.
Treating muscle tension alone may provide temporary relief, but lasting improvement often requires restoring normal spinal alignment, joint mobility, movement patterns, and postural mechanics.
Today, the patient remains symptom-free from acute episodes and continues monthly maintenance care to help preserve spinal function and reduce the likelihood of future recurrence.
Looking for an English-Speaking Chiropractor in Yokohama?
At Spine Chiropractic, we provide evidence-informed chiropractic care for a wide range of musculoskeletal conditions, including:
- Acute lower back pain (Gikkuri-goshi)
- Chronic lower back pain
- Neck pain
- Sciatica
- Lumbar disc disorders (when appropriate for conservative care)
- Sports injuries
- Postural dysfunction
- Recurrent back pain associated with prolonged desk work
Our clinic is conveniently located in central Yokohama, just 1 minute from Bashamichi Station, 7 minutes from JR Kannai Station, 8 minutes from Nihon-Odori Station, and 12 minutes from JR Sakuragicho Station.
We welcome both local residents and international patients, providing chiropractic care in both English and Japanese.
If you are searching for an English-speaking chiropractor in Yokohama for acute or chronic lower back pain, we would be happy to help you restore movement, reduce pain, and return to your normal activities safely.