A man in his 30s who works in Yokohama visited the clinic, suffering from persistent lower back pain.

He started experiencing lower back pain in his twenties after beginning his career, but since the pain would subside after returning home or on weekends, he didn’t pay much attention to it. However, as time passed, in his mid-thirties, the pain not only occurred during work but also became a regular issue in his daily life. Previously, he would feel some relief after walking or during holidays, but now he constantly experiences discomfort in his lower back, with a particularly strong sensation on the right side.

He works in an office in Kannai, mainly on the desk work. The persistent lower back pain makes it difficult to concentrate on his tasks, forcing him to frequently stand up and twist his back to relieve the discomfort.

Since the onset of the COVID-19 pandemic, he has been working from home more often, resulting in less commuting, which has made the pain feel more intense. However, being at home allows him to stretch and move around, which helps manage the pain by twisting and extending his lower back.

On weekends, he has tried alleviating the pain through chiropractic treatments and massages, but the relief never lasts more than a week before the pain returns. Realizing that these measures were not providing a fundamental solution, he decided to visit deferent chiropractical approch Spine Chiropractic in Bashamichi, hoping to find a more permanent improvement.

[Initial Symptoms]

  • Interview:

He has been dealing with lower back pain for over 10 years and has visited hospitals, osteopathic clinics, and massage parlors in the past. Among these, he visited a Chiropractic and felt significant improvement, with longer periods between symptom recurrences.

After being transferred for work and moving to Yokohama, he continued visiting chiropractic clinics. However, he felt that the effects were not as good as the previous clinic, so he is currently looking for a place that suits him, which led him to visit Spine Chiropractic.

  • Visual Inspection:

While conducting the consultation in a seated position, the patient’s lower back appeared significantly rounded, and they were conversing with a hunched posture.

  • Static Palpation:

The patient exhibited a pronounced posterior curvature of the lower back (where the lumbar spine should normally have an anterior curve). Even when asked to sit upright, the forward curve remained absent.

There was also significant tension in the lower back muscles (such as the erector spinae and quadratus lumborum), with noticeable asymmetry between the left and right sides.

  • Motion Palpation:

The right sacroiliac joint (pelvis) showed posterior displacement (tilted backward) → Tenderness upon palpation.

The fifth lumbar vertebra (the lowest vertebra of the spine) exhibited right rotational displacement (shifted to the right) → Pain when pushed from the left.

No significant differences were observed in the trunk motion.

  • Orthopedic Tests:

Several tests, including the Adam’s test, were performed, but no abnormalities were found. Neurological abnormalities such as herniated discs were ruled out.

  • Muscle Strength Examination:

Left gluteal muscle group: 4/5 (slightly weak)
Right iliopsoas muscle: Same as above

[Initial Treatment Plan]

According to the graph above (provided by the Ministry of Health, Labour and Welfare in Japan), the prevalence of lower back pain is significantly higher in men.

Based on the examinations and interviews, it was determined that pure muscle hypertonicity is the primary cause of the lower back pain. However, if the root cause of the pain is not identified and addressed, the treatment will only be a temporary measure.

Muscle Condition Assessment:

Lower back muscles (bilaterally)/Right gluteal muscles/Lateral muscles of the right leg/Abdominal muscles (bilaterally)
Overtension of these muscle groups

Skeletal Condition Assessment:

Loss of lumbar lordosis (normally, the lumbar spine forms a gentle curve toward the abdomen)
Posterior displacement of the right sacroiliac joint (pelvic misalignment)
External rotation of the right hip (slight pelvic opening)
Since these differences were identified, it was concluded that achieving symmetry in skeletal positioning and range of motion would help eliminate discrepancies in muscle movement. This is considered essential for addressing the root cause of the stronger symptoms on the right side.

Specific Treatment Details

Muscle Approach:
Taking into account the tension differences in the spinal erector muscles (running along the spine), quadratus lumborum (running obliquely from the lower back to the pelvis), gluteal muscle group (buttocks), and iliopsoas muscle (located in the abdomen), relaxation techniques were performed while carefully considering which side needed relaxation and which side did not.

Joint Approach:

Loss of lumbar lordosis ➡︎ Range of motion improvement therapy (mobilization)
Upper lumbar right rotational displacement / Lower lumbar left rotational displacement ➡︎ HVLA adjustment (High Velocity Low Amplitude)
Elevated sacrum ➡︎ Adjustment toward the abdominal side
These treatments were performed, and a follow-up visit within one week was suggested.

Note:
The first chiropractic session primarily focuses on understanding the patient’s condition. To prevent post-treatment aggravation and to assess effectiveness, high-intensity approaches are not used during the initial visit.

[Prognosis]

2nd Visit (5 days later): The effects of the treatment were good, and the patient said, “I haven’t felt much pain over the past week.” The interval between visits was extended to 2 weeks.

3rd Visit (2 weeks later): Pain started to return around the middle of the second week. The intensity of pain seemed to be about a 7 on a scale of 10 (where 10 is the worst).

To maintain the effects of the treatment, I instructed the patient on stretches for the gluteal muscles, iliopsoas, and quadratus lumborum.

4th Visit: Thanks to the stretches, after 2 weeks, the pain was reduced to about 3/10, which was less than half of what it was before.

The patient said, “Before, the pain would return to 10 within a few days, but since starting chiropractic care here, I’ve really been able to maintain a comfortable state. I’m so grateful,” which made me very happy.

At Spine Chiropractic, I aim for a 2-week treatment interval. Once the patient is satisfied with the sustained improvement, chiropractic treatment is considered complete, and the patient can choose whether they want to continue with preventive care or come back if the pain reoccurs.

This patient spends a lot of time sitting due to work, so it was anticipated that symptoms might flare up again. The patient understood this and opted for regular maintenance. I have been seeing this patient for a total of 5 years, from the clinic I worked at in the past to my current practice.

[Practitioner’s Opinion]

This patient experienced recurring episodes of lower back pain despite receiving treatments such as chiropractic care or massage, which provided temporary relief but did not prevent the symptoms from reappearing shortly afterward.

In many cases of chronic lower back pain, excessive tension in the lumbar muscle groups is the primary cause. This patient also had stiff muscles around the lower back, and prolonged sitting added to the strain, leading to the onset of symptoms.

The problematic muscles in this patient were the major muscle groups spanning from the lumbar spine to the pelvic region. These muscles are constantly subjected to significant tension, especially when maintaining the same posture (such as prolonged sitting or standing), as opposed to lying down or moving, where the muscles can lengthen and shorten to maintain flexibility. However, in this patient’s case, there was a noticeable asymmetry between the left and right sides. While massage or chiropractic adjustments can temporarily restore muscle flexibility, it is essential to address the underlying factors that cause the muscles to remain excessively tense. Specifically, understanding why the symptoms were concentrated on the right side of the lower back required a structural analysis of the skeletal system and targeted improvement.

The specific approach to addressing these issues is detailed above, but the Joint Motion Theory-based intervention used at my clinic proved effective.

Even when muscle over-tension is purely the issue, incorporating skeletal adjustments based on the muscle attachments and their biomechanical relationships is crucial for maintaining muscle flexibility and symmetry. This case clearly demonstrated the importance of integrating both muscular and skeletal approaches to achieve lasting results.

At Spine Chiropractic, I address a wide range of musculoskeletal conditions directly impacting daily life, not merely as a form of relaxation therapy. Conveniently located within a one-minute walk from Bashamichi Station, an eight-minute walk from Nihon-Odori Station, a seven-minute walk from JR Kannai Station, and a 12-minute walk from JR Sakuragicho Station, my clinic is well-suited for residents and workers in the Yokohama area.

If you are experiencing similar symptoms, please feel free to visit Spine Chiropractic. I am committed to providing care with sincerity and professi