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It's easy to underestimate the cumulative effects that your daily habits can have on your low back pain.
You're paying attention to your posture, avoiding sitting for too long and doing the exercises you've been prescribed.
But, despite your diligence, your back pain is still there. Sometimes you need to look more closely at the details.
Bruno is an executive and travelling is part of his job. He noticed that if he had to stand in line for too long or walk long distances in the airport his nagging low back pain would always come back.
During his assessment it was clear that he was extension-intolerant (think lifting up your tailbone so the top of your pelvis tips forward). This placed additional stress on his already sensitised lumbar spine.
When I asked him what shoes he was wearing when this happened he said typical dress shoes for work because he always had to go straight to a meeting when he got off the plane.
He showed me his shoes. They may not have been 5-inch Louboutin stilettos, but, they did have a small, significant 1.25 inch heel.
That was enough to tip his pelvis forwards into a position that placed his lumbar spine into slight extension. Not enough to immediately provoke his pain, but enough, so that after 1 km of walking his sensitised spine became irritated.
I persuaded him to make some space in his hand luggage for his work shoes so he could wear some flat, training shoes while he was travelling, especially when knew he might have to stand around or walk through long airport terminals.
That was the detail that made the difference for Bruno.
Wearing flat shoes tipped Bruno's pelvis back slightly, guiding his spine into a more neutral position, reducing the stress that had been provoking his pain.
He had been doing everything else right, but it wasn't until he removed the final offending pain trigger from his daily routine that his back could begin heal properly.
