A few years ago a colleague of mine asked me to weigh up on a scenario – if a person living in a small city like Nottingham, experiencing low back pain could be treated and approached in the same way of a one living and working in a huge crazy city like London.

Generally talking of course!

I didn’t understand the question entirely; low back pain is low back pain and the spine remains same, it ultimately doesn’t change according to the latitude.

A spine doesn’t your lifestyle change.

After one year working in UK and after 3000 treatments provided to a variety of people with different cultures, backgrounds and beliefs, I can finally say – Giancarlo you were right.

The way I approach a client in London is very different apposed to when I was living in my little city in Italy.

To expand on this further

Working in places like Victoria and Canary Wharf means that you treat business types: accountants of large multinational companies, lawyers, engineers and traders.

I am talking about people who live in the office.

I am talking about people who works 14 hours a day

I am talking about people who start working at 7am and have to commute 1 and half hours to the office.

I am talking about people who are 35 years old or younger and their hair is grey and thin, in addition of this the bowel is fucked up and they live with IBS.

I am talking about people who ask me to finish 10 minutes earlier because their manager needs them in the office, in front of 3 screens.

I am talking about people who live with the sympathetic nervous system working their asses out like a motherfucker. People who sleep 5 hours a night and take drugs to keep going.

They come to the clinic sacrificing their lunch-time and well earned breaks yet complain about neck pain and headaches.

According to what I studied I should assess them and treat them following a specific protocol (if we can speak about protocols in rehab).

I should do my mobilisations, my PA (physiotherapeutic techniques) and I should correct the way they move, I should make them train the core (so you can stabilize the back, like someone says!) and I have to make sure that they do the exercises at home (maybe they live in Cambridge, arrive at home at 10pm, they  have to eat and to spend few mins with the kids.. I am sure they are looking forward to exercising)

SURE

Once I realise, after a deepened initial assessment, that there are no major issues, no neurological signs, nothing that requires a “proper” treatment or a specialist consultation, but there is just tension and stiffness in the soft tissues due to several hours spent in the chair what I do is to relax the patient.

The goal of the treatment is to switch off for 30 minutes the sympathetic nervous system.

What I generally do is to do a gentle and pleasant soft tissues treatment (myofascial release, positional release etc..) and I finish with a 15 minutes massage or a hypnotic induction (I don’t deny a manipulation to anyone btw).

The result is: everyone happy and better.

Doesn’t work? I change, no problems.

Dear colleague, remember that IS NOT THE CLIENT THAT HAS TO FIT YOUR TREATMENT, YOU NEED TO UNDERSTAND THEIR NECESSITIES AND TO MAKE SURE YOU ARE DOING THE RIGHT THINGS FOR THEM, IN THAT MOMENT OF THEIR LIFE.

Thus spoke Zarathustra

Thank for reading

Davide