Case Study – Low Back Pain: Emphasis on neutral spine & core strengthening

May 24, 2013 | By

– Dr. Indrayani. Harchekar

A 48 year old housewife, Mrs. X was referred to our clinic with complains of low back pain along with tingling numbness in both her legs since 6 months.


  • She had difficulty in carrying out activities of daily living.
  • Simple activities like turning in bed, getting up from the chair, walking for more than 5-7 minutes produced tingling and numbness.
  • She expressed, “Low back problem has overly debilitated my life”.


  • Moderately build middle age female, increased arch in low back (increased lumbar lordosis)
  • Lax abdomen, poor core strength
  • Any movement of the spine reproduces tingling numbness
  • Wearing a lumbar corset makes her feel better


  • Radiogragh (X ray) and MRI revealed instability in her lumbar spine along with an intervening disc issue.

MRI of a normal spine
MRI of a normal spine

Xray indicating instability in lumbar spine
Xray indicating instability in lumbar spine

Spine surgeon’s opinion:

  • Surgery to stabilize the unstable segment
  • Physiotherapy for core strengthening


Mrs X wanted to give her best efforts to physiotherapy and postpone surgery as far as she could.

The concept of neutral spine:

A person who has a disc problem may respond better to backward bending of the spine, where as a person with compression of the spinal cord may respond better to forward bending of the spine.

What do we do when patient has discomfort or his/her symptoms aggravate in whichever position of the spine, even a simple position like lying flat on the back produces symptoms?

We introduced the concept of neutral spine for Mrs X, in her exercise sessions and also in her activities of daily living.

Definition of neutral spine:

Neutral spine is a position, where your back is neither too arched, nor too flat. It is half way between the two extremes, where the stress on your discs /spine is the least and all your muscles are working to their optimum to hold you up instead of relying on passive ligamentous support.

Arched BackErect

Flat BackSlouch

Neutral SpineNeutral

Imagine yourself having severe back pain and having you wear a loose back support (belt/corset), which won’t be serving any purpose. Similarly having loose/lax abdominal and back muscles will be of no help to support your spine. We need to strengthen the natural belt/corset, i.e. the core.

For Mrs X, the plan of care was core strengthening in neutral spine position.

Outcome of rehab:

Within 3 months

  • Pain completely gone
  • Tingling numbness reduced by 25%

7-8 months post rehab of pure core strengthening, i.e. upper and lower abdominal training

  • A stronger body
  • No tingling numbess while doing most of the activities of daily living

Mrs X says:
“I am 99% better, my tingling numbess almost gone, I can managemy daily routine effortlessly and can walk for an hour and more without getting tingling numbess. At times when life gets hectic, my tingling numbness shows up just to give me a reminder to take things easy, but it is just 0.1% of what I used to have earlier. All thanks to PHYSIOREHAB team and their honest efforts in making me stronger.”

What the therapist has to say:
“Being a non-invasive approach towards rehab, we have done and are doing our best to help Mrs X. She still has to be careful about a few things like avoiding running, picking up heavy objects, undue jerks to the spine, avoiding end range movements of the spine.”

Red flags (when she has to rush to the hospital) :

  • Loss of control of the bladder / bowel
  • Difficulty in gripping footwear
  • Loss of sensation for a prolonged duration

PHYSIOREHAB team hopes and prays for her good health and appreciates her diligent efforts towards a better and a healthier life.

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Category: Case Studies

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