Wednesday, 30 October 2013

A SIRPA case study - Lower back pain

Since June 2012 I have been using a new approach to treating pain called the Stress Illness Recovery Programme (SIRPA). It is a different way of thinking about pain than the traditional postural-biomechanical model used in physiotherapy/osteopathy and chiropractic treatment. It works on the basis that if our stress levels get to high, the brain and nervous system produce pain and other physiological changes like increased muscle tension as a protective mechanism. Once this is understood I then help people to manage the stress more effectively and enable them to return to previous activity levels. It is an approach that I have found extremely effect for some people and has helped people to recover from there chronic pain, which before I would not have thought possible. Below is a case study of a lady with chronic lower back pain who I have used this approach with.

Vicky came to see me as she had learnt about the SIRPA approach after reading John Sarno’s ‘Healing back pain’ and then searching for a TMS practitioner in the UK. At the time she was suffering with lower back and left buttock pain, which had been on going for ten months and had got particularly worse in the past three months. Prior to seeing me she had already seen three other physiotherapists, an osteopath and a shiatsu specialist, but to no avail. Vicky had also had a MRI scan of her lower back, which showed a large centre left disc protrusion compressing the S1 nerve root.

When I initially assessed her, Vicky had only 50% of normal range of lumbar flexion and 50% left side flexion, there was also a limited straight leg raise on the left side compared to the right. Prior to attending the session, she had already filled out a Sirpa assessment form and was beginning to make the links between stressful events in her life and the onset of pain. So we used this as a starting point to examine Vicky’s personality traits and how this could have lead to these events becoming stressful and triggering her pain. Vicky used journaling to help her gain perspective on certain events and also to deal with day to day stresses as they arose. She began to challenge the conditioned responses she had to pain and started to do things that she had previously avoided because of pain.

In total, I saw Vicky on four occasions over a two month period and she made excellent progress by putting the advice I gave her into practice and working hard at home to understand herself better and to make time for herself. On her last visit her range of movement was restricted but had improved to 75% of normal range and she reported that she was having more pain free episodes. At this stage we both agreed that Vicky was making good progress could continue on her own with the techniques she already put into practice.

Two weeks after our last session Vicky emailed me to say that she had continued with the journalling and that her range of movement was much improved. She even provided photo evidence:

I also recently emailed Vicky (four months after the last session) to ask if she would be happy to be a case study and to see how she was getting on and she replied ‘Feeling fitter and stronger than ever and enjoying running, also sleeping better than I ever have!’

For me these results would not have happened using conventional physiotherapy. I feel this approach provides long term health benefits and empowers the patient to take control of their pain. 

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