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‘Pain is not the only problem’: First Encounter Checklist

LBP flare-ups can come from curious places. This is a list of uncommon findings from my clinical experience.

1. Unkept roads; potholes, speed bumps, sudden stops.
2. Driver’s seat/office chair tilted back; seat cushion front edge tilted up + back rest tilted back.
3. Plush/deep seating, watching TV + ‘C’-spine, soft beds, water beds, reading in bed.
4. Stop and go traffic requiring the right foot to hover over the accelerator and brake, commute driver.
5. Long term static standing or sitting more than 30 minutes without a movement break.
6. Body-shape compensation while reading, hobby-ing, ADL-ing.
7. Body-shape compensation due to viewing: eyeglass Rx, small screens, screen distance < 18”.
8. Shoes with too much lift, small toe box, undersized/oversized shoes, flip-flops, sandals, high heels.
9. Flat feet undiagnosed/untreated, exercising in unlaced shoes, shoes wearing prone.
10. Treadmill (motorized) used for most or all cardio training, steep incline treadmills ‘hanging on.’
11. Stationary cycling (spin) used more than once a week, jumping out of the saddle (lead foot.)
12. Elliptical used for most or all cardio training, narrow 14” stride length, best to avoid it all together.
13. Bike riding: seat too low, hunched over, posterior hip tilt.
14. Absence of daily long-stride + long-arms walking, workload does not cause breath seeking.
15. Exercises requiring a supine or prone position, exercises absent of pedal GFR.
16. Imbalanced exercise routine; all exercises in sagittal plane
17. Rope jumping and plyo-exercises without CORE engagement, double/down jumping.
18. Uni-lateral sports: golf, tennis, volleyball, baseball, etc.
19. Metabolic dehydration, diuretics (caffeine), no hydration from water.
20. Tight-fitting + high-waisted underwear, thin-banded underwear, tight belts, tight gym shorts.
21. One-side shoulder bags, thin strap shoulder bags, overloaded purse or briefcase/satchel/backpack.
22. Holding baby on the same/preferred hip, holding times un-monitored.
23. Reaching from driver’s seat into the back seat. Reaching too far into trunk, or down into back seat.
24. Inflammatory diet, low biotics, low anti-inflammatory foods and supplements, high sodium.
25. Delays in bladder and bowel emptying.
26. Patient resistance to adopt suggested changes from the list.

LBP Blog General information

Series Description

These articles intend to (1) re-evaluate the prevailing clinical practices thought to manage low back ‘pain’, (2) submit and debate novel low back ‘pain’ contributors and mechanisms, (3) meet patient expectations & satisfaction and clinically meaningful results, (4) recommend a conservative non-surgical course of care to over-ride ‘pain’ instantly, and (5) restore ADLs and patient confidence on the first visit at low cost. This article has a companion podcast.

Dr. Dean Bio

Forester Dean is a chiropractic and physiotherapy sports medicine doctor practicing in Los Angeles, California. Dr. Dean is a lifetime athlete, and currently teaches tennis, track, boxing, yoga. The Core X System™ Campus flagship location was opened by Dr. Dean in 2020.

© Copyright 2021 SpineSync, Forester Dean, DC
Duplication with permission only

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