Case Study: Mechanical neck and lower back pain on semi-professional Rugby player

On this blog we are going to look to a physiotherapy case study that we had at Nailsea Physio.

In this case we are going to see how the training load and the appropriate exercise prescription can make a huge difference on athletes.

The patient is a 32 year old male, playing semi-professional Rugby with 4 training sessions per week, 1 Rugby match per week and 6 gym weight training sessions per week.  He suffered with intermittent neck and lower back pain for 4 years. Pain was in the centre of the neck on C6-C7 area (base of the neck), both upper trapezius, and then on L4-L5 area and both quadratus lumborum muscles dull ache pain (lower Back). No neurological symptoms or any other systemic symptoms. Had an ACL injury in May 2023, had a rehabilitation by then but still has some weakness on the thigh muscles. Most of the pain was triggered by the Rugby and the gym training. Patient had some chiropractor and acupuncture treatment, which were helping for a short-term period of time, but he wants a long term solution.

We started to discussed about the gym training and the Rugby training to check which training load he was doing at that time. Gym training was mostly weight training and HIIT training. This is a good base for an athlete but with further questions we find out that some hip, neck and lower back muscles were not engaged properly and for some of the other exercises, the volume, the intensity and the sport specificity (Rugby) were not enough for his goal. After this long discussion about the training, we started the assessment.

At Nailsea Physio we start the physical assessment with the observation of the posture and the feet position, to see if there is any biomechanical issue that may lead to that injury. In this case there was hyper lordosis. Hyper lordosis creates an excessive and characteristic C-shaped curve in the lower back, or lumbar region, where the spine curves inward just above the buttocks. While lordosis refers to the natural inward curvature of the spine, hyper lordosis refers to an extreme curvature.

Then we see the range of motion, which was normal for neck and lower back, but there was some restriction on right and left hip flexion and external rotation. After that we see with some specific functional and orthopaedic tests which showed some hip flexors lack of flexibility. Then we measure the strength. In this case we use a handled dynamometer, which is an electronic device connected to an app that gave us the exact amount of strength for the muscles that we want to test. In this case we notice quite big difference with weakness on the left hip abductors, external rotators, hamstring and quadriceps.

At the touch there was tension on the left quadratus lumborum and upper trapezius. 

Patient was suffering with mechanical lower and neck pain due to these biomechanical issues that we found through this assessment. Mechanical low back and neck pain is a pain that cannot be attributed to an issue with one particular part of your spine and is related to movements of the cervical, lumbar and sacral regions of the spine. This is the most common form of neck and back pain.

We agreed with the patient that the best treatment option was training load management, modification of some of the exercises, targeting mostly the weakness and restrictions that we found. Exercises were not light , we started with some intense strengthening exercises for the neck, hip , lumbar and abdominal muscles because the patient was capable of. Most of them were single leg, to avoid any compensation by the stronger side. The modification of training was involving some Rugby and HIIT exercises modification on volume and intensity. No hands on treatment was involved.

Throughout the following sessions we progressed those exercises to make it more difficult and we always measured the strength to see if the exercises were effective for the goal that we want to reach. After 6 sessions, patient strength as come back full, no more neck and lower back pain for 6 months in a row and also training performance has improved.

Written by Andrea Cutrupi, Chartered Physiotherapist.