A patient came to see me with chronic right sided low back pain and left hamstring pain at my Leeds Clinic.
He had had problems for 4 years and as a professional cricketer his pain was aggravated by fast bowling and after long periods of prolonged standing whilst fielding during a game.
He had previous bilateral stress fractures in his spine. These were treated with conservative physiotherapy and rest. A recent MRI scan showed disc degeneration, but there was no nerve involvement or active stress fracture.
A few weeks before the appointment with me, the patient had a caudal epidural spinal injection which had calmed down his symptoms but not resolved them completely.
I used specific clinical tests developed by Ron Hruska at the Postural Restoration Institute, to assess the position of the patient’s pelvis and ribcage. My assessment and tests showed the patient to have an anteriorly (forward) tipped pelvis on the left side and his ribcage was rotated to the left.
As a standard part of my practice now I also consider the influence of a patients ‘bite’ on their body position. For many, the connection between how the teeth hit together and the effect on body position is completely new.
This patient had a significant ‘malocclusion’ or poor ‘bite’. This causes an imbalance in the muscles around the jaw (used for chewing and swallowing). As a result these muscles and the jaw are out of position and this then has a knock-on effect on the position of the neck, ribcage and spine. For more information on my approach watch this video.
My initial treatment focused on restoring the position of the ribcage and pelvis using specific manual techniques developed by Ron Hruska at the Postural Restoration Institute.
However, in this patient, any treatment gains that were made during the session were immediately lost as soon as the patient contacted his teeth together.
From my clinical experience I decided to use a ‘bite’ appliance to change the contact from the patient’s teeth. It is well documented in the literature that malocclusion can influence the muscles in the cervical spine and entire thorax.
I worked closely with a neuromuscular dentist to fabricate a flat plane bite splint. It is made with hard acrylic and is constructed to achieve balanced contacts with all opposing supporting teeth. The patient was advised to wear the bite appliance during sporting activities and overnight to sleep in.
The use of the bite splint influenced the balance of over/under active muscles around the pelvis and ribcage. The aim of treatment for this patient was to improve his right ribcage rotation without the need for compensation in the lumbar (lower) spine. Once ribcage rotation was improved, my treatment then focused on improving gait (walking) mechanics. The player had a marked reduction in symptoms with the exercise programme and he continued with a set of specific exercises throughout the season.