<h3><b>Accuracy Of Diagnosis Is Only 15-20%</b></h3>
<span style="font-weight: 400;">Back pain is as common as a headache, according to researchers in Australia; in fact, up to 80% of us will have back pain at some time in our lives, and rugby players are no exception.</span>

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<span style="font-weight: 400;">A recent study also showed that if you see a GP with back pain, who then refers you to a specialist, who in turn sends you for X-rays and MRI scans, the accuracy of diagnosis is still only 15-20%, a frightening fact. Unfortunately, the principles of modern medicine mean that the medical profession cannot treat an injury without an accurate diagnosis, so there is little wonder that the incidence of back pain has doubled every decade for the last 30 years.</span>

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<h3><b>Long Term Back Pain</b></h3>
<span style="font-weight: 400;">As you can imagine, the problem is worse when you have suffered from back pain for some time, since when you have an injury for more than 6 weeks, another part of the body will start to compensate, giving rise to fresh pains as your condition deteriorates. So you can actually end up with more than one injury due to the mechanical compensations, which makes diagnosis even more difficult. Therefore, we need to shift the paradigm and look at back pain quite differently. </span>

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<h3><b>Can You Achieve Better Recovery Rates By Looking At The Mechanical Causes?</b></h3>
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<span style="font-weight: 400;">Biomechanics Coaches&#x2122; look at the mechanical causes of back pain, rather than focusing on the pain itself. They have found that they achieve better results by managing the biomechanical causes, than many in the medical profession achieve by treating the symptoms. In fact, independent research has shown that if you see a physiotherapist over a 6 week period for low grade back pain, the average improvement will be around 39% in functional capacity, which is the ability of your back to perform work (New England Journal 1998). If, however, you were to perform an exercise programme to manage the mechanical causes of your back pain, the average improvement would be around 141%, a profound difference and one that cannot be ignored. </span>

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<h3><b>How Rugby Players Can Actually Help Their Own Back Pain</b></h3>
<span style="font-weight: 400;">This intrinsic biomechanical approach is rapidly establishing itself as a much more effective method of treating back pain, especially for rugby players. Furthermore, the most interesting aspect of this approach, is that players can be shown how to look after themselves. This reduces the risk of them becoming reliant upon a particular therapist or doctor and, significantly, their compliance with exercise programmes is higher too. </span>

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<span style="font-weight: 400;">Of course no single method can be the panacea of all ills, but we are finding that once the mechanical causes are addressed, the pain can often subside without treatment to the 'injury', whatever it might be. Sometimes treatment is also required, although patients find that, once they've committed to an exercise programme that addresses the causes of pain, they are more able to manage the problem themselves. Then, should local treatment still be necessary, it is more likely to be successful, as the mechanical causes are no longer present. </span>

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<h3><b>Time To Get Practical: The 4-Sign Test</b></h3>
<span style="font-weight: 400;">So, let us look at one of the most important tests that we use, called the 4-sign test:</span>

1) First, sit on a chair or stool and cross on ankle over the opposite knee.

2) Relax the crossed knee down to a comfortable position

3) To measure, look at the height difference of the crossed knee to the grounded knee, by running an imaginary line through the grounded knee, parallel to the floor and up to your crossed knee; your knee should be only 2-3” higher than this line.

<img class="aligncenter wp-image-1479" src="https://www.biomechanicseducation.com/wp-content/uploads/2017/01/Screen-Shot-2017-01-13-at-10.57.16-1024x576.png" alt="Screen Shot 2017-01-13 at 10.57.16" width="650" height="366" />

<span style="font-weight: 400;">4) Now try the the other leg and see if there is a difference in knee height from the imaginary line, when you compare both sides.</span>

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<span style="font-weight: 400;">There should be symmetry between the two, with the right side’s range of movement the same as the left. If you have asymmetry, where one knee is higher</span> <span style="font-weight: 400;">than the other, there is an associated 4-sign exercise that will help improve this.</span>

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<span style="font-weight: 400;">The asymmetry is caused because there is a muscle in the hip that is tight or in spasm, which can limit movement in the pelvis and, in turn, put more pressure on the back, causing pain. In addition, spasm in this muscle can increase the load on the hamstring, knee and calves, contributing to more injuries or compensations.</span>

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<span style="font-weight: 400;">This simple exercise</span><span style="font-weight: 400;">, to reduce spasm in the pelvis, can help the muscle to move again, thereby taking the pressure off these structures. When trying out this 4-sign exercise, make sure you are gentle and do not work at it too hard, otherwise it can be counter-productive.</span>

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<span style="font-weight: 400;">As with any new exercise you may experience some discomfort afterwards, although if this is low-grade muscle ache or stiffness that is not usually something to worry about, so keep going. If it is sharper or more severe, you may have overdone the exercise so be more gentle with the contraction next time; if it continues to be painful afterwards, stop the exercise. Should you have pain when you adopt the cross legged position, then simply lift the knee a couple of inches higher and that should take the pressure off. </span>

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<span style="font-weight: 400;">You should find that, as you perform this exercise more frequently over the coming weeks, your knee falls lower as you cross your ankle. That should coincide with a reduction in pain or stiffness in the back or pelvis, both when running and during day-to-day activity. You may also find the 4-sign exercise helps with your playing style and tempo, so try it as part of your warm-up and cool-down regimes too.</span>

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<span style="font-weight: 400;">Move Freely,</span>

<span style="font-weight: 400;">Rachel@biomechanicseducation.com</span>