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Evaluating Pain and Getting Rid of It

According to a research team from the Ministry of Health, Labour and Welfare, an estimated 28 million people in Japan suffer from lower back problems. Of those in the 40~60 age group, approximately 40 percent are concerned about pain in their lower backs.

As physiotherapists, how do we deal with this? The short answer is that we pinpoint the source of pain by evaluating the body’s physical functions, and create and offer treatment programs to optimize those functions. Let’s use a lower back problem as an example to explain in more detail how we handle the treatment of pain.

Step 1—Interview
First we interview the patient to understand what problems he or she is experiencing. Since the term “lower back” would be too vague here, by the way, we need to determine both the precise area of the pain and its relative severity. From there, we use the following mode of inquiry to establish a hypothesis to determine if the source of the pain is the joints, the muscles or a vertebral disc or discs:

・Assessing the nature of the pain:

・What illnesses or injuries have you had?
(Past medical history)

・Assessing environment and habits

There are many elements of the lower back that we have to evaluate:


1. Erector spinae muscle
2. Lumbar vertebrae
3. Gluteus maximus muscle
4. Quadratus lumborum muscle
5. Zygapophysial joints
6. Sacro-iliac joint
7. Piriformis muscle

Step 2—Examination
We conduct an examination to confirm that the diagnosis we made based on the interview is accurate. We need to examine both the central region of the pain and the body as a whole. We pinpoint the location of the pain by observing the slightest movements of the joints and the state of the muscles, and how that section affects the body as a whole.

We also do a motion analysis and posture check to see what actions and body positions lessen or intensify the pain. By evaluating the patient’s posture while both sitting and standing, we can see which muscles and joints are under strain. Even if we focus only on the areas causing pain, we cannot eliminate the pain if it is being generated by incorrect use of the joints and/or muscles.

Step 3—Create and implement a program
People with lower back problems are often told to do sit-ups and strengthen their back muscles. Working out without any guidance like that is unwise, however. We therefore devise and offer custom programs that address the source of the pain and match the needs of each patient.

During the actual treatments, we first adjust the joints that are not moving properly, work on easing stiff muscles, and regulate the interaction of the bones and muscles. After that, we conduct training designed to activate weakened muscles that are seldom used.

The causes of pain differ from person to person. Creating the necessary rehabilitation program with methods that match the needs of that person and implementing them correctly is the quickest way to relieve pain. We also have to keep in mind that major causes of pain are not limited to physical factors such as joints, muscles and nerves, but can include the patient’s lifestyle and psychological factors.

We recommend getting evaluated by an expert, both to discover the fundamental cause of any pain and to gain an understanding of how your body works. Knowledge will change your consciousness, which in turn will change your actions and ultimately your body. This body awareness will also help you avoid and relieve pain in the future.

Mayuko Kawahara - Physical Arts
Physiotherapist, Pilates Instructor
Physical Arts: established in 2008. We provide care using conditioning with pilates as a base targeting a broad range of people; for example: people who are experiencing pain, people with the objective of promoting good health, athletes, etc. Prenatal and postpartum care and care for dancers, artists, and the like are also being performed actively. So as to improve not only the symptoms, but the fundamental source of the condition, programs that are suited to each individual are being offered.
Physical Arts

Tags:Pain