Over the past 20 years as a physiotherapist, I've helped thousands of people recover from a wide variety of back pain issues.

I met 32-year-old lawyer Diana when her aunt (one of my patients) called me in a panic. Two days earlier, Diana had sneezed while doing her weekly grocery shopping, and her back had gone into spasm. She’d had to leave all her shopping and be helped to a chair, and then call her flatmate to drive her to hospital. An X-ray had shown that she didn’t have any broken bones so she’d been sent home, and she’d barely been able to get out of her bed since.

When I examined her, it was clear that Diana had a case of what Sarah Key calls the “acute locked back”. This is when your multifidus muscles momentarily fail to support your lower back, allowing the capsule of your facet joint to get caught in the joint as you move your spine from flexion into extension, and causing instant excruciating pain and massive muscle spasm.

The first job was to get Diana out of acute pain; and I did this by gently working her joints and muscles until they relaxed, and then giving her gentle and specific exercises to practice. I encouraged her to see her GP; and my exercises, in conjunction with muscle relaxant and pain relieving medication, helped her to navigate to the initial stage.

The next stage was to work out why this had happened; and this is where I started to look further afield. It became clear that Diana’s habitual posture was quite twisted, and we traced this back to a fall on ice when she had hurt her ribs, after which she had always wanted to sit with her torso and hips pointing in opposite directions. Her hips were both tight, and so were the muscles between hips and ribs; and her pelvic floor muscles had become inhibited by pain.

Diana attended regular physiotherapy for around 3 months, and was then able to reduce the frequency of her treatment sessions, as her stabiliser muscles improved and started to support her more effectively. She has now taken up Pilates and dancing, to maintain her flexibility and muscular support system in a way that works for her, for the long term.