Recalcitrant chronic low back and leg pain--a new theory and different approach to management.

The management of chronic low back and leg pain has always provided a challenge for therapists. This paper examines the influence of a repetitive movement such as walking as a possible causative factor of chronic low back pain. Diminished shock absorption and limited hip extension and external rotation are hypothesized to affect the mobility of the lumbar spine. These compensatory changes can result in lumbar spine dysfunction. Treatment must therefore be directed not only at increasing the mobility of the hips and thoracic spine, but also the stability of the lumbar spine. Sometimes however, the symptoms can be exacerbated by treatment, so the neural tissue needs to unloaded to optimize the treatment outcome. This can be achieved by taping the buttock and down the leg following the dermatome to shorten the inflamed tissue.