average, 11 days per year are taken off sick and 48% give up hobbies in order to try and cope with their pain and it has a yearly cost to the country of approximately €5.34 billion.

A huge amount of conservative treatments exist including massage, acupuncture, Pilates, yoga and back muscle strengthening are probably all familiar to anyone who has been suffering from their back for an extended period of time.  In a recent review of exercise interventions (Searle et al, 2015), it was suggested that exercise-based treatments only have a small but statistically significant effect on low back pain. Of all the treatments, resistance training that focused on the whole body and trunk had the largest effect on study participants.

Our approach is a little different to most others though. Rather than the machine-based strength training commonly used, our patients use squats, deadlifts and a large number of other free weight exercises to increase the strength of the whole of their posterior chain (back, gluteal and hamstring muscles) and change the biomechanics of how they move day today.

We are very rigorous with the techniques we teach to ensure that the patient fully understands the key areas they need to work on. Once we are happy with their technique, the emphasis is then placed on progressive overload or, in other words, increasing the amount of weight they lift. Some of our patients who are able to make the journey regularly to us will enter our Low Back Pain Programme and train in our gym under the supervision of a strength and conditioning coach and a physiotherapist. Others will follow a programme in their own gym and come back periodically to check their technique. Both ways work well and we have had good success with some very long term and painful backs.