Lucy has spent years researching the best treatment approaches for lower back pain management. She finds that the only real long term solutions emerge from ongoing commitment to rehabilitation and exercise and consequently in tandem with her other directors established Balance Performance Physiotherapy in order to provide her clients with the environment to combat spinal pain.

What is your name, age and profession?

ANSWER Dr Lucy Goldby, 44 (and a ½ - very important in my house with three children) and I’m a spinal and sports rehabilitation physiotherapist

How long have you been a sports and spinal physiotherapist?

ANSWER: 23 years

What was your PhD on and do you have an area you specialise in?

ANSWER: My interest area is clinical efficacy of conservative interventions for low back disorders. In a nut shell it means what is the most effective intervention for the given diagnosis for the spine in front of me, or in front of you. It was a clinical (as opposed to lab based) PhD and all of my research has been clinically based, so I have continued to practice through out all of my academic research, which is very important, as it is very useful to critically analyse techniques when you see the effect there and then.

Within the research we looked at rehabilitating the muscles involved in spinal stability (commonly called core stability). We looked at the reasons why having back pain causes these muscles to stop working and then worked out the best ways to re-engage the muscles.

Was the research well received?

ANSWER Yes. In terms of validity and importance the UK has a number of institutions and organisations that investigate quality of research and inform medicine, namely NICE (The National Institution for Clinical Excellence) and Cochrane (a search engine reporting board). Both of these organisation site only three or four high quality studies that are capable of informing the UK and western society on the optimal ways to manage and treat back pain and my study is included in both of these.

What did the research show?

ANSWER Two things essentially, it demonstrated very clearly that manual physiotherapy effectively reduces pain, but more importantly that rehabilitation of the muscles involved in protecting the spine was much more effective at reducing pain, medication in take, disability and at improving quality of life and function in patients with back pain over the immediate, short and long term.

Did you do anything differently to what had been done before?

ANSWER Plenty of things. Every single exercise within the study was based on research, rather than tradition and belief, so we knew what every exercise did. We introduced lots of tricks to stimulate these muscles and it all worked wonderfully, it took a little while for the rest of the world to catch up!

Do you use these techniques at Balance Performance?

ANSWER Yes. We have a large and very talented back pain team, and everyone is very capable at stimulating these muscles and resolving low back pain.

Since establishing Balance Performance ten years ago, we as a team have become much more effective and resolving and reducing low back pain. The introduction of real time ultrasound means that we can clearly see which muscles are working and which substitution mechanisms the patient has adopted. It means that we are much more effective at introducing the correct method to correct the situation for the client. Back pain can be bespoke to the individual.

At Balance Performance, all professions work together rather than competing to establish efficacy, with the end result being that the most effective interventions are arrived at far quicker for that particular client. Fro example, I have plenty of clients who need a lot of myofascial work, more effectively performed by our sports masseuses than me, and once they have worked their magic, its much easier for me to stimulate and get the muscles to contract. Simply more effective and efficient for the clients.

Which sports have you worked in over the years?

ANSWER: I’ve travelled with many teams, mostly in rugby, but the sports physiotherapists and strength and conditioning coaches from the squads that we support generally ask me to get involved for their trickier spines but essentially I’ve looked after individuals from football, rugby, judo, cycling, hockey, swimming, triathletes, Cage fighters….the list could go on and on.

Are they are well know elite athletes or celebrities that have you treated over the years?

ANSWER: Both…

What sports physiotherapy services do Balance Performance provide?

ANSWER: The best. Balance Performance is expert at analysing how the individual needs to perform in which ever sport…In terms of the spine it’s simply a question of analysing the load on the spine and ensuring that the muscles can support and sustain it for optimal performance. This differs form each individual and within each sport.

What is different at Balance Performance compared to other physiotherapy centres.

ANSWER: Firstly the knowledge, quality and length of service of the staff. The endeavour, brilliance, willingness to both learn and share knowledge amongst individuals is central to our raison d’être. We are committed to educating the individuals into best performance…...it’s very difficult for clients to go elsewhere after they’ve been seen at Balance Performance. Secondly and most visually are the interventions we employ. The majority of the intervention is rehabilitation based so it all takes place outside of the treatment rooms…As Scott Morris, our Performance Director stated when he took up position with us earlier this year…”you just don’t see this type of treatment anywhere else in London”….That’s why we set the centre up ten years ago.

On average how many people do you treat a week?

ANSWER: As many as 20 a day on a long day.

Can you describe a typical working day at Balance Performance?

ANSWER: I get in at 6.00am, start work on my early clients who can then get to work with a spring in their step and enjoy myself all day. My work load varies from a whole day of pure spines, to a mixture of sports, second opinions, and education. Things differ if big events are coming up. Balance Performance is heavy on education, so it’s rare to get through the day with out evening lectures, in-service training or one to one instructions and advice. It’s very varied. I work with a great bunch of professionals, there is always someone doing something amazing.

Can you describe your most memorable experience working at Balance Performance?

ANSWER: Introducing the Alter-G and seeing it change our clinical practice for injuries amongst runners was fantastic. The majority of recreational runners who are training for a marathon have difficulties because they don’t follow strict strength and conditioning programmes and try and train by simply increasing their mileage. Disaster for the endurance muscles which then can’t support the joints at mid -long distances and pain results. We used to have to make them rest for 3 weeks (very tricky if it’s March and they are training for London) whilst we got the muscles functioning correctly. These days it’s straight on the Alter –G and not a days training lost. Wonderful.

The TPT has done a similar job with DOMS (delayed onset muscle soreness) and injury prevention. Historically clients would crawl in for their victory massage but post event these days, our clients are skipping in, its wonderful to see so many of our clients taking our advice on injury prevention, getting the most out of their performance and really maximally enjoying their sports and training.

What are the most enjoyable parts of your job and what elements do you dislike?

ANSWER: I have the best job in the world. I spend my life taking people’s pain away, it’s a great privilege. Having worked for 23 years, I have an extensive client base, I particularly like my job when, for example well known authors that I haven’t seen since the deadline for the last novel, rush to me with a cricked neck and again, I’m able to get them sorted out so that they can go straight back to work to finish their chapter for the deadline. It’s very satisfying.

In your option what are the long-term health benefits for people who have regular physiotherapy treatment throughout their life?

ANSWER: I would turn that into regular ‘prevention mechanisms’…as the clients who employ the self-massage and trigger point work build the best resilience to bounce back, perform best and remain injury free. Our job is to educate and clearly explain why these techniques should be introduced.

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Q&A with Dr Lucy Goldby

06 December 2011

Dr Lucy Goldby PhD MCSP is Director of Spinal Care at Balance Performance. She has over twenty five years experience in clinical spinal disorders and is a renowned back pain specialist. She has lectured nationally and internationally, and unusually for an academic continued as a full time clinician.

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