What about the wallet? A health Solution in plain sight.
Some time ago - I had a gentleman book in for physiotherapy treatment. He reported low back pain on and off for over 10 years. It seemed worse in winter months, and during work hours. Exercise helped temporarily, as did manual therapy. He was otherwise healthy, and had not suffered any major injuries.
He had seen multiple physios, myotherapists, chiropractors, doctors and so on, and nobody could explain WHY he had this problem, nor why it seemed to disappear in summer and when he was on holidays.
After some additional discussion, it became clear this patient had no other red flags that would raise concerns of underlying pathology. He had an excellent health history, and imaging and blood tests were all very normal. He walked every second day, played golf on the weekends and did a yoga class weekly.
So, with the same curiosity as always - I embarked on a physical examination to explore the problem and work out how I might be able to help. I asked him to slip off his shoes and walk to the centre of the room so we could begin with a simple physical mobility and movement screening test. And as he did this, he also removed the BIGGEST FATTEST WALLET from his left back pocket that I had EVER seen in my ENTIRE LIFE. He had been shoving those little EFTPOS receipts and business cards and appointment cards into this wallet since who-knows-when. It had begun splitting down the seams in protest. A thought flickered in my mind.
And then as he stepped into the centre of the room and turned his back to me - I had a moment to observe the shape of his left jeans pocket. It hung limply and saggy - the denim stretched and deformed from harbouring the world’s FATTEST WALLET for months on end.
So I asked - “Do you always have your wallet in your back left pocket?”
He replied - “Yeah, always, I just stick it in there at the start of the day, and only take it out when I wash my jeans”.
The thought that had flickered moments earlier was forming into a realisation.
“And you are a courier/delivery driver? So you sit a lot in your car. Are you sitting ON your wallet the WHOLE TIME!?”
“Yeah, I do. Oh…..”
And we simultaneously came to the same conclusion simultaneously. Sitting on a two-inch thick mega-wallet was tilting his pelvis to the right so severely that it was causing compression through his spine, tightening in muscles and generating all kinds of PAIN. It disappeared in summer because his shorts did not have a back pocket, so he left his wallet in the car console. And holidays were similarly devoid of wallet-sit time.
We laughed, and I prescribed “Intermittent front pocket usage, pending a FULL clean out of the wallet”. We did some stretches and manual therapy to give him the relief he needed that day. He left with a spring in his step, and my bin was full of those tiny annoying EFTPOS receipts from 2004 and now-defunct business cards.
One week later - he came back for review.
His back pain was GONE. Completely. Since our consultation. He had ceased all wallet-sitting and found that a level pelvis was the key to success. And had a new pair of jeans!
We laughed together and he thanked me for actually looking at him in the WHOLE.
I never saw him again - he phoned to cancel his follow-on appointment because he felt great!
This interaction taught me something critical. It’s that we must always take a moment to look at the whole human in front of us when we are practicing health. We should consider not just the internal issues, but the broader context of the person standing in our clinical rooms. The assessment really begins the moment that they walk into our space, and we enquire with them about how they live, spend their time, and how they use their body and mind on a daily basis, what they believe about themselves and how they are resourced to help their own recovery. Sometimes we can over-pathologise and are too quick to blame the body, it’s structures and functions as the cause of pain, rather than seeing pain as a symptom of something else. We jump to arthritis, postural imbalances, and other internal derangements. We diagnose and image and prescribe, and then wonder why we fail to help.
Because sometimes it’s as simple as a wallet.