Jenny Resmondo | Diagnosing Severe Back Pain Red Flags | Tom Rowland Podcast Ep. 682

Jenny Resmondo, a physiotherapist at South Alabama Physiotherapy, joins Tom Rowland to break down how to diagnose and address severe back pain—a condition that affects countless anglers, outdoor enthusiasts, and active individuals who push their bodies to the limit. In this Physical Friday episode, Jenny reveals the red flags that separate normal back pain from conditions requiring immediate attention, walks through the diagnostic process physiotherapists use to assess spine-related issues, and explains why pain level doesn't always correlate with the severity of structural damage. She shares specific treatment approaches for herniated discs, muscle strains, and facet joint dysfunction, and discusses realistic recovery timelines that many patients don't expect to hear. If you've ever wondered whether your back pain is serious or how to prevent it from sidelining your time on the water, this conversation delivers answers you can actually use.

Understanding the Spectrum of Severe Back Pain

Not all back pain is created equal, and Jenny makes this distinction crystal clear early in the conversation. She explains how severe back pain differs from the everyday soreness that comes from a hard day of fishing or working out—and more importantly, when you should be concerned enough to seek professional help. The red flags she lists aren't just medical jargon; they're specific symptoms that could indicate nerve compression, structural damage, or conditions that won't resolve on their own. Jenny also addresses a critical misconception: the intensity of your pain doesn't necessarily reflect the severity of the underlying problem. You might have excruciating pain from simple muscle tension, or surprisingly little discomfort from a herniated disc. This insight alone changes how you should think about your body's warning signals. Jenny's full breakdown of severe back pain categories and red flags begins at the start of the episode.

The Diagnostic Process: What Happens in the Evaluation Room

When you walk into a physiotherapy clinic with severe back pain, you might expect someone to immediately start poking and prodding your spine. Jenny reveals a different approach—one that starts with detailed questions about when the pain began, what movements make it worse or better, your injury history, and your current symptoms. Only after gathering this comprehensive history does she move to the physical examination, which includes specific tests to assess range of motion, strength, neurological function, and structural issues through palpation. She explains when imaging like X-rays or MRI becomes necessary and when it doesn't add value to the diagnostic picture. The conversation reveals how much detective work goes into understanding the true source of back pain, and why rushing to get an MRI isn't always the right first step. The detailed walkthrough of Jenny's diagnostic process starts mid-episode.

Common Culprits: From Herniated Discs to Muscle Dysfunction

Jenny breaks down the most common causes of severe back pain she encounters in her practice, and the list might surprise you. Herniated discs top the charts, particularly among people with poor posture or improper lifting mechanics—two issues that plague anglers who spend hours bent over the gunwale or hauling heavy coolers. Muscle strains and sprains can cause significant pain despite being less structurally serious. She also discusses facet joint dysfunction and sacroiliac joint issues, and notes that often it's not just one problem but a combination of factors creating the pain experience. What's fascinating is her explanation of why pain intensity and structural damage don't always match up—a concept that challenges how most people think about their injuries. Jenny's discussion of specific back pain causes and conditions unfolds throughout the middle section.

Treatment Approaches and What Actually Works

When it comes to treating severe back pain, Jenny emphasizes that the approach must match the diagnosis—there's no one-size-fits-all protocol. Physical therapy forms the foundation of almost every treatment plan, with specific focus on addressing root causes whether that's correcting posture, strengthening stabilizer muscles, increasing mobility, or fixing dysfunctional movement patterns. She discusses when manual therapy techniques like massage or joint mobilization provide benefit, when medication management becomes necessary, and when injection therapy enters the conversation. Surgery, she notes, is reserved for rare cases where conservative treatment fails. What stands out is her emphasis on addressing the underlying cause rather than just chasing pain relief, and why patient compliance with treatment plans determines success more than any single intervention. The treatment strategy discussion, including recovery timelines, happens in the latter portion of the conversation.

Final Thoughts from Tom

Back pain is one of those things that can completely derail your fishing season, your training, and honestly your quality of life. What I appreciate about this conversation with Jenny is how practical and specific she gets—no generic advice about taking it easy or doing some stretches. She gives you the actual framework for understanding whether your back pain is something you can work through or something that needs professional attention right now.

The part about pain not correlating with damage really stuck with me. I've had times where my back felt terrible but I could still function, and other times where something structural was clearly wrong but the pain wasn't as intense. Understanding that distinction changes how you respond to what your body is telling you. And her emphasis on prevention—the posture work, the core strengthening, the proper lifting mechanics—that's the stuff that keeps you on the water instead of on the sidelines.

If you deal with back pain, if you've been putting off getting it checked out, or if you just want to understand how to prevent it from becoming a problem, listen to the whole thing. Jenny breaks it down in a way that makes sense and gives you action steps you can actually take.