Patient case study

Gary’s story: why the same side kept flaring upWhat a standing EOS scan showed about his pelvis, posture and lower back

Right lower back
Sciatica
Pelvic tilt
Forward posture
Flatter lower-back curve

Pain relief treated the flare. The scan showed what kept causing it.

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Real ScanAlign patient
His own scan video
About 12 minutes to read

Gary · Scan video Watch Gary’s scan

Gary’s own scan video, shared with his permission.

The short answer

Why did Gary’s back pain keep coming back on the same side?

Why did Gary’s back pain keep coming back on the same side? His standing EOS scan showed three things working together: a tilted pelvis, a body that sat forward over his feet, and a lower-back curve that was flatter than usual. Together they sent more load through one side of his lower back, the right side, which was the side that kept flaring up. Pain relief settled each flare, but it did not change the loading that set them off. His plan moved to correcting his spinal mechanics with posture and strength work.

Patient: Gary
What hurt: Right-sided lower back pain with sciatica
The pattern: Flare-ups that kept coming back
Plan before the scan: Pain relief
Scan: EOS full-body standing scan, front and side views
Key findings: Pelvic tilt, forward posture, flatter lower-back curve
Plan after the scan: Posture and strength work to change how his spine is loaded
Where: ScanAlign, 19 Harley Street, London

Before the scan

The pain had a plan. The pattern did not

Gary came to us with lower back pain on his right side, along with sciatica down the same leg. The pain came in flare-ups. It would settle, then return.

Pain relief was the main plan. That is a reasonable place to start, and it did help. Each flare quietened down. But nothing in the plan answered the question he kept asking, which was why it kept happening, and why always on the same side.

Pain that stays on one side is a clue. The body is roughly symmetrical, so when one side keeps taking the damage, something is usually loading that side harder. The question was what.

Painkillers worked on the flare. Nobody had looked at what kept setting it off.

The pattern

The flare-up loop Gary was stuck in

Recurring pain usually runs in a loop. Select any stage to see what happens at that point.

and round again

Flare: pain builds on one side

Gary’s right lower back would flare, sometimes with pain travelling down the leg. Sciatica is irritation of a nerve that runs from the lower back into the leg, which is why it can be felt a long way from where the problem sits.

Settle: rest and pain relief

Rest, painkillers and time take the heat out of a flare. The nerve calms down, the muscles stop guarding, and the pain fades. This part of the plan was working.

Back to normal: the same standing position returns

Once the pain eases, you go back to standing and moving the way you always have. Your pelvis sits where it sat before. Your spine carries weight at the same angles as before.

Build-up: the same side loads up again

Day after day, the same side takes more than its share. Nothing dramatic happens on any single day. It builds quietly, until the next flare.

A plan built only around pain relief works on the first two stages of that loop. It does not touch the third and fourth. That is why rest alone often is not enough, and why the same side keeps coming back.

What the scan found

Three findings, all linked

None of these three is unusual on its own. Together, in the same body, they explain why one side of his lower back kept taking the strain.

A tilted pelvis

The two sides of his pelvis did not sit level, which is often called a lateral pelvic tilt.

What it is
Your pelvis is the base your spine sits on and the top your legs hang from. It is designed to sit level. When one side sits higher, everything above it has to adjust to keep your eyes level.

Why it mattered for Gary
A base that is off level means the two sides of his lower back were not sharing load evenly. One side was taking more, every hour he was upright.

What the standing scan shows
Both sides of the pelvis appear in a single standing image, so their heights can be compared directly rather than estimated by hand.
Forward posture

His whole body sat forward over his feet, sometimes described as a forward leaning posture.

What it is
Ideally your head, chest and pelvis stack roughly above your feet, so your skeleton holds most of your weight. When the whole body drifts forward, the muscles and joints down the back of your spine have to pull you back upright all day long.

Why it mattered for Gary
It gave his lower back constant background work. Muscles that never switch off get tired, and tired muscles pass more load on to the joints behind them.

What the standing scan shows
A standing side view captures the head, spine, pelvis and feet in the same image, so how far forward the body sits can actually be measured. Lying down, there is nothing to measure.
A flatter lower-back curve

The natural inward curve of his lower back was flatter than usual. That curve is called the lumbar lordosis.

What it is
Your lower back is not meant to be straight. It curves gently inwards, and that curve works like a spring, spreading load across several joints instead of concentrating it in one place.

Why it mattered for Gary
With less curve, there is less spring. More load passes straight through the joints at the back of his lower spine, close to where the nerves leave the spine on their way to the leg.

What the standing scan shows
The whole spine is imaged standing, front and side together, so the real shape of the curve under his own body weight can be seen. A full spine X-ray taken standing is the usual way to measure it.

How it connects

Three findings, one overloaded side

Select each step to see where it sits in the body. The side view shows posture and curve. The back view shows the pelvis and the side that took the load.

Pelvis off level
Flatter lower-back curve
Sits forward of the feet
One side takes more, nerve irritated

Illustration, not drawn from Gary’s images. Simplified and exaggerated for clarity. The direction of the tilt shown is illustrative, because which side sat higher is not part of his published summary.

Start at the base. If one side of the pelvis sits higher, the lower back above it cannot sit square. One side closes down slightly more than the other.
A flatter curve spreads load across fewer joints. There is less give in the system, so whatever arrives goes more directly into the joints.
Being forward of your feet adds a constant pull on everything behind your spine. The further forward you sit, the harder that work is. It is measured as your sagittal vertical axis.
Put the three together and the extra load lands in one place: the right side of his lower back. That is also where nerves exit on their way down the leg, so irritation at the nerve root can be felt as pain in the leg.

Watch the scan

Watching Gary’s scan: what to look for

The video walks through Gary’s real EOS images, front and side. You do not need any medical training to follow it. These three things are worth watching for.

What to look for in the video

In the side view, notice how far the body sits forward over the feet.
Look at the lower back in the side view and how flat its curve is.
In the front view, compare the two sides of the pelvis.

Scan images can look unfamiliar at first. That is normal. The written report that comes with every scan explains the findings in plain English. Replay Gary’s video

What a standing EOS scan shows

How your bones and joints line up when you stand
Whether the two sides of your pelvis sit level
The curves of your whole spine, front and side, under your own weight
How far forward or back your body sits over your feet
The shape of your joints and the space inside them while they carry weight

What it does not show

Discs and nerves in detail
Cartilage, muscles, tendons and ligaments in detail
Inflammation and other soft-tissue causes of pain

For these, MRI is usually the better tool. With sciatica the two often work well together: MRI shows the state of the nerve, and a standing scan shows why load keeps arriving there.

After the scan

How Gary’s plan changed

Before

Pain relief

After the scan

Correcting spinal mechanics, posture and strength, aiming to stop the nerve irritation coming back

With the mechanics on the table, the plan could aim at the cause of the loading rather than the symptom. That usually means two things working together: changing how he stands and moves, and building the strength to hold the new position. Our guides on posture exercises and strength training for back pain explain the general idea.

It also reframes the flare-ups. A flare is no longer a random event to be endured. It is feedback about load. Treat the load differently, and the pattern can change. Pain relief still has a place, but as support rather than as the whole plan.

Changing mechanics takes time, and progress is usually measured in months rather than days. The advantage is that each side of the problem can be worked on by the right person, with the findings in hand.

ScanAlign is a diagnostic imaging clinic. We show you what is going on and explain it clearly. Treatment is planned by the specialists you choose, with the findings in hand.

Why standing matters

Why a standing scan made the difference

Every one of Gary’s three findings is about being upright. A flatter curve, a forward lean and an off-level pelvis are all things your body does while it is holding itself up and carrying its own weight.

Lying down takes that weight off. Muscles relax, the spine settles into the table, and curves can flatten or straighten out. That does not mean the pain only happens when you stand. Plenty of people hurt lying down too, and night-time back pain is common. It means the cause often sits in how you are aligned and loaded when upright and carrying your weight, even if you feel it at other times.

An EOS scan is a full-body weight-bearing scan in 15 seconds, unstitched and non-magnified, with front and side views captured at the same time. It uses about 90% less radiation than a standard X-ray, around ten times less.

Lying down: MRI and CT

The load comes off

Muscles relax and the body settles into the table. A tilt, a lean or a flattened curve can soften or disappear. These scans are excellent for discs, nerves and soft tissue.

Standing: EOS

Your real working position

Pelvic level, spinal curves and how far forward you sit over your feet show as they are when you carry your weight. Head to feet in one image, front and side together.

An honest note about MRI. EOS shows bones, joints and alignment. If your problem is mainly discs, nerves or soft tissue, MRI is usually the better tool, and we will tell you so on your free call. See how EOS compares with MRI, CT and X-ray.

Seek urgent help first if you have new numbness, weakness in your legs, or loss of bladder or bowel control. Contact your GP, NHS 111 or A&E.

Your story

Does your pain keep coming back the same way?

Which of these sound like you?

Tick any that apply. Nothing is saved or sent.

My flare-ups nearly always happen on the same side
Pain relief helps for a while, then the pain comes back
The pain travels from my lower back into my leg or buttock
I feel like I am holding myself forward, or people tell me I lean
Rest settles it, but going back to normal brings it back
No one has looked at how I line up standing, from head to feet

Tick any that sound like you.

Talk it through on a free call

Questions to ask your specialist

Whoever is treating you, these questions move the conversation from the flare to the cause.

Why does my pain keep returning on the same side?
Does my pelvis sit level when I am standing?
How much inward curve does my lower back have, and is it enough to spread load?
Would seeing my spine, pelvis and legs standing in one image change the plan?

Good clinicians welcome these questions. If you are not sure who to ask, our guide on when to see a specialist can help.

How a story like Gary’s starts

A free video consultation
Tell us what has been going on and what you have tried. No GP referral is needed, and we will say honestly whether a scan is likely to help.
Your standing scan at 19 Harley Street
You stand naturally, with light undressing, and the scan captures you from head to feet. Read what to expect on the day.
A clear written report
A plain-English report of your findings, with a summary you can take to your GP, physiotherapist or specialist.

Questions

Questions people ask after reading Gary’s story

Why does my back pain keep coming back on the same side?

One-sided pain usually means one side is taking more load than the other. That can come from an off-level pelvis, a leg length difference, an old injury you now work around, or the way you stand and sit. Until the loading changes, the same side tends to keep flaring.

Can posture cause sciatica?

Posture does not pinch a nerve by itself, but it changes how much load passes through the part of the spine where nerves leave on their way to the leg. If that area is already narrow or irritated, extra load can be enough to set symptoms off, and less load can help settle them.

Does a flatter lower-back curve cause back pain?

Not on its own. Plenty of people have flatter curves and no pain. It matters when it appears alongside other things, because less curve means less spring and more load through fewer joints. A very flat lower back is sometimes called flatback syndrome.

Why did pain relief only help for a while?

Pain relief works on the pain. It does not change the position your body holds or the load it carries, so when the medication wears off and normal life resumes, the same loading resumes with it. This is also why sciatica can keep returning even after it settles.

Can a tilted pelvis be corrected?

It depends what is causing it. If muscles and habits are holding the pelvis off level, targeted work can often change it, and our guide to pelvic tilt exercises covers the general approach. If the difference comes from the bones themselves, the aim is usually to manage the load rather than remove the tilt.

Do I still need an MRI if I have sciatica?

Often, yes. MRI is the better tool for discs and nerves, which is usually what sciatica involves. A standing scan answers a different question: why the load keeps arriving at that spot. If you have numbness or tingling in your leg, tell whoever is assessing you, because that changes which tests matter most.

Is the EOS scan safe?

Yes. EOS uses about 90% less radiation than a standard X-ray, around ten times less. You stand in an open scanner, with no tunnel and no injections. There is more detail on our safety page.

How much does it cost?

Prices are on our cost page. The first video consultation is free and there is no obligation to go ahead.

Keep reading

Guides linked to Gary’s findings

Your story

Recognise the loop in Gary’s story?

If your pain keeps returning to the same side, or pain relief only buys you a few weeks, a free video consultation is the easiest way to find out whether a standing scan could help you too.

Book a free video consultation Call 020 7935 0001

Gary’s story, first name and scan video are shared with his permission. Individual findings and care plans vary, and this story does not predict your results.

This page is general information and not a diagnosis.

ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital’s CQC licence.