More than half the patients that see Raina Steer do so because they are suffering with back pain. Ms Steer, a registered physiotherapist, said on average she sees between 40 and 50 people a week with complaints of back pain.

And her caseload breaks the commonly held view that this pain is largely suffered by the elderly. She said she sees the broad spectrum of ages.

Her youngest patient was 15 years old and the oldest 91. The majority are between 25 and 60. But she does see an age-related trend in the problems.

“I see more slipped discs in the elderly and pulled back muscles in 30 year olds,” she said. “There is a greater prevalence of degenerative changes in the joints and discs in the elderly and more strained muscles in people 15 to 40. Disc injury though happens in all ages.”

Ms Steer has postgraduate training in spinal injuries and said when she worked in her native Canada she was given most of the patients with back complaints.

In Bermuda her caseload of back injuries is higher than she had at home, but she doesn’t feel the overall number of people suffering here is very different from Canada or the US.

She said the most common back pain injuries she sees are low back and neck injuries. “These are coming from prolonged sitting at work as well as lifting injuries from more labour intensive jobs,” she said. “There is an equal ratio of disc and joint injuries and a smaller percentage of muscle injuries.”

While back pain can be excruciating, Ms Steer said most of her patients do get relief and heal. “On average 80 percent of my clients have 80 to 100 percent resolution of their low back pain if they are compliant with treatment, the suggested lifestyle changes, and the home programme,” she said. “Ten percent will have 60 to 80 percent resolution and be discharged to another healthcare practitioner. The other 10 percent will be referred back to their family doctor for follow up care and possible further testing.”

Of course the healing times differ from person to person and severity of injury but Ms Steer said typically her patients are fully functioning after anywhere from five to 15 treatments. Treatments differ depending on the injury and often require the patients to take an active part.

Exercises and/or stretches targeting certain muscles are usually the main prescription. When her patients are not improving Ms Steer said: “I ask them if they are doing their home exercises, being more careful with their lifestyle, and if they feel we are addressing the main areas. I always reassess to make sure I am treating the right structure. After all of that if I don’t see results and they are not getting some relief from treatments after five to six sessions I will refer them to another therapist or back to their family doctor.”