Back Pain

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Back Pain

 

 

Lower Back Pain


Eighty per cent of the human race has back pain at some time. There is evidence that our lower back has not fully evolved to support our upright posture and it is very likely that its design doesn’t work well for the amount of sitting modern humans do. We sit in the car to go to work where many of us sit in front of computers then drive home to sit in front of the television. Sitting puts about eighty percent more pressure on our lumbar discs than standing.

 

Reaching out in front to pick something up is a common cause of lower back pain because the muscles that lower us forward and lift us back up are only a few centimetres behind the fulcrum or support point which is the vertebral disc where the weight that we lift which includes our arm and upper body can be a metre in front of us. Lifting a few kilograms can result in our back muscles contracting with hundreds of kilograms of force which overloads the spine. The receptors send a distress signal to our brain which responds to protect us by turning the boost up to the muscles (the gamma loop) and the spinal muscles go into spasm in an attempt to splint the spine. Even when the threat is over the protective reaction often continues resulting in pain from what some call a spinal joint sprain or a spinal joint dysfunction or a subluxation and even a disc lesion when those contracted muscles squeeze the disc space and cause a protrusion or a prolapse of the disc.

 

The sufferer can present bent forward or leaning to one side (an antalgic lean) as the brain attempts to force a posture to limit the amount of pain.

We have had a lot of experience in diagnosing and treating even the most acute cases of lower back pain. Our approach is a functional one, that is we test all the movements looking for a pain free movement and use forces in that direction to free up the joint and turn off the protective spasm. We constantly recheck the painful movements to get the feedback that we have made a change and modify our treatment as more movements become pain free. It’s very rare that we can’t demonstrate an improvement in the pain free ranges of movement before our patient leaves the clinic. We sometimes use a special flexion dystraction table to articulate the lumbar spine, in particular directions depending on the case, whilst under traction. We recommend the use of a lumbar support brace in the acute cases and lend our patients such a brace until they can buy their own. We recommend that hey minimize their sitting. Sitting usually makes them worse.

 

There are other causes of back pain such as an extension sprain where the patient complains of a constant pain on standing, relieved by sitting and in bed they like to lie on their side with their knees bent up. We can reproduce their pain by getting them to bend backwards but in these cases bending forward rarely hurts. The results in these cases are usual quick. We lever the extended joint into flexion after which there is no longer pain on bending backwards and we give them a stretching exercise which helps them to help themselves.

We teach our patients core stability and stretching exercises and coach them on good lifting and sitting posture in an attempt to prevent future relapses.

 

There are occasionally cases of lower back pain that are not suitable for our treatment such as fracture and tumour and disc prolapse where the disc material has ‘leaked out’ (nearly always in the young adult). We have experience in the diagnosis of such cases and refer them to the appropriate professional.