In the sub-sections following this introduction I will first be discussing the degenerative spine disorders because they are the most common. You'll read that all of us have degenerative changes to our spines. They are there because they are part of the ageing process, from twenty years on, as we get older. Some aspects of the degenerative sequence may be more advanced; simple spinal problems quietly becoming more complex under the skin. But mostly, the degenerative spinal sequence is painless. Getting older does not always mean getting painer.
You can get to know what's wrong with your back!
After the degenerative sequence, I will be discussing the common congenital spine disorders - such as spinal scoliosis, vertebral stenosis and spondylolisthesis. You will understand exactly what each spine disorder is, whether you should be unduly worried about it and perhaps what you can do to help, if anything, through your own efforts.
More than anything else, I will be aiming to take away the fear and ignorance. Because most spine disorders are simply lambs in wolves' clothing. In other words, they my look bad in the descriptors and the pictures but they are innocent of causing pain.
There are many different spine disorders. You may have been told that you have some remarkable spinal anomaly, the name of which is almost un-spellable and frightens you witless. The good news – although also the rather disturbing news – is that ‘false positive’ correlations are frequently made with bad backs; that is, between what the scans say and the pain you may be feeling. It's all too easy to point to some black-and-white evidence of a spine disorder on your scans and blame it for your pain. It's easy to catastrophize about back pain (most people wonder, at some stage, if they might have cancer). It's that much easier to catastrophize if you are too hooked in to the scans.
Truth is, there is a relationship between symptoms and scans - but only a very vague one. So let this lift the dread in your mind about your back. Because it's often the way you are thinking about your back and what what you are thinking about your back that is keeping your back bad, or even making it worse.
The human body has a most extraordinary capacity to conceal inner difficulty. In the words of Professor Eyal Lederman*: 'biological systems contain reserve capacity to accommodate for loss without failure or symptoms'. In other words, the body has the most astonishing, indeed awe-inspiring, powers to absorb both insult and anomaly without complaint. And often with a bad back, treatment - whatever the spine disorder - should be aimed simply at getting it back to its former, non-complaining state. Not trying to fix the perceived anomaly.
For this reason, scans and images are often misleading (indeed they are often a nuisance from the point of view of the practitioner keen to get on with the job). Scans are by no means final judge and jury on what is causing your pain. So remember this: Your back pain may not be coming from the spine disorder and lofty diagnosis you've been given. In fact it rarely is. You may be interested to hear what Professor Richard Deyo from Oregon in the USA has to say on the inability of scans to accurately account for what is really going on.
The most commonly diagnosed spine disorder is ‘disc prolapse' (or herniated disc, bulging disc, or ruptured disc). This is still going on, despite MRI breakthroughs a decade or so ago, making it clear that vast numbers of asymptomatic people have bulging, herniated and ruptured discs. And although true disc prolapse does occur, and is a diagnosis, you will read later that it accounts for fewer than 5% of cases of low back problems. Through the years it has become an amazingly glib diagnosis not reflecting in the slightest its true incidence in the back suffering community.
Another spine disorder commonly cited as a cause of back pain is osteoporosis with multi-coloured bone scans, often . . . . well, almost seeming to seduce people (women) into feeling they ought to feel pain. Similarly, scans may show a spine riddled with degenerative disc disease - certainly an indication all’s not well. But here again, there may be no pain at all, and never has been. There is poor correlation between the-pictures-and-the-patient. Indeed, clinicians are often thwarted and confused by this poor correlation. It's important that you know, scans are a guide only. Scan are not a holy tablet.
Although I will be describing each condition individually and the broad treatment requirements for its management, there are only a few bedrock principles of treatment. These apply to all conditions.
Quite simply, these first principles are:
1. Getting the spinal segments more comfortably separated
2. Getting the spinal, abdominal & pelvic floor muscles behaving properly
3. Re-learning normal, unselfconscious, unguarded movement
Before anything else, restoring the back to a more soft and relaxed state lets the blood flow and all the spinal juices circulate – and this in itself reduces pain. And as soon as pain levels start abating natural spinal movement will start creeping back in. From here, it is then possible to start on more specific and proactive measures specific to each condition.
Lots of people say: “But what about me!? Mine's more serios because I’m osteoporotic” or “But I've been told I have four bulging discs." "They told me I'd be in a wheelchair one day” (You wouldn’t believe how often I hear this!). Wrong. Wrong and wrong again.
Even with your own self-treatment, you have to make your spine do its stuff ‘as normally and naturally as possible’. With all treatment, you have to proceed slowly and carefully, using a proper proportion of appeasing exercises to proactive, mobilising and decompression ones (Click here to see the summary of different types of spinal exercises). But the message is loud and clear: all spines should do as much as they possibly can to move and get about as normally as they possibly can. Natural movement is the most therapeutic thing of all. Move cautiously at first. But move you must.
You will see in the following sections on congenital, inflammatory or traumatic spine disorders that I am mindful of the underlying condition. But to a certain extent, I also ignore it and get on with the job of making a spine move properly again.
Broadly speaking spine disorders fall into four different categories. This is only a loose guide, since most spinal conditions are either developmental (acquired through subtle breakdown caused by the borderline viability of discs) or a complex amalgam of developmental conditions superimposed on traumatic, inflammatory and congenital.
Click each link below to read about each one:
• Degenerative Spine Disorders (acquired slowly through breakdown)
• Traumatic Spine Disorders (accidental mishap)
• Inflammatory Spine Disorders (systemic illnesses)
• Congenital Spine Disorders (inherited from birth)
*Ref: 'The fall of the postural–structural–biomechanical model in manual and physical therapies: Exemplified by lower back pain' Eyal Lederman CPDO Ltd., 15 Harberton Road, London N19 3JS, UK
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