This article by Sarah Key - the author of The Back Sufferers' Bible first appeared in 'thinkback.com'
The first is the most subtle but also the most profound. It is the concept of the 'stiff spinal segment'; the stiff vertebra in the spinal column which can sometimes be seen but always felt. This is important because for years we back-treating professionals could feel it, knew we could feel it, spent all our professional daylight hours feeling it - yet the broad mass of the medical profession did not acknowledge it - either is its existence or its relevance.
I believe a stiff spinal segment is very commonly cause of the ubiquitous 'simple back pain'. It not only causes pain in the early days when it is still healthy, but further down the track as a painful 'motion segment' degenerates further and the intervening disc between its two adjacent vertebrae become like a flattened washer, it can be the root cause of other more complicated (and less reversible) things going wrong . The fact that stiff spinal segments (SSS) are so commonly overlooked, to me provides the first mosaic in the jigsaw of unraveling the problem of human back pain.
The second main area of controversy is putting a name (and rationale) to the alarming business of an 'acute locking back' (ALB). This is where a chance fluke movement can, in the course of a millisecond, change the course of a life. It is when you are caught like a bolt from the blue by a jolt of pain through your back like an electric current, whereafter you are literally paralysed with pain and can't move.
I suspect this is a tiny subluxation (mini-dislocation) of one of the facet joints at one of your spinal levels. For one of a few reasons, the co-ordinated muscular control of that spinal segment is caught below par, letting the vertebra slip askew slightly as you go to bend. But - and here's the clue - this usually has its provenance in the muscles misbehaving and/or the disc of that level being slightly 'flatter' than it should be because. It is like this because it has the makings of a stiff spinal segment (SSS). The devitalised disc lacks pressure and therefore cannot generate sufficient oomph or springing-apart tension to spring load its vertebra and keep it stable as the spine bends. Bang! And down you go.
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The third and most controversial area is the business of bending, which flies in the face of what is presently being taught the world over in back care programs. I see bending from its absolutely antipodal direction; that is the spine is unsafe bending (and lifting light to moderate weights) while keeping itself straight and bending the knees. I say that unless the back is rounded or 'humped' as it goes over, it is much more susceptible to its segments jostling about and slipping askew.
Rounding the back while bending does four main things: it puts the powerful 'posterior ligamentous lock' down the back of the spine on the stretch which generates maximum holding tension, it invokes the nipping-in effect of the tummy which turns the abdominal space into an 'airbag' in front of the spine which prevents the spinal segments shearing forward, it puts the small intrinsic muscles at a better angle of pull so they can control their individual lumbar vertebrae, and all of these mechanisms help 'prime' or pre-tense the intervertebral discs which also helps them keep their vertebrae steady as the spine goes over. I believe you must bend, down and up again, like a ballerina - yes! even a 15 stone road worker.
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