Archive for July, 2010

Segmental Instability

Thursday, July 15th, 2010

A motion segment is the vertebra, the disc, and the next vertebra. When you lose disc height, the segment can sheer. Sheer in the lumbar spine is not a physiological movement. sheer produces a change in the location of the axis of motion, and that leads to muscle guarding and pain.  It is fair to say that sheer in a motion segment equals instability.  an unstable motion segment can make the pain tricky to resolve or pin down.

For instance, I saw a patient this past week who experiences pain at night – which is very unusual for mechanical lower back pain, but she sleeps on a soft bed. As she relaxes into her sleep, the pain increases because the segment sheers, creating pressure on pain sensitive structures.When she is up and around, she has no pain, and is even able to engage in activities such as horseback riding. But the pain at night wakes her from sleep. Usually pain in a non-weight-bearing posture would be a red flag for requiring further investigation, but in the absence of findings, it is most likely that her pain originates in an unstable segment, and this was confirmed by physical examination.

Nevertheless, it is quite challenging to stabilize an unstable segment though, because the instability is mechanical, while the stability has to come from muscles. The deep paraspinal muscles multifidus and rotatores for example, are responsible for providing stability to motion segments, and can be over trained allowing dynamic stability to reduce mechanical instability. In addition, this person has to restore normal functional length to her hamstrings which are tight, and her thoracic spine which is restricted. Taking the pressure off the lumbar spine for motion reduces the tendency to sheer. Coupling that new flexibility with core stability drills and in particular, deep rotator muscle drills will sort this problem out.

Posted in Uncategorized, deep rotators, motion segment, multifidus, night time pain, segmental instability | 2 Comments »

Why Walk When My Back Hurts?

Tuesday, July 6th, 2010

It seems impossible. The idea that you should walk when you are in pain. But the thing of it is that you should. Simple as that.

The literature is clear on this point, bed rest does no good, and people who maintain their usual activity schedule, seem to do better.

Physiologically, the best form of exercise is simple aerobic exercise. Walking is perfect. When you walk, in addition to the benefits of aerobic walking, improved circulation, improved aerobic capacity, lowered blood pressure and so on, the step after step after step results in the muscles around the spine, the deep muscles, contracting and relaxing repeatedly which leads to reduced muscle guarding.

When in pain, the deep muscles contract to protect the injured part. There are various explanations for this, but the explanation I like is that because there are no valves in the veins of the spine, which means that venous blood can flow either way, the muscles contract to prevent the circulation of a bacteria, and also to protect any damaged or injured structures. Muscle guarding is governed by nerves that can cause them to contract by levels as far away as 5 levels. One of the most important things I think that you can do when in pain is to do all you can to reduce and or prevent the muscle guarding. Muscle guarding itself turns into a secondary problem of ischemic pain caused by the accumulation of metabolites secondary to the prolonged muscle guarding.

Aerobic walking is one way to do that , and ice is another. See the earlier post about ice.

I think that you should go for a walk every day, twice or three times a day for about a half hour at a pace that causes you to work up a light sweat and your breath to be a little deeper. You will feel great if you do.

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Posted in Aerobic exercise, Uncategorized, muscle guarding | 2 Comments »

Lower Cross Syndrome

Saturday, July 3rd, 2010

In the Western world, it is very common for people to develop a “lower cross syndrome”. This is a mechanical circumstance where tight hamstrings, tight hip flexors, weak abdominals and a sway back conspire to cause lower back pain. In a culture that sits a lot, doesn’t exercise much and has a high incidence of lower back pain, it is common to find lower cross syndrome at the root of the symptoms.

The best “treatment” for this syndrome to to combine stretching of the hip flexors and hamstrings with strengthening of the abdominals, or core strengthening. The core program can be found in the LITE version of our app. The stretches are to be found in the full version of the app.

For long term back health, combining core strengthening with lower extremity flexibility is key. In our clinic, Sports Reaction Center in Bellevue, WA, we have successfully treated thousands of lower back patients over the years using these strategies. In the absence of disc herniation or other mechanical causes of lower back pain, this simple strategy can solve your problem.

Posted in Uncategorized, back pain, lower cross syndrome | 1 Comment »