When we have our first episode of low back pain our back is rarely stiff unless we are just like that, having a tendency towards stiffness. Mostly our back moves like the well designed machine it is. The discs separate the vertebrae and allow movement to occur, with thicker discs in areas of greater movement. The facet joints control and limit movement of the segments and prevent abnormal displacement of the spine under the shearing loads it must cope with. The muscles are all in good condition and working in the most functional patterns. Until, at least, an episode of back pain occurs and it all changes.
Initially back pain causes an inhibition and a wasting of the core muscles which provide stability to the segments and to the whole back. This allows instability to occur which may predispose to future back pain episodes if nothing is done to correct it. With time and repeated episodes of pain and degenerative changes which occur in the discs and facet joints, the back can become stiff and develop chronic back pain. Gravity tends to force fluid out of the disc under load and is counterbalanced by an absorbing force which is more active when lying.
Discs will narrow and lose part of their hydration under the forces of compression which occur in normal life, the disc becoming stiffer and narrower. X-rays can show up this narrowing when it reaches a certain level, but many discs will be troublesome long before this stage. The intervertebral disc and the two vertebrae each side of it are referred to as a vertebral segment and an abnormal stiff segment will move in such a way as to impose inappropriate levels of load upon structures not adapted to take them. The stiffness of individual spinal segments can be felt by a physiotherapist palpating the spine.
After an acute back pain injury the surrounding musculature tends to go into muscle spasms to splint and protect the injured segment until inflammation reduction and healing have had a chance to begin. Steady reduction in pain and progress in healing is usually accompanied by lessening of the back spasms and a restoration of normal spinal movement. However, this does not always occur as muscles may remain contracted and overprotective, causing a shortened tissue area which keeps the local joints and other tissues in a permanently shortened position.
Segmental stiffness can also be contributed to by sitting too much with its increased spinal compression forcing fluid from the discs. Avoiding flexion for many of us has led to a loss of this useful and disc-maintaining movement which increases fluid throughput to the discs and keeps them healthy. Other contributors are maintaining abnormal postures and weakness of the abdominal muscle group.
Chronic segmental stiffness is usually indicated by a history of back pain and general backache with some leg referral also possible. Since many and variable areas of the spine can be stiff or mobile, the stiffness which contributes towards the painful problem might have been present for some time. The pain is worse on sitting for long periods or doing bent over activities, anything which stresses the stiff segment towards the end of its available range of motion. The facet joints become stuck in an extended position and the segment tightens up by adaptive shortening, losing its ability to flex or maintain flexion comfortably. My back problems are like this and can be quite troublesome on stressing, leading me to avoid heavy work such as lifting objects of any weight.
Sarah Key, a physiotherapist who is well known in the UK, has produced the Sarah Key's Back Sufferers Bible, a book in which she sets out her views of what is going on in this most common of musculoskeletal syndromes. She does acknowledge that it is hard to bring solid evidence for many of her interpretations but seems to have many good and practical therapy ideas to approach the back pain problem with. She covers the main syndromes which typically occur, giving treatment routines for self management of each one, all of which I have found very useful for my own lower back pain. Now I have something I can do about it rather than accept it as a fact of life. - 14130
Initially back pain causes an inhibition and a wasting of the core muscles which provide stability to the segments and to the whole back. This allows instability to occur which may predispose to future back pain episodes if nothing is done to correct it. With time and repeated episodes of pain and degenerative changes which occur in the discs and facet joints, the back can become stiff and develop chronic back pain. Gravity tends to force fluid out of the disc under load and is counterbalanced by an absorbing force which is more active when lying.
Discs will narrow and lose part of their hydration under the forces of compression which occur in normal life, the disc becoming stiffer and narrower. X-rays can show up this narrowing when it reaches a certain level, but many discs will be troublesome long before this stage. The intervertebral disc and the two vertebrae each side of it are referred to as a vertebral segment and an abnormal stiff segment will move in such a way as to impose inappropriate levels of load upon structures not adapted to take them. The stiffness of individual spinal segments can be felt by a physiotherapist palpating the spine.
After an acute back pain injury the surrounding musculature tends to go into muscle spasms to splint and protect the injured segment until inflammation reduction and healing have had a chance to begin. Steady reduction in pain and progress in healing is usually accompanied by lessening of the back spasms and a restoration of normal spinal movement. However, this does not always occur as muscles may remain contracted and overprotective, causing a shortened tissue area which keeps the local joints and other tissues in a permanently shortened position.
Segmental stiffness can also be contributed to by sitting too much with its increased spinal compression forcing fluid from the discs. Avoiding flexion for many of us has led to a loss of this useful and disc-maintaining movement which increases fluid throughput to the discs and keeps them healthy. Other contributors are maintaining abnormal postures and weakness of the abdominal muscle group.
Chronic segmental stiffness is usually indicated by a history of back pain and general backache with some leg referral also possible. Since many and variable areas of the spine can be stiff or mobile, the stiffness which contributes towards the painful problem might have been present for some time. The pain is worse on sitting for long periods or doing bent over activities, anything which stresses the stiff segment towards the end of its available range of motion. The facet joints become stuck in an extended position and the segment tightens up by adaptive shortening, losing its ability to flex or maintain flexion comfortably. My back problems are like this and can be quite troublesome on stressing, leading me to avoid heavy work such as lifting objects of any weight.
Sarah Key, a physiotherapist who is well known in the UK, has produced the Sarah Key's Back Sufferers Bible, a book in which she sets out her views of what is going on in this most common of musculoskeletal syndromes. She does acknowledge that it is hard to bring solid evidence for many of her interpretations but seems to have many good and practical therapy ideas to approach the back pain problem with. She covers the main syndromes which typically occur, giving treatment routines for self management of each one, all of which I have found very useful for my own lower back pain. Now I have something I can do about it rather than accept it as a fact of life. - 14130
About the Author:
Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in Nottingham visit his website.
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