A Typical Story:
A person who has low back pain goes to his medical doctor. The Family doctor, not knowing how to address the cause of low back pain, writes a prescription. They refer the patient to a surgical consultation and physical therapist when pain persists. When the patient goes to a surgeon, he says there is a problem, and I can fix it with surgery. A surgical date is set, but the patient gets better on its own; now, the confused patient goes to see the doctor with a question;" should I get the surgery?" Most discogenic pains are episodic, meaning they have an episode of acute pain that diminishes, and the cycle repeats itself. In the following cycle of pain, the patient revisits the surgeon, and he says why don't we put off the surgery, and why don't you try Yoga or Pilates? Well-intended advice without knowing that those two are the exact triggers of the patient's pain.
Develop Spine Hygiene
Just like our teethes, our spine requires daily hygiene; Spine hygiene allows you to be free from pain, meaning you can live your life free from the effect of pain regardless of the pain. This blog is a step-by-step guide to help you maintain a healthy spine, an adaptation of Dr. Stuart McGill, and for further study and understanding, I recommend you read the book, Back Mechanic.
If you have tried physical therapy, chiropractic, and primary care and still have pain, it is time for a new approach.
First, we need to discuss our spine; it is not a freestanding pillar and thinks of it as a radio tower. Each patient will experience spine pain( low back or neck pain) differently, and their body's response to it also varies, and that is because spine-related disorders are multi-factorial, and therefore treatment also must be personalized. Our radio tower's responsibility is to signal, so the structures, such as muscles and ligaments, provide support and strength.
The spine comprises bony vertebrae, discs, and muscles attached to the bones and nerve pathway that ravels down in the middle of the spines with roots at the outlet of each joint.
The Neutral Spine
A neutral spine is like a home-based where the Neck ( Cervical), upper back ( Thoracic), and Low back ( lumbar) are at their best position and are most resilient to the load. A good posture in standing, sitting, and walking means maintaining a neutral spine while moving from one position to the other is the goal.
To deal best with pain, we need to understand how this structure-function. "It is not the load that injured you; it is the load you weren't prepared for that has caused the injury." Dr.McGill
repeated spine flexion or bending will delaminate the layers of the discs, and the best way to avoid it is by making sure the torso muscles are intact and in balance with one another, and the key is in balance. A torso that is flaccid or weak causes spine pain.
What is commonly known as core muscles is basically Rectus abdominal" six-pack" and obliques that anchor the Rectus, which forms a hoop around the torso that is an intelligent design that allows us to throw, create a hip transfer, and works like a spring; our trunk is attached to our shoulder and arms, and their movement influences the core as well. The problem is that many people train this hoop incorrectly or don't train it. In the back, we have erectors ( multifidus, longissimus, iliocostalis) and quadratus lumborum, latissimus dorsi, rhomboids, trapezius, and many smaller ones. Their job is to stiffen when bending forward and balance the shear forces. Latissimus is a forgotten muscle; it is crucial to stabilize the spine and allows us to lift, pull and carry loads. We can not think of core muscles without the hip and pelvis muscle groups as they are attached and must work synchronously, such as gluteal, quad, and hamstrings. These muscles respond differently to back and hip pain which explains that complete rehabilitation involves the back, hip, shoulder, legs, and arms muscles.
For example, carrying an object on one side is a good illustration of the roles of these muscles. If one carries an object with their right hand, the left gluteal muscles support the pelvis and allow the leg to swing. On the right side, the Quadratus lumborum assists the holding. In contrast, the internal oblique stops the pelvis from tilting and prevents twist motion of the torso, while the external oblique plays the same role in the opposite direction. The last is a link to the shoulder, creating stiffness to control the bending. All muscles must work homogeneously, and if there is any shortcoming in any of the muscles, the chain is broken and, over time, results in pain.
Spine Stability vs. Mobility
Stiffness is essential to prevent buckling co
llapse of the spine when the spine is loaded; it also facilitates movements of the limbs; think of it like a corset around the joint to prevent micro-movements. That is the source of our spine stability. Injury causes laxity in the joint, and pain allows the micro-movement to occur. It is imperative to create an effective muscular girdle around the spine. One crucial point is that achieving this requires muscles to be active for extended periods. These muscles are endurance muscles; therefore, training should be arranged as such. Another point is that while
some injuries benefit from mobilizing, others need stiffening, and the doctor who evaluates you needs to know the difference.
As I have mentioned, Spine Related Disorders are multifactorial. The mechanism of injury varies, including; Disc bulges, Degenerative Disc Disease, Spondylolisthesis, Sciatica, Femoral nerve pain, Stenosis, muscle pain, Facet joint disease, torn or strained ligaments, scoliosis, muscle inhibition, and traumatic d
amage. However, all of them causes low back pain treatment is very different.
Many times pain gets relieved by corrective the faulty movement; if you keep repeating the harmful movement, you continue to provoke the pain and trigger the body's response. The key is to find repeating pain-free movement.
Another factor that must be addressed is the psychology of pain; when pain occurs, it affects various parts of our brain, and some people's brains tend to hold on to the picture of pain and learn to acknowledge it. How we deal with pain also depends on our personalities; some of us are detail-oriented and driven, which means we need to know the exact date of recovery, while others focus on the ache and obsess over pain, and tend to hold on to pain and dwell on it. Learning a new way to deal
with pain also plays a role in recovery.
Is Surgery Right For You?
Suppose you have exhausted all conservative approaches and failed. Surgery must be considered if you have neurological issues such as bowel or bladder control loss, numbness, or muscle atrophies. But before you think about surgery, I want to warn you about New treatments. Over the past few years that I have practiced, many new treatments and devices haven't met the expectation; over a long time, it has failed the patients—success over a long time is defined as full resumption of former activities without pain.
Be aware of any surgeon or institute that only reviews your MRI or CT but doesn't assess you. The surgeon must confirm that the pain is coming from the structure identified on the MRI; there have been many cases where the painful structure looked fine on the MRI while the damaged one didn't cause pain.
Rule on guidelines for a healthy back
Practice healthy movement
Maintain balance
Remove the cause ( faulty movement, posture, etc...)
Be aware of any clinicians that require numerous return visits.
Be aware of passive treatment; they are just like band-aid.
Not all clinicians are competent
ent; if you leave the office only with a pain pill, and no active treatment, it is time to change.
Establish a balance between strength, power, and endurance
One Therapeutic doesn't fit all
Success is achieved through continuous personal assessment.