Archive for the ‘Back Care’ Category

This was a 10 minute presentation to a local business networking group.

 In this talk I reveiw our spinal curves and why we loose height as we age. 

 Do you want to know how to sit properly? 

What about spinal degeneration and aging? 

What about treatment? 

I also explain a little bit about the physiology of Intra Muscuar Stimulation (IMS). 

So get comfortable and enjoy the talk.

What would you think if you were informed that you had “degenerative disc disease?” It would be shocking to think of

 having a disease of the disc.

What is the disc?  

What kind of disease is it? 

Is it curable? 

Well, this condition is really not a disease. It is really one part of the spinal anatomy that is wearing out faster than the

 other parts that are wearing out from the normal aging process. 

In order to fully understand what is happening, we need to understand how the spine works and what is normal aging.

UNDERSTANDING THE ANATOMY OF YOUR SPINE

Picture taking 24 of those kids blocks (the ones with the alphabet letters on them) and stacking them one on top of the

 other. These represent our vertebral bodies. But they are not stacked perfectly, they are slightly curved one way for

the first five (your lower back or lumbar spine is a lordosis).  Then they curve the opposite way for the next 12 (your

 thoracic spine is kyphotic).  They curve again the other way (like the lumbar spine) for your neck (or cervical curve).

Now take a 10 lb bowling ball and balance it on top.  This represents your head.  Of course these curved stacked

 blocks are not resting on the ground but sitting on the pelvic (sacrum which is a small upside down triangle bone of

five fused together blocks) that sits between your two pelvic bones. This all rests on two pedestals (your legs). 

But of course these blocks are not just sitting one on top of the other. They have small water-filled balloon type

 structures between them.  These are the discs.  This does not sound like a very stable structure at all does it?

 

 

HOW DO WE STABILIZE OUR SPINES?            

In order to add stability to this stack of blocks, we add a strip of duct tape to the front and the back. This represents

 your ligaments. We will talk about the structure of muscles, ligaments, and tendons another time. You can also add

 some smaller strips of these ligaments between the blocks (running between two adjacent blocks or spanning a few

 blocks).  

HOW DO WE GET THE SPINE TO MOVE?

Now we know that the spine has to move, so the tape can’t be too tight and rigid.  To add to the stability, but allow

 some movement we add in some small elastic bands (muscles) close to the blocks. These attach to the bony parts

sticking out from the vertebra (spinous processes and transverse processes). Some of these bands run between only a

few blocks, while others span more than a few. 

In the back there are three layers of these muscles.

The deepest layer adds the stability to the vertebrae (www.dianelee.ca) for more information on the inner

 core).  The middle layer helps move the back, pelvis and neck in different directions. While the outer layer helps

move the arms and legs.  All add some stability (inner versus outer) to the spinal column. 

These elastics are controlled by electrical signals coming through wires (nerves).  

 

WHAT HAPPENS AS WE AGE?

Deconditioning 

First of all, many people in middle age get caught up in the rat race of life and stop being physically active.  So now the

 muscles don’t work as well as they should. 

 

Changes in the disc

At the disc level, there is a movement toward the disc moving into the bone. To picture this, take your hands and hold

 them slightly apart but level with each other (young disc). Now cup your hands but without moving them together.

Notice how your fingers come together. The part where your knuckles bend is the part moving into the vertebrae. As

 the fingers come closer together what happens to the duct tape that is spread between the fingers on the right and

 those on the left?  Yes the tape crinkles. It does not shorten because it, unlike the muscles, is not very elastic. 

 

Wear and tear

Now you have a muscled deconditioned back with loose ligaments. Now part of your stack of blocks

is moving too  much. This puts stress on the joints (where two bones come together) and the discs.

 The joints may start to wear under stress and soon you will be told that you have arthritis. Or the

disc starts to be placed under too much stress and you develop a bulged or herniated disc. There is also a lot of stress

 on the disc if you are doing a lot of bending and twisting, or sitting in a slouched position.

 

SPEEDING UP THE AGING PROCESS

Fractured end plates

Now you can speed up this aging process by doing a number of things.  You could have had a hard fall

 onto your back or buttocks. Just think of all those impact sports we played as children, the falls off our

 bikes and monkey bars or those tumbles because we really should not have been doing gymnastics,

but the teacher did not listen to us. These falls can create a fracture to the thin plate (end plate) on the

bottom of your vertebrae. The disc then gets exposed to foreign material causing an inflammation process and it

starts to degredate (thin). This is your “disease” process. 

 

Smoking

You can make the disc more fragile by smoking (reduced blood flow and nutrients get to the disc).There is a study out

 supporting that individuals who smoke and perform heavy lifting activities are at increased risk of lower back

injuries.  Smoking is essentially like putting your nice supple tissues into a dehydrator.  They start to become like

 dried out leather and tear more readily. (Also if you fracture a bone, it has been shown to not heal as well, and

sometimes not at all in smokers).

Tight or weak muscles (muscle imbalances)

You can have nice tight muscles in the back that will compress the disc and which can limit nutrition to the disc and

 compress the spinal joints (contributing to arthritis). Another thing that has been shown to occur after trauma to the

 back (fall or other accident, repetitive trauma from bending and twisting) is the deepest muscle (multifidus) can shut

down. Yes it just stops working. Now you can imaging what would happen if one person at work just up and quit. All

the other people would have to step in and try and do the work to keep the pole from falling over or moving too

 much.  So now the middle layer of muscles get overworked and tight. Some people even try to keep the pole stabilized

 by squeezing their buttock muscles. This just leads to a whole new set of problems. 

 

WHAT CAN YOU DO?

Don’t fret, it’s not too late. With a proper assessment to determine all your muscle imbalances (what is tight and what

is not helping out) and working on releasing the tight muscles and getting the lazy ones back to work, you can in most

cases improve the stability of your spine, reduce the compression and irritation to the spinal joints and take some of

the stress off of the disc. However, you need to be willing to do some work. You will likely be required to start a

 stretching program, and work on re-engaging your inner core (reconnecting the wires from your brain to the

muscles) and then working on overall conditioning. 

 

References/More Information

1. www.dianelee.ca

Start Line Physiotherapy (250) 746-7463

wendy@wendybowen.com

How do you know that traction will work for you (and you won’t hurt yourself)?

Physiotherapists have used traction as a treatment modality for decades (used medically for over 50 years). There are certain tests that we do to help determine who will benefit or not from traction.

Nowadays you don’t need to see a physiotherapist to have traction with the invention and sale of the inversion table.

Why would someone hang themselves upside down? 

The rational behind traction:

• Arthritis
  • light separation of the vertebrae (bones) in the spine
• Disc bulges or herniations
  • takes stress off of the discs

We, as upright walking humans, are subjected to the law of gravity. I have read over the course of the day we can loose up to 2 cm in height (so always measure your height in the morning). First thing in the morning we also have more fluid and height in the discs in our backs, which is why people with back pain from disc problems (herniations or bulges) often feel more pain in the morning. 

There is a list of contraindications for inversion table use. You should not use an inversion table if you have the following medical conditions:   

Glaucoma
Pregnancy
Hiatal hernia
Ventral hernia
Detached retina
Extreme obesity
Middle ear infection
Arterial hypertension
Severe vascular disease
Anti-Coagulants (use of)
Conjunctivitis (pink eye)
Bone weakness, recent fractures
History of congestive heart failure
History of space-occupying brain lesion
Vulnerable areas of stress from recent surgery

Why see a physiotherapist first?

1. Traction can aggravate the problem.

2. There may be other treatment techniques that would also be helpful.

• IMS
• Exercises
• Manual Therapy
• Education

3. There are several different causes of back pain (www.cbihealth.com).

4. May aggravate conditions in the knees and hips.

Bahram Jam reviewed Spinal Decompression in the APTEI report (www.aptei.com/report winter 2009). In this review, Bahram looks at an article published in Chiropr Osteopat. 2007 May 18; 15:7. This is more of a review based on marketing claims and scientific literature. 

The conclusion drawn is there are few studies that exist supporting spinal traction. 

There was a good study published in Spine 2007 Dec 15: 32 (26) again summarized by Bahram in the APTEI report on who might benefit from traction. 

People with the following symptoms are likely to benefit from traction:

1. Leg symptoms below the knee

2. Signs of nerve root compression (a pinched nerve where it exits the spinal column)

3. Peripheralization of symptoms with extension (backwards bending decreases the pain in your leg)

4. Symptoms down one leg when the other is lifted (positive crossed straight leg raise)

Conventional traction versus inversion tables

(Physiotherapy Theory and Practice (2000) 16, 151 –160 © 2000 Taylor & Francis)

• Randomized controlled – 29 clients with lower back pain and sciatic from disc herniations.
• Both groups benefited (as noted by clinical changes on CT scans) but there was no clinically significant difference between the groups.   

When making the decision to invest in the “spinal decompression” advertised in the newspapers, or on an inversion table, or physiotherapy, I would suggest doing your research and know what you’re getting for your investment. 

References/More Information

1. Bahram Jam’s reports: Chiropr Osteopat. 2007 May 18; 15:7 online: (www.aptei.com/report winter 2009) and Spine 2007 Dec 15: 32 (26)

2. (Physiotherapy Theory and Practice (2000) 16, 151 –160 © 2000 Taylor & Francis)

For more information:

1. http://www.energycenter.com/grav_f/contra.html

2. www.cbihealth.com

Start Line Physiotherapy (250) 746-7463

wendy@wendybowen.com