Sarah Key's Back in Action - Brossura

Key, Sarah

Brossura

ISBN 10: 1865087343 ISBN 13: 9781865087344

Casa editrice: Allen & Unwin, 2002

Riassunto

Book by Key Sarah

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Back in Action

By Sarah Key

Allen & Unwin

Copyright © 1991 Field Mill Holdings Ltd
All rights reserved.

ISBN: 978-1-86508-734-4

Contents

INTRODUCTION: How This Book Came About, 
1 WHY IS BACK PAIN SO COMMON?, 
2 BACK TO BASICS, 
3 DIAGNOSING THE PROBLEM, 
4 A CHOICE OF TREATMENTS, 
5 BENEFITS OF MOBILISATION AND MANIPULATION, 
6 EXERCISES FOR A BACK PROBLEM, 
7 SPORT AND THE BACK, 
8 OTHER FACTORS THAT INFLUENCE A BACK PROBLEM, 
9 YOUR OTHER QUESTIONS ANSWERED, 
10 A DAILY SELF-TREATMENT PLAN, 
11 BACK WITH OPTIMISM, 

CHAPTER 1

Why is Back Pain so Common?

Back pain certainly is common, but the fact is that backs are only painful if they aren't working properly. Pain exists for a reason. When all the joints in our spines work smoothly, there is no reason for pain.

If you wonder why it is so important for a back to let us know when things are wrong, the answer is simple: the longer that spinal function faults go unchecked, the more widespread the strain suffered by the skeleton as a whole. The role of pain is to bring faults to the forefront of our consciousness so they stand a better chance of being fixed.

An active, well-working spine provides effortless gross and fine adjustments in the stance of the frame to set the stage for all deliberate fruitful activity. If it isn't working properly, we are put at a physical disadvantage and all our skills become handicapped. Although we may not be conscious of the change, the most simple, automatic and effortless activities become laboured and require more energy. Subtle strains are stored up, and this means trouble. In its perfect working order, which is rare in reality, properly balanced muscle groups at the front, back and either side of the spine prevent it from deviating from good alignment; correct spinal alignment is essential for placing all the other joints on their best working pitch.

But sadly our sedentary way of life, with many long hours spent sitting, compresses the base of our spine and makes the lower discs lose their bounce. In addition, our activity mode is frequently flexed or bent over, so the muscle groups holding the skeleton upright become unevenly matched.

Without us being aware of it, our spinal base becomes brittle; at the same time, some muscle groups get tighter and shorter while others get weak and elongated. As a result, the upright spine becomes inadequately supported. It tolerates shock badly and starts running out of kilter, with all its actions out of trim. Everywhere, joints afflicted by poor working conditions are jarred and forced to work at awkward angles. As the spine suffers impact, the segments grind and chafe as they begin their own journey of breakdown.

Furthermore, because the skeleton becomes permanently kinked and constricted, we find we can perform fewer and fewer actions. All purposeful activity takes place within a limited variety of starting postures. We don't have the 'release' to do as we please with our bodies. We are trapped as if the wind has changed. Movements become stereotyped and repetitive, rarely allowing us the benefits from full, opening-out stretch. In fact, most of the time we are unaware of the delights of full, elastic freedom. Instead, we toil away within the same old patterns of movement. We put the toothbrush away, we open the car door; we might even go the whole day without doing one original movement. Day after day we grind the joints back and forth over the same old territory. Eventually, the joints lose their 'play' and become almost rigid except in its well-worn tracks. I don't have to tell you this is not good for them!

With this background of poor shock absorption and muscle imbalance, the working spine is debilitated in everything it does. The discs dry out and lose their romp, and the muscles and ligaments lose their stretch. The final straw is when we do decide to get out of that chair and do a bit of exercise; we do it with such ferocious gusto, we then introduce a whole lot of new and sudden strains on top of the older ones. The combination is lethal. No wonder such a high percentage of the population has or has had backache.

Mind you, there is a good reason why we are gripped by a sudden desire to leap out of that chair and fling ourselves into frenzied activity. It is a subconscious attempt to redress the balance. It is a desire to 'reflate' the spine, to puff up the lumbar discs and bump up their shock absorption; an intuitive yearning to experience the skeleton at full stretch. It makes us feel so good to S-T-R-E-T-C-H, to open out the frame widely and savour the delights of emancipated freedom rather than permanent, static flexion. This 'spurt' is our modern-day method of releasing energies once used in foraging for food and fighting off enemies.

However, unexpected physical activity can put a handicapped skeleton under duress. If you lead a sedentary life, sitting for hours behind a desk or hunched over a steering wheel, you can 'do something' to your back with unnerving ease. A history of poor posture and basal compression makes it all too easy to harm a spinal segment. You can then develop a simple linkage problem and so it all begins. Sooner or later, back pain will develop. Whether it becomes a nuisance or a nightmare, the fact is, if the function fault worsens, the pain will worsen.

If we are to rectify the problem and thus get rid of the pain, we cannot afford to ignore the fact that the spine is compressed and failing to work properly. It is useless to swallow pills or strap yourself into a corset. It is often equally inappropriate to operate on the link surgically and try fixing it that way; which is rather like taking a hammer and chisel to a rusty hinge in a door; when really all it needs is to make the discs puffy again. A scalpel cannot cut out stiffness, any more than a chisel can cut out rust. There is no object to be removed; the problem is a function fault.

The first steps in curing an aching back are persuading the low lumbar discs to reflate and making the stiff spinal segments work better. And here is the good news. The more the segments are moved, the more they can move and the more they will want to move. Working them back and forth gradually achieves a better fluid exchange, which keeps them more robust and able to rebuff shock. The link becomes more stretchable, pressure lifts off the walls, and pain starts to recede.

Different as our individual approaches are, we practitioners working in the field of manual medicine have thousands of patients who can testify to this. It works! This is what 'spinal mobilisation' and the rest of this book is all about.

CHAPTER 2

Back to Basics

First, let's start with the basics, in our search for a cure for back pain.

WHAT IS A BACK?

The spine is a tall, graceful column which rises out of the pelvis and waves in the breeze. It is jointed throughout its length into twenty-four small segments called vertebrae.

Seven vertebrae make up the neck. Twelve make up the thorax, or chest part of the spine. Each of these thoracic (or dorsal) vertebrae has a rib coming off either side which encircles the chest wall and joins the sternum, or breastbone, at the front. The ribs move as we breathe in, like bucket handles, and with each in-breath, the ribs lift up and out as the lungs fill with fresh air. As we breathe out, expelling stale air, the bucket handles move down and in again, as if to rest on the rim of the bucket until the next inspiration.

By and large, the thoracic part of the spine moves less generously than any other part. This is hardly surprising when one considers the engineering feat in attaching a pair of ribs to either side of each thoracic vertebra. The ribs move incessantly every time we take a breath, and carry on doing so without faltering. At the same time, that part of the spine could be contorted into throwing a cricket ball, walking, talking to a colleague or simply turning over in bed.

Five vertebrae make up the low back part of the spine, sometimes called the lumbar spine. Although the lumbar vertebrae are very bulky and strong, and built to carry a lot of weight, they are also exceedingly light. This is because the bones themselves are not solid. If you were to cut one open, you would find it looks like a honeycomb inside. In reality, it is a three-dimensional grid of narrow, bony pillars: the vertical ones act like struts which resist the flattening pressure of weight from above and the horizontal ones act like cross-bars which prevent the vertical ones buckling. The lowest lumbar vertebra sits about five centimetres below waist level, higher than you might think.

The base of the spine sits on the sacrum. This is a large, triangular wedge of bone which joins the two ear-shaped bones of the pelvis (the ilia) at the sacro-iliac joints on either side, where the two dimples are. The sacrum can be felt as a broad, flat bone above the buttocks and is made up of five fused sacral vertebrae. By 'fused' I mean permanently joined together so they do not move, except in a congenital condition known as lumbarisation where the first sacral vertebra is mobile (see 'Have I an Extra Vertebra?' Chapter 3).

The coccyx projects off the tip of the sacrum as a brittle extension. It is a vestigial remnant of a tail. If it protrudes down too far, it can be bent under with a hard fall on to the bottom or bent backwards during childbirth as the baby is pushed out of the pelvis.

In its upright state, a normal spine carries itself with all the vertebrae stacked vertically in three gracefully arching curves which are perfectly designed to disperse body weight in a balanced, effortless way. The lumbar spine hollows in slightly and the curve is called the lumbar lordosis; the thorax arches out slightly and its curve is called the thoracic kyphosis; and the neck arches in again in a cervical lordosis. As you will read, a properly functioning lumbar lordosis is vital to the health of a low back.

The vertebrae are separated by beautifully designed little cushions of fibro-elastic gristle called the intervertebral discs. They consist of a soft, squashy centre like a liquid pearl called the nucleus, contained by a tough rim of concentric rings of fibrous tissue called the annulus. The annulus holds the nucleus tightly corseted in the centre of the disc. Discs are perfectly engineered to bear weight by acting as 'hydraulic sacks' and dispersing pressure evenly in all directions.

It is worth dwelling upon this upright stacking arrangement of the human spine because there is an absurd belief that we are not designed to walk upright. Hearsay tells us it is a bad arrangement and we really should be crawling around on all four legs rather than striding about on two. This old wives' tale is one of many which clutter the understanding of human backs and shroud any cure with an air of defeat.

Even though standing and sitting cause squashing of the discs at the bottom of our spines, the alternative of slinging a spine horizontally between widely separated front and back legs brings on other problems, and four-legged creatures must accept marked limitation in functional performance because of this. Humans can get away with being relatively unfit and still maintain a more or less upright posture, but any four-legged creature must remain permanently fit, young and strong to prevent its spine sagging earthwards. For instance, overweight dachshunds with long-drawn-out bodies commonly suffer backache.

Our superior co-ordination and balance mechanisms, combined with an upright spine, make it possible for us to perform many more sophisticated activities than other animals and the human spine has evolved in such a way that it can easily manage many different stresses. A horse can only go forwards quickly or slowly; it can never pole-vault or stand on one leg. And who said horses never get backache? There is a whole stable of equine osteopaths out there who spend their waking hours treating horses for ricked backs, especially the ones that jump fences or play polo. And those same horses might not yet be four years old!

By and large, a spine is far better off working vertically than horizontally. There may be hardening of a disc (which causes a stiff spinal segment), or even the occasional ballooning of one lower down if subjected to torsional strains (the 'slipped disc'), but these problems are eminently reversible, especially if caught early on.

The human spine performs three basic functions. It provides support to keep us upright. It has the mobility to bend and lift, and to put two long arms about; it adapts the torso to the walking process; and it carries an extremely heavy head which constantly nods and swivels during activity. The spine therefore provides dynamic mobility and support. It is also a casing to protect the fragile spinal cord, part of the central nervous system, which runs down the inside of the spinal column from the base of the brain.

Spinal nerves branch off from the cord and pass out of the spinal casing at each intervertebral level. They leave the spine through short, bony canals called intervertebral foraminae. These canals are created where the bony notches of two adjacent vertebrae come together and make a bony gutter.

So it is true that those small nerves, almost as soon as they have branched off the mother cord, go straight into the jaws of the hinge between one bone and the next, to leave the spine. Not a good arrangement. That hinge only needs to get jammed or 'rusty' and — watch out for that nerve!

This crucial combination, where a delicate and important network of nervous pathways is so intimately related to a generously mobile mechanical structure, can lead to trouble. It is a mechanical set-up which, of necessity, must be in perfect working order because nervous tissue is extremely sensitive and does not take kindly to being interfered with .

Imagine a healthy spine and its normal joints and you will see how easy it is for things to go wrong. If the mechanics of a spine go adrift then pain is never far behind. Each spinal segment consists of a front and back compartment, with the spinal canal containing the spinal cord between the two. The front compartment consists of the disc-vertebra complex where the disc is bonded strongly to the vertebral bodies above and below. So, as well as the vital role of bearing weight, this mechanism also allows the secure, strong movement of the vertebral stack careening about in all directions.

The disc-to-bone union is strengthened by the extremely strong anterior and posterior longitudinal ligaments. The anterior longitudinal ligament covers the front and sides of the round vertebral bodies; the posterior longitudinal ligament runs down the back of the vertebral bodies and, by covering the back walls of the discs, intercedes between them and the valuable nervous matter behind in the canal. Strong encircling ligament therefore runs down the entire length of the spine, encasing the round vertebral bodies in a strong, elastic strait-jacket which controls movement.

Behind the spinal canal is the back compartment which contains the apophyseal or facet joints. These are the bone-to-bone junctions of neighbouring vertebrae. Slippery, glistening cartilage covers the opposing bone surfaces and helps them slide more easily against each other. Further friction is prevented by the body's natural lubricating oil called synovial fluid. The two opposite bones making up the joint are held together by the very strong joint capsule, the inner lining of which manufactures the synovial fluid. The facet joint capsules are often referred to as the capsular ligaments.

The facet joints act as a bony 'catch' to prevent each vertebra slipping off the one below. Their role, therefore, is to guide or stabilise the generous movement of the vertebra-disc compartment so it doesn't go too far. The facet joints act rather like two small outrigger canoes stabilising the bigger canoe in the middle.

In a well-aligned lumbar spine, these joints hardly bear weight at all. However, when the back sits or stands with too deep a lumbar hollow — an increased lumbar lordosis — the facet joints are forced to take more weight. They are not designed for this and soon complain.

WHY SHOULD A BACK GO WRONG?

The root cause of most low back pain is basal compression from the spine being upright. The weight of the rest of the spine bearing down causes the lowermost segments to ride down, making the pillow-like discs lose water. To a degree, this happens in a cyclical way throughout every day; the spine dries out and shrinks, the longer we stay upright. It occurs through the entire length of the spine but is more marked at the base, particularly if we sit a lot.

Compression of the spinal base causes the discs to stiffen but it can lead to semi-permanent flattening, which is more difficult to reverse. If the process escalates, disc narrowing can be picked up on X-rays but, long before this, the vertebra on top becomes sluggish in movement. This can be the first sign of common, or garden-variety low backache.

As soon as there is any dysfunction of the lower back, the muscles controlling both spine and tummy also start working discordantly — and this is usually how a stiff spinal segment gets worse. Problems can go on occurring through either front or back compartments, or both. If the disc continues to break down, it might completely disintegrate, so that the top vertebra fuses with the one below. Alternatively, disc prolapse may occur, where one section of the wall weakens and the nucleus squirts off centre, making a focal bulge in the wall; or you may develop segmental instability, as the disc progressively loses pressure and the disc-vertebra union loses cohesion.

On the other hand, the segment may continue breaking down via the facet joints of the back compartment. They can become 'arthritic' from the wear and tear sustained by bearing too much weight, or by their protective role of limiting bending and twisting. Eventually, the facets can also become unstable, either because their cartilage buffer has worn thin, or because their facet capsules have become stretched and weak.

The human spine can be likened to a ship's mast. It has 'stays' at the front, back and sides to help support and balance the spine. The tummy muscles are the stays at the front and sides, and the back muscles are behind. Laxity in any of the stays results in the mast either bowing forwards, in the case of a slack front stay (weak tummy muscles) and an over-tight back stay (back muscles), or the mast bowing backwards if the front stay is too tight and the back stay is too long. The same happens if the back (stay) muscles are too weak.

(Continues...)

Excerpted from Back in Action by Sarah Key. Copyright © 1991 Field Mill Holdings Ltd. Excerpted by permission of Allen & Unwin.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Dettagli dell'edizione

• Editore: Allen & Unwin
• Data di pubblicazione: 2002
• Lingua: Inglese
• ISBN 10: 1865087343
• ISBN 13: 9781865087344
• Rilegatura: Copertina flessibile
• Numero di pagine: 224
• Contatto del produttore: non disponibile
• Persona responsabile: non disponibile