Low Back Pain

My mom had some low back pain recently, she did what I told her to do and she felt better.  I learned this after PT school, I learned to treat this way in my McKenzie courses.

My mom said that it really is the natural tendency and automatic response to want to “stretch it out” and bend forward with low back pain.  There is a reason that doing this makes it feel better momentarily, but doing that actually makes the problem worse in the long run.  Ok disclaimer – this is for the majority of back pain.  The majority, certainly not all.  Not every person is the same and not every back problem is the same.  Hey, all strokes are different so it makes sense that all back pain is different.  But this really is true for backs.  I have personal experience here as well.  You absolutely cannot give someone generic exercises to help their back pain without first thoroughly evaluating how that person’s pain responds to different positions and movements.  This is why this is soooooooooooo wrong…..  Williams’ Flexion Exercises are a very old school thing given out to people with back pain.  Sometimes, you would need exercises like these but if someone has you do these and just says “here are some exercises for back pain,”  be afraid, be very afraid.  There is a handout for these exercises in my PCP’s office with the heading “Exercises for Back Pain” and it makes me want to vomit.  Sometimes, you’ll have pain or other weird symptoms far away from your back, your back may not hurt at all but the symptoms are caused by the spine.  This is why it is SO vital to be evaluated.  The right way.

I was always told that I was really good at explaining this so here goes nothin.’  Everyone has a back.  I hope.  Your back is made up of a column of bones called vertebrae that are stacked of top of one another.  Here’s what it looks like.  Clicking on the picture makes it bigger.  In between each of those bones is an intervertebral disc.  Here’s what that looks like.  The bottom picture.  I always told people to picture a jelly doughnut.  An inner layer of gelatinous liquid surrounded by a more solid thing.  That’s what the intervertebral disc is like, a bunch of jelly doughnuts in between each of your back bones.  The outer part of the disc, the annulus fibrosus, has no nerve endings.  The inner part of the disc, the nucleus pulposus, has some nerve endings, but still not a lot.  When you have back pain – in most cases, not all – that jelly on the inside of the disc gets moved around and deforms the shape of the disc and then touches stuff that does have nerve endings or touches nerves themselves.  This is what hurts.  In really severe cases, the outer part of the disc will tear and then all the jelly on the inside comes outside of the disc and you have all this crap where it shouldn’t be and maybe the jelly maybe hits a nerve or something, and then your whole leg hurts (sciatica?) because every nerve is connected to every other nerve.  IN MOST CASES, what happens is that because of everyone’s crappy posture and frequent bending over forward, that jelly gets compressed on the front side and pushed to the back of the disc.  Like this…..

Lumbar_Spine_Figure_9

So if the jelly is squished backwards because of bad posture and bending forward and lifting things incorrectly, how should that be treated?  Well you wanna push the jelly forward to get it back where it should be and the way to do this is by bending backwards.  Then the disc needs to heal, and it will in a little while.  What I’ve just explained is why I’m so crazy and obsessive about posture and body mechanics.  If you always keep your spine straight, the jelly has a much smaller chance of getting moved around and you have a smaller chance of bad things happening.

The reason it feels better initially to bend forward and stretch the back is because when you do that, you’re momentarily relieving the pressure of the displaced and misshapen disc from the nerves of the spinal column that the disc is hitting and causing pain.  But when you return to a normal position, you just displaced the jelly more and made the disc even more misshapen.  So in the long run doing that actually makes it worse.

I really can’t believe I remember all of that.  I just kind of impressed myself.  DISCLAIMER, DISCLAIMER, DISCLAIMER!!!!!!  This will not work for all back pain and if you’re having pain in your back(or neck) I highly suggest you go get evaluated by a McKenzie practitionerOh and buy this book  This book explains everything I just said and gives exercises and progressions of exercises.  Oh wait another disclaimer:  I’m brain-damaged so don’t listen to a thing I say.



Categories: Health, Recovery, Rehab

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4 replies

  1. Hi Amy, For me this post hit home. I have been going to PT therapy for herniated low back disc, actually more than one disc. I checked out some of the McKenzie exercises for sciatic nerve pain on line. I am doing some of them in PT, although I don’t think they are Mckenzie certified where I go. I do like the DPT who evaluated me though. I really do not want to have surgery again on my back, so I am going this route. You always give knowledgeable advice, I am trying hard to keep my posture right and I will have to get that book. Take care, Love, Aunt Marilyn

  2. Hi. Finally, a patient who sees the light! The “knees to chest” exercise and other nonsense that is out there in some the very old handouts in very old orthopedists’ offices does absolutely nothing for your spine health. This stretch is even on the American Acdemy of Orthopedists website as part of their back exercise handout available for download. It makes me crazy when I see exercises like this in Shape, Self, Prevention and other mass market consumer magazines. They should actually research their articles….where does this come from!? To get your spine healthy, you need to build trunk endurance and stretch out the hips muscles so the spine can be spared. My two cents…

    Jamie Glick MS, PT
    http://www.HowToHelpBackPain.com

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