Chronic Segmental Low Back Stiffness
Posted on May 31, 2009
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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.
Inhibition of the stabilising musculature occurs with an episode of acute spinal pain and this can persist beyond the resolution of the pain to generate a long-lasting instability which puts the segment at increased risk of re-injury over time. Longer term effects include the occurrence of degenerative alterations in the spinal structures such as joints and discs, causing segmental levels to develop stiffness and eventually chronic back pain. The discs have fluid forced out of them by gravitational compression forces and must counteract them by generating a fluid absorption force.
If over time the compressive force gets the upper hand, the disc loses some of its hydration and eventually narrows. Narrowing can be seen on x-ray but the disc can start to become troublesome before it is changed enough to show up on the x-ray. In the spine two vertebrae and the intervening disc are known as a segment and it is the segments with altered discs which become stiff, preventing normal movement and forcing anatomical structures to take abnormal loads in abnormal positions. The vertebra above a stiff segment is unable to participate in normal movement and this stiffness can be felt by a physiotherapist.
Protective muscle spasms are common after an injury and this splints the affected area and allows the process of inflammation and healing to get started. With the gradual resolution of the injury and its pain reduction the amount of back spasms normally lessens and slowly normal movements begin to be apparent again. But muscles can remain in muscle spasm in some cases, leading to a stiffened and shortened group of spinal structures which, by this adaptive shortening, leads to the production of shortened and abnormal spinal joints, ligaments and muscles.
Increase of the compression forces through the spine can be promoted by sitting for long periods, leading to increase in the fluid loss from the discs. Discs rely on us repeatedly bending forwards for disc health and nutrition and avoidance of this movement compromises disc wellbeing, leading to an increased potential risk of degenerative change. A weakness in the abdominal muscles and the development of abnormal postures also contribute to these problems.
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.
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