Low Back Tidbits

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The spinal column consist of 33 vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused), and 4 coccygeal (fused) Injury occurs when the spine and its supporting structures can not withstand acute or chronic forces (ie compression, distraction, shear) The curvature of the spine is preserved in part by the ligamentum flavum, which runs between the posterior aspects of the verebral bodies. The paraspinous musculature, which runs anterior to the spine, works to counter balance the bodies center of gravity. Normally, the anterior aspects of the spine bears most to the body's load in an upright position. 75% of elite athletes have complained of back pain at some point in their careers. Spencer CW III, Jackson DW. Back injuries in the athlete. Clin Sports Med. 1983; 2: 191-215. Gerbino PG II, Micheli LJ. Back injuries in the youn athlete. Sport Med Arthroscopy Rev. 1996; 4 : 122-131. More than 75 percent of disk herniations occur below T8. The peak is at T11-12 where there is greater spinal mobility. Central protrusuons are the mast commom. Okada Y, Shimizu K, Ido K, Kotani S (1997) Multiple thoracic disc herniations: case report and review of0the literature. Spinal Cord, 35: 182-186. According to McGill. relatively few low back injuries occur from a single event. He proposes a back injury most often occurs after a series of excessive loads gradually and progressively reduced tolerance to tissue failure. He further explains the injury process may not always be associate with loads of high magnitude. ACSM (2001), ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription, 4th ed, pg 117. LBP Prognosis Acute low-back pain (lasting less than 3 weeks) usually resolves itself without any intervention 75% of individuals recover from acute low back pain within 3 weeks 90% of individuals recover from low back pain within 2 months Chronic low-back pain (symptoms lasting more than 7 weeks) number one cause of disability in the United States the longer an individual suffers from CLBP, the worse the prognosis Carpenter DM, Nelson BW (1999). Low back strengthening for the prevention and treatment of low back pain. Medicine and Science in Sports and Exercise Jan; 31(1): 18-24 . Low Back Debate McGill condemns the use of isolated lumbar spine machines claiming the compressive forces of these devices can cause disc herniation based on a pig spine model. Nelson recommends the use of these devices and has successfully used these devices to treat chronic low back pain. See Erector Spinae Weakness. McGill suggests certain exercises and movements that flex the spine through the full range of motion be should be eliminated although he admits several thousands of cycles under a load to full range of motion are required to produce disk herniations. It can be argued that potential injury would be prevalant in this situation not due to full range of motion, but rather due to overtraining or lack of progressive adaptation. Nelson explains the avoidance of full range of motion during exercise is a short term solution which promotes deconditioning and consequently deterioration of the joint structures. Eric Serrano, MD, (ExRx.net medical advisor) suggests these machines can be useful in the early stages of rehabilitation. Dr. Serrano prescribes more functional movements as the patient progresses, introducing transverse / multiple plane exercises in the later stages, particularly with athletes. Also see adaptation criteria. McGill Stuart (2002), Low Back Disorders, pg 55. Textbook Nelson, B.W., O'Reilly, E., Miller, M., Hogan, M. Wegner, J.A., Kelly, C., (1995). The clinical effects of intensive, specific exercise on chronic low back pain: a controlled study of 895 consecutive patients with 1-year follow up. Orthopedics, 18(10), 971-981. Nelson, B.W. (1993). A rational approach to the treatment of low back pain. J Musculoskel Med, 10(5), 67-82. Walking & Low Back Health Walking may benefit low back health by imposing a rotational torque on the spine at an estimated 8° of rotation. The vertebral disk undergoes this torque along with a slight degree of compressive force from the upper body weight and contraction of the trunk muscles. The torque is impressed on the annular fibers of the intervertebral disks enhancing their rigidity. Cailliet M (1996). Low back Pain. Soft Tissue Pain and Disability, FA Davis Company Philadelphia. 3; 153-155. Spinal Stenosis Condition involving any type of narrowing of the spinal canal, nerve root canals, or tunnels of intervertebral foramina. First described by Verbiest in 1954.

Spondylolysis & Spondylolisthesis Definition Spondylo: spine Lysis: dissolution Listhesis: slipping or falling Classifications Type I (isthmic) Anatomic defect in pars interarticularis. Usually found in adolescents and may be a result of trauma causing a fatigue fracture. The fracture usually heals and becomes stable. Type II (congenital) Postural elements are structurally inadequate due to developmental defects. Type III (degenerative) Facits and their ligamentous supporting structures have become deficient. Type IV (elongated pedicles) Variation of isthmic: neural arch is elongated positioning the facets more posteriorly. Type V (destructive disease) Any systemic bone pathology caused by metabolic, metastatic, or infectious disease Piriformis syndrome Entrapment of the sciatic nerve as it emerges from under the piriformis muscle may cause low back pain with sciatic radiation. Sciata is usually cased by pressure on a dorsal root and/or a ventral root. Sciatica can also result from pressure on the sciatic nerve in the pelvis, gluteal region, or thigh. The sciatic nerve is really two nerves, the tibial and common peroneal nerves. In most cases the sciatic nerve passes inferior to the piriformis muscle. In 10 to 12% of the population, the sciatic divides before entering the gluteal region and the common peroneal division passes through the piriformis. In 0.5% of the population the common peroneal division passes superior to the piriformis. Moore KL (1985). Clinically Oriented Anatomy, Williams & Wilkins, 2. Cailliet M (1996). Low back Pain. Soft Tissue Pain and Disability, FA Davis Company Philadelphia. 3; 153-155. Sitting and Occupatinal Low Back Pain Sitting by itself does not seem to increase the risk of low back pain or sciatica. The risk, however, increases while sitting in awkward posture, sitting for more than half of the workday, and during whole body vibrations, such as in certain vehicles and on machinery. Eur Spine J. (2006). Association between sitting and occupational LBP. Scoliosis Mediolateral curve of the vertebral column. Structural scoliosis caused by deformity in vertebrae Functional caused by mechanical problem examples: one short leg, muscle spasm on one side disappears with forward flexion of trunk as the back becomes horizontal can be treated with bracing, heel lift, or exercise exercises stretch concave side curve strengthen convex side of curve if vertebral column rotation present appropriate oblique abdominal strengthening Screening Adam's Test Viewing subject spine while standing may not reveal scoliotic curves Bending forward at waist allows for easier detection Refer to phyisician if: Structual scoliosis Functional scoliosis deviations greater than 20 degrees vertebral column rotation detected Therapy in these cases are not within realm of exercise profressional Kreighbaum, E., Barthels, K.M., (1996). Biomechanics; A Qualitative Approach for Studying Human Movement, Allyn & Bacon, 4, 235.