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As children we have the great gift of a mobile, strong, well designed and painless spine and it is unusual for stiffness to be an issue as the lumbar spine has evolved to do the job of weight bearing and providing movement. Intervertebral discs separate the spinal vertebrae, allowing more movement in areas where they are thicker and also coping with variable loads. The posterior spinal facet joints limit and control segmental movement, preventing the spine from displacing inappropriately under the shear forces. Strong, balanced and coordinated muscle actions complete the picture.
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.
After an acute back pain injury the surrounding musculature tends to go into muscle spasms to splint and protect the injured segment until inflammation reduction and healing have had a chance to begin. Steady reduction in pain and progress in healing is usually accompanied by lessening of the back spasms and a restoration of normal spinal movement. However, this does not always occur as muscles may remain contracted and overprotective, causing a shortened tissue area which keeps the local joints and other tissues in a permanently shortened position.
Segmental stiffness can also be contributed to by sitting too much with its increased spinal compression forcing fluid from the discs. Avoiding flexion for many of us has led to a loss of this useful and disc-maintaining movement which increases fluid throughput to the discs and keeps them healthy. Other contributors are maintaining abnormal postures and weakness of the abdominal muscle group.
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.
However, I have been significantly improved by following Sarah Key's method of back care, popularised in her book Sarah Key's Back Sufferers Bible. While it is hard to agree with all the assertions she states in her book (as she herself admits), there is no doubt she has some very good ideas on how to practically manage low back pain. She describes the chronically stiff segmental back along with several other back pain syndromes and prescribes an exercise and management regime for treating them. The regime is not difficult but has very good results, particularly in my case where I felt I was stuck with my lower back pain and now realise this may not be the case.
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