After twenty years of practice I think I have almost heard everything when it comes to people describing how they injured their back and also what they think the diagnosis is. These include "I threw my back out", "I have a rib out", or "I slipped a disc". There is no doubt that when someone says these things that they have a legitimate problem, but often it is not what the person thinks. This weeks blog will help uncover what really is going on behind these phrases:
Meet the Spine:
The back is made up of the vertebrae, the discs between the vertebrae, the ligaments that hold everything together and then four different layers of muscles. Throw in a whole bunch of sensory nerves to help the brain to know what is going on and to contract the muscle, and you have the wonderful structure of the spinal column.
The nervous system controls the movement of the spine by receiving sensory information from receptors in the muscles, ligaments, and joints. The brain then relays back a signal to contract the muscles which causes either movement or stabilization. When you combine millions of signals from the muscles and joints, and then a response back to them from the brain, you have a movement pattern. These movement patterns allow us to do everything from walking to hitting a baseball.
The Injury Response
Low back pain will affect 8 out of 10 Canadians at sometime in their lives. Low back injuries can occur slowly over time, such as prolonged sitting, or by a trauma, such as a slip and fall.
The small, (first two layers), of muscles of the back can be injured when excess force is placed on them. This can occur when the larger muscles of the core do not support the load placed on them and extra force is transmitted into the deeper muscles. This is common when the back muscles are fatigued and then a heavier lift or an unexpected movement causes the smaller muscles to fail.
Another mechanism is if the muscles of the spine can't handle the force put on them and the spinal joints take the brunt of the trauma, casing a sprained joint. Again, in this case the body will naturally tighten up around the area to protect that joint.
Often a short term inflammatory response also occurs, causing swelling, pain, and more muscle guarding.
Is My Back Out of Place?
When the back is injured, the body always wants to protect itself and does this by shutting down movement in the injured area. This allows the body to save any further damage to injured tissue and to prevent injury to the surrounding nervous system. Protective muscle spasms cause the joints to loose movement and then the connective tissues around the joint also loose flexibility causing joint stiffness and pain. The results of this is that the body recruits other muscles to achieve the movement needed. This change in muscle recruitment can cause a change in the position of the pelvis, often resulting in a higher side and a change in leg lengths. It very much feels like your back is out when you are walking like and "S" and you have a leg short leg but it would be more accurate to say my back is "locked up" rather than "out". The body will also unconsciously off load injured joints and discs by causing you to bend out of your normal form.
Rib pain in the mid back also feels like the rib is sticking up and out of place. This is because the muscles around the rib head, the part that attaches onto the spine, are inflamed and swollen. When the rib is aggravating the exiting spinal nerve it can cause a deep breath to be painful and for you to compensate with this spasm.
What Do You Do?
When your body is responding to injury by tightening up, the best thing to do is to manage the inflammation and then work on getting the area moving. Research shows that range of motion exercises and stretches along with short term use of anti-inflammatory medications help with acute spinal pain. Chiropractic care is a great modality for getting joints moving and helping muscles relax. An adjustment to the spine has a direct effect on soft tissues by stretching the ligaments and joint capsules. This frees up restrictions at this level as well as directly effects the tight muscles of the spine. The smaller muscles of the spine relax in tone when they are quickly stretched with an adjustment. Overall the adjustment frees up the joint and muscles rather than "putting it back into place".
Activity Fact: Low back pain is the leading cause of lost work days and activity limitation (WHO), and is responsible for about 40% of missed work days.