The Spine and Lower Back Pain
The information provided is for informational purposes only. Please consult a health care provider to address any concerns you may have.
The 4 Spinal Curves
The spine is made up of 33 vertebrae separated by 23 intervertebral disks. Vertebrae are named based on the region where they are located. Cervical vertebrae are located in the neck, Thoracic vertebrae attach to the ribs, and Lumbar vertebrae are found in the lower back just above the sacrum. There are 7 cervical vertebrae, 12 thoracic, and 5 lumbar. A simple saying will help you remember how many are in each region. "Breakfast at 7, Lunch at 12, Dinner at 5." Those who have already done the math recognize 7 + 12 + 5 = 24. The sacrum, just below the lumbar vertebrae, and the coccyx, or tailbone, become fused as we age. Originally the sacrum is comprised of 5 bones and the coccyx 4, hence 24 + 9 = 33.
When we are born our spine has 1 curve. Learning to lift our heads and crawl we begin to develop the anterior curve of the cervical spine. As we begin to stand and walk the anterior lumbar curve develops. The curves of the spine are very important. A curved spine can support 10 times more weight than a straight spine.1
The vertebral disks act as natural shock absorbers and provide space between the vertebrae. Looking at the image on the right you will see a few things. Notice that when the top vertebrae moves forward the disk below it moves to the back. The opposite is true when the top vertebrae moves back the disk material is pushed forward. Also notice the facet joints highlighted by the black arrows. These are smooth bony surfaces that glide over each other during spinal movement. If a disk is compressed the distance between the vertebrae is reduced and the facet joints will have limited mobility, especially on extension, or bending backwards.
In the figure above notice the hole just in front of the facet joint. This is where the spinal nerves branch out from the spinal cord. If the vertebrae are not aligned properly the spinal nerve will be pinched on one side or both. Not only do these nerves control muscles they also ensure proper functioning of organs.
Back in the 1920s, Dr. Windsor, a doctor of medicine from the University of Pennsylvania, was interested to find out if there was a correlation between curvatures in the spinal column (meaning, bones in the spine out of place) and diseased organs. To investigate this theory, Dr. Windsor examined fifty cadavers from the pathology department to search for unhealthy organs. In the fifty cadavers, he uncovered 139 infected organs, such as hearts, livers and gall bladders, in different phases of sickness. Next, Dr. Windsor studied the nerves from the affected organs and traced them back to the spine.
The discovery by Dr. Windsor was amazing! In all of the cadavers, there existed a misalignment of the curvature in the spine, which was directly connected to the nerves leading to the unhealthy organs.
From top to bottom different regions of the spine control different organs. These nerves are part of the autonomic nervous system, the "automatic" nervous system. The signals they send to the brain and spinal cord, the central nervous system (CNS), are interpreted. When the information has been processed the CNS sends a message back to the organs resulting in a metabolic change. So, if the spinal nerves are pinched the communication between the organs and CNS is diminished. Typically people associate pinched nerves with excruciating pain. In many cases that is true, but there are varying degrees of nerve compression. A nerve can be slightly compressed and not produce any pain symptoms. For a visual demonstration of spinal mechanics the video below demonstrates movement in the lumbar spine.
Mechanics of The Lumbar Spine
Lower Back Pain
At any given time 2-5% of the world's population suffers from lower back pain. 3 In some cases the pain is only musculoskeletal. In these instances the bones and muscles are out of proper alignment so they have to work harder than normal. There is a phenomena in the body called the pain-spasm-pain cycle. It works as a protective mechanism, but if it is not addressed it leads to further problems. Whenever an area of the body is injured or in pain the body will tighten the muscles in that area to prevent further damage. Although this helps reduce the pain, the tight area begins to affect surrounding muscles and tissues not originally involved.
Herniated Disk and Sciatica
Bulging and Herniated Disks
More serious forms of back pain include bulging and herniated disks. Remember how the disk material moves posteriorly, towards the back of the body, when the spine bends forward? This is why lifting with your legs instead of your back is so important. A disk that is bulging or herniated posteriorly can press on the spinal nerves and or the spinal cord.
A disk that presses on a spinal nerve between the 4th and 5th lumbar vertebrae can cause sciatica. Symptoms of sciatica include pain in the lower back, weakness in the legs, and pain and tingling down the leg.
However, the symptoms of sciatica can also be caused by gluteal muscles. Specifically, the piriformis muscle. For some of the population the sciatic nerve runs under the muscle and in others the nerve runs through the belly of the muscle. Genetics determine where the nerve is located in relation to the muscle. This is one of the reasons why gluteal massage is so important for back health. The forces generated by every step we take are transferred through the pelvis to the back. If the pelvis and legs aren't happy it is virtually impossible for the back to be happy. Without a proper foundation muscle asymmetries will develop leading to back pain.
Lower Cross Syndrome
Muscle Asymmetries of Lordosis
When the muscles of the lower body create an anteriorly tilted pelvis it is referred to as the lower cross syndrome. Drawing an imaginary line from the weakened gluteals to the weakened abdominals creates half of the cross. Connecting the shortened iliopsoas with the shortened erector spinae makes the other half of the cross. This is a very common muscle imbalance that is the source of most back pain. Many people view their body as separate parts which are not related to anything else. In the case of lower back pain it does not occur to most of us that our stomach is the front of the lower back. Pregnant women are the perfect example of this muscle asymmetry and lower back pain. Not only does the weight of the baby pull the spine forward the abdominal muscles also become stretched and weakened. Since there aren't many people over 25 with abdominals toned to a six-pack it is easy to understand why so many suffer from lower back pain.
If we could travel back in time I'm sure we would notice that cavemen didn't sit behind desks 40 hours a week. Our brains continuously monitor muscle tension. While sitting for extended periods of time the brain detects too much slack in the quadriceps, front of the thigh, muscles. When the front of the thigh muscles are short and tight they pull the pelvis down in the front. This causes the back of the pelvis to move up towards the spine creating lordosis. One would think that if the pelvis is tilted forward then the upper body should be tilted forward as well. Looking around it is pretty rare to see people walking around bent forward at the waist. The brain also works to keep the eyes level with the horizon. So as the pelvis is tilted forward the brain shortens the muscles in the lower back to bring the torso upright.
If you have been diagnosed with lordosis there are a few steps you can take to help prevent further low back pain. Strengthening the weak abdominal, gluteal, and hamstring (back of the thigh) will help even out muscle asymmetries.
Massage can also be an excellent tool to aid in lengthening the shortened quadriceps and lower back muscles. As the shortened muscles are lengthened the pelvis can begin to rotate posteriorly. Look for a therapist who performs myofascial release. It's a gentle technique that addresses the connective tissue, fascia, of the muscles. Fascia can be thought of as pantyhose surrounding a muscle. If the pantyhose are pulled tight it is virtually impossible for the muscle to occupy its optimal form and function.
Chiropractic work can also aid in proper spinal alignment. In my professional experience chiropractic and massage therapy work very well together. Since the muscles hold the bones in place, chiropractic adjustments are usually more productive after the muscles and fascia have been released.
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