Friday, February 8, 2019

Treating Back Pain: A Spine of the Times

by Jill Jonda, PT
You’re 34 years old with a 9-5 desk job, but you still regularly go to the gym and play a couple pick-up games of basketball a week. One day you wake up and have nagging, gnawing pain just to the right of your spine in the low back. You wait a couple days and it’s not getting any better: in fact it’s traveling into your right buttock. You think, “But I’m just 34 years old! What’s happening to me?”

Unfortunately, this is a pretty common internal dialogue. According to the NIH, about 8 of 10 adults will experience back pain at some point in their lives. Luckily, physical therapists are equally as used to diagnosing and treating back pain, and the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is a well-studied, noninvasive approach for diagnosing and treating pain of a mechanical origin (mechanical pain).  But what is “mechanical pain?” 

Mechanical pain is produced when a stress or force is placed on an anatomic structure and can be aggravated or relieved with greater or less deformation on those tissues. You can demonstrate this easily with just a finger: if you bend your index finger backward to the point of resistance, you’ll experience a strain. Initially, it’s uncomfortable but as you hold it there, pain – the brain’s way of saying to the body, “Stop doing that!” – starts to set in. Once you relieve the stretch on the finger, the pain should subside. The same is true of mechanical pain: many times it completely goes away once the mechanical stress is eliminated.

More often than not, back pain originates from mechanical stress. The spinal column consists of vertebrae and intervertebral discs, which sit between each vertebra. The disc is a very mobile structure consisting of 2 layers – an outer fibrotic layer and an inner gelatinous layer – kind of like a jelly donut. When we flex our spine (bending forward and rounding it), we put greater mechanical stress on the front portion of the disc. The disc becomes displaced backward to the area of least pressure. This generally isn’t a problem, but repeated force on the front portion of the disc can cause the back portion to weaken and start to bulge. The bulge can press on nerve and/or other tissues along the spine, causing pain in areas away from the spine, such as in the buttock or even into the leg (sciatica). Eventually, a bulged disc can lead to a herniation: the jelly center of the disc begins to squish out of the fried dough part, and that’s not ideal for donuts or spines.

As physical therapists, it’s our job to evaluate each of our patients and treat the not only the symptoms but also the cause of their pain, while also preventing similar pain to return in the future. I know my patients think I’m the “posture police,” but for those with pain originating from either the cervical or lumbar spine, I always recommend sitting with good lumbar support in a firm chair to promote a neutral spine. Sitting with slouched posture is bound to produce some sort of mechanical pain, either in the neck or low back, because of the stresses placed on the spine. Also, if sitting is bothersome, stand up and reverse the curvature in your spine by walking around for a few minutes.  Remember, you should see your PT or healthcare provider if your pain isn’t improving. We can help you stand (and sit) corrected!

Treat Your Own Back by Robin McKenzie