A functionally unstable spine may be the cause of a person's back pain. It is a painful disorder thought to result from a loss of the spine’s ability to maintain appropriate mechanical stiffness throughout it's NORMAL range of movements. In biomechanical terms, spinal stiffness refers to the spine’s ability to prevent unwanted movement or buckling. People often think of stiffness as a bad thing. It isn't always. When a muscle contracts, it creates both force and stiffness. Spinal stiffness is necessary to perform basic daily movements. With minimal amount of force, muscles around the spine act as guy wires, a tensioned cable designed to add stability to a free-standing structure.
It is important to note that a functionally unstable spine is not synonymous with hypermobility or radiographic instability. Hypermobility and radiographic instability is where spinal joint motion is excessive BEYOND normal joint movement. This is typically demonstrated on appropriate imaging.
Some indicators that a functionally unstable spine may be the cause of a person's back pain often include:
40-60% of typical back pain patients experience recurrence or low level chronic symptoms, but a pattern of sudden flare ups caused by minimal loading events may be linked in this instability phenomena. The theory behind this is that poor stability increases the risk of a “spinal buckling” under minimal weight, often just bodyweight movements, and triggers episodes. This accumulative repetitive buckling makes it difficult for the patient to truly feel a healing of their back pain.
The safest and most effective conservative treatment for patients with a functionally unstable spine is through an effective spine stabilization exercise routine. Stabilization exercises are designed to improve spinal stability, relieve pain and increase movement performance. A large number of muscles cross the spine, and all contribute to the modulation of lumbar stability and movement to some extent. Multiple imaging studies have demonstrated muscle atrophy in patients with chronic back pain. A stabilization exercise routine is designed to target these areas of muscle atrophy to improve strength and reduce muscle fatigue over time.
Some of the muscles that are most commonly weakened and atrophied in patients with a functionally unstable spine are:
Most people are surprised to learn that the diaphragm, which is mainly involved in breathing, is a key muscle in creating spinal stability. As the roof of the cylinder of muscles that surround the spine and assist with stability, the diaphragm is a major contributor to intraabdominal pressure and therefore lumbar stability. The diaphragm contributes to this spinal stiffness before the initiation of large limb movements to assist with spinal stability and greater strength of the arms or legs.
Some of the most effective stabilization exercises studied include:
Once these exercises are mastered, a person suffering from a functionally unstable spine can gradually progress to various bodyweight loading strategies that would ordinarily be seen a training weight training environment. This type of training of the spine will carry over into the performance of functional activities, daily living activities, and work ultimately resulting in reduced episodes of functionally unstable back pain.
If you feel your back pain is the result of a functionally unstable spine, please click the link below to request an appointment!
Incorrect use of a proper back pack can be just as damaging as using an improper back pack. Our growing children use their back packs for many years. Repetitive loading of heavy back packs combined with poor ergonomics can be a source of dysfunction in their body and can lead to chronic back and shoulder pain. Smart choices now are important to your child's health long after their school days are gone.
Signs that your child's back pack is inappropriate for them or that they are wearing the pack incorrectly include:
When purchasing a new back pack one should look for:
Maintain regular adjustments with your chiropractor to detect and correct spinal problems before they cause pain and dysfunction in your growing child.
Additional tips for proper back pack ergonomics:
When a patient is diagnosed with a lumbar disc herniation, what is the best treatment?
Best Answer: Both conservative and surgical options are backed by research. Though the ultimate decision of which route to choose should be made by the patient based on their individual goals and needs after an honest discussion with their surgeon.
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Lumbar disc herniations are a very common condition affecting the spine of young and middle-aged folks. The incidence of lumbar disc herniations within certain populations has been estimated to be greater than 50% though often the disc herniations is asymptomatic, meaning without symptoms. A disc “injury” quite often happens in the absence of any pain and you don’t even know about it. Medicare estimates that spending on lumbar discectomy procedure, a surgery to remove disc material, exceeds $300 million annually. Back pain related disorders may or may not always be the result of a disc herniation but are a common cause of disability nonetheless. The American health care system spends over $1 billion annually to address back pain conditions.
The structure of the disc is composed of circular, basket woven-like annular fibers made of collagen, proteoglycans, and a variety of regenerative cells that surround a gel like structure called the nucleus pulposus. The disc serves to dissipate forces exerted on the spine as well as give space between the vertebra above and below the disc so the nerves have room to exit the spine. As we age, the disc tends to lose water content and height. This loss of hydration and disc collapse can increase strain on the annular fibers which may lead to bulging, a protrusion or extrusion of disc material that would be seen as a herniation. The joint made up between the two vertebral bones and disc is called the intervertebral joint. It is classified as a fibrocartilage joint and can also be referred to as a symphysis joint, similar to the pubic symphysis of the pelvis. If you know anything about symphysis joints, you know that they are EXTREMELY STRONG and they certainly don't slip out of place, giving the impression that discs are inherently weak. It takes about 740lbs of force to compress the disc height 1mm in young subjects and 460lbs of force to compress the disc height 1mm in older subjects. End story is that discs are VERY strong.
With all that said, back pain may still occur due to disc bulging without pressure on the spinal canal or nerve roots. However back pain with radiculopathy can occur when pressure or irritation of the extruded disc material contacts the thecal sac or lumbar nerve roots. The pain commonly felt with radiculopathy can be felt as electrical, shooting, pins and needles, numbness, tingling, or weakness into the leg. Often patients will experience this as "Sciatica". Sciatica is a description of any of the symptoms above felt in the leg as a result of pressure or irritation of the specific nerve roots levels of L4, L5, or S1. The good news is that 90% of patients with lumbar disc herniations will improve without substantial medical intervention like surgery. Too many people think that once you have a disc herniation (or disc bulge), that you’ve got it for life. Discs have the ability to heal. A patient should not be fearsome of low back pain, even if pain is caused by a disc injury.
Regarding treatment, the research supports both conservative management and surgical intervention as viable options for the treatment of lumbar disc herniation even when radiculopathy is present. Surgical intervention may result in faster relief of symptoms and earlier return to function, although long-term results studies show similar outcomes regardless of type of management. It should be noted that contrary to popular belief of some including surgeons, the size of a lumbar disc herniation does not predict outcomes or the need for surgery. Research indicates from many studies, multiple medical association position statements, and my own clinical experience treating these disorders validates this notion. This is consistent with findings from a 2010 study which found that even massive disc herniations can successfully be treated conservatively. In fact, on several occasions patients with nearly complete spinal canal narrowing were successfully managed without surgery, some as great as 85.1%. Literature suggests that less than 10% of disc herniation cases ultimately require surgery.
The typical patient with lumbar disc related pain will often present to their primary care physician first. However research supports chiropractors being a great first contact for these patients. In fact, medical costs may significantly be reduced when a patient visits a chiropractor first. Initial management of these disorders should include regular movement within a patient's tolerance, exercise guidance, manipulation of the spine, proper nutrition and supplementation, and adequate sleep. A patient should not be told to completely rest. Many of these patients are able to continue lifting. In most instances, radicular symptoms will go away within six weeks. Patients with symptoms that persist beyond six weeks will often be referred for advanced imaging like magnetic resonance imaging (MRI) in order to identify the area of disc pathology and to determine if they are also candidates for more invasive treatments like injection or surgery.
If you are suffering from back pain, please click the link below to request an appointment!
Dr. Jared Wilson, DC, MS
Dr. Jared Wilson blogs about chiropractic health and other relevant health news. He is an expert in musculoskeletal injuries and functional rehab. He holds a Chiropractic Doctorate degree and a Masters degree in Exercise and Sports Science.