The Way of Low Back Problems...

Are you wandering in a wilderness with your back, wondering what to do and who to see next? Are you one of eight in ten people suffering (or have suffered) from back pain?

Low back pain has reached pandemic proportions. It is present in every society, every social group, every occupation - scientists and stevedores, computer operators and carpet salesmen, shearers and chefs - young and old, tall and small, large and thin. Back pain is on the move.

The human spine is a stupendously sophisticated structure, but compromised by one factor - its base carries extra load. This is not to say we should be better getting around on all fours, because it's a very difficult engineering feat slinging a spine out horizontally between two widely separated front and back legs. Horses, particularly those that jump fences, often have spinal problems as young as four years.

The intervertebral disc is the central spinal structure from which degeneration spreads. This doesn't mean the disc has 'slipped' but it does mean the disc's function as both shock absorber and spinal connector is below par. As long ago as 1970, the eminent Scandinavian researcher Alf Nachemson postulated that impaired nutrition was chief cause of disc breakdown.

In the early stages of degeneration the disc is simply dehydrated, which causes it to distribute load poorly and also to resist stretch. As the spinal segment becomes less compliant, it is rendered a sitting target for additional micro-trauma from run-of-the-mill activities of daily life. The sensitive outer ligamentous layers of the disc (the annulus fibrosis) develop scarring and lose extensibility, just like any ligament repeatedly sprained. This segment loses the stretch to 'give' when the spine moves and its unyielding disc wall emits pain; the typical discomfort of most cases of simple back pain.

Degeneration escalates as movement of the stiff segment gets more sluggish. It then cannot generate sufficient changes of pressure within the disc to suck and squirt fluid in and out. Thus it loses one of its main mechanisms for imbibing nutrients and expunging waste products.

As pain and disability spread, the interplay between spinal and abdominal muscles becomes discordant. The large back muscles keep on keeping on (we call it 'muscle spasm') which further compresses the segments and is uncomfortable in its own right. Spasm also exerts an inhibitory effect on both the deep abdominal muscles (transversus abdominus) and the small muscles which hold the individual segments stable (multifidus). This causes bending to become difficult, which further disables the mechanical pump-imbibition method of disc nutrition.

 

Listen to an Interview on ABC Radio Overnight Program [3rd March 2010] Click here 

 

The good news: 'pressure change therapy'

Recent research tells us that stretching discs makes them less prone to degeneration [Lotz et al 2008, ‘Anulus fibrosis tension inhibits degenerative structural changes in the lamellar collagen’] although it is proposed by Sarah Key that discs that have already degenerated can also be helped by intermittent distractive or decompression forces. As well as making the disc more resilient to compression, Sarah believes that dynamic end-of-range movement [‘pressure change therapy’ or PCT] introduces extremes of pressure through the discs, which shunts extra quantities of fluid through. In spines with disc degeneration, PCT uses macro spinal movement to compensate for impaired performance at a micro or molecular level within the disc. Segmental decompression is most simply and effectively achieved by using a BackBlock [see 'About Our Products'] and also by touching the toes, or squatting through the day.

Declining concentrations of proteoglycans weaken the nucleus' attraction to water and is one of the first signs of the disc degeneration. The good news is that synthesis on new proteoglycans is also stimulated by the pressure changes delivered by large-scale spinal movements. Thus ‘pressure change therapy’ for painful unhealthy discs works by augmenting the role of the mechanical or convection 'nutritional engine' to compensate for degenerative weakening of the other two mechanisms: osmosis and diffusion.

Disc degeneration also involves stiffening and thickening of the disc wall [in some cases up to 80%], making spinal movement stiffer and the wall itself a more obstructive barrier to diffusion of nutrient molecules through to the nucleus. The good news is that bigger tides of fluid passing through the more metabolically-active outer disc wall gives it ‘first use’ of the nutrients coming in and bolsters the repair processes– since most of the pain of ‘simple low back pain’ comes from painful scarring of the sensitized outer layers of this posterior disc wall.

Patients using The Sarah Key’s ‘pressure change therapy’ regime do most of the treatment themselves at home, although painful backs must not launch willy nilly into full-scale spinal movement from a standing start. The metabolic rate of discs is very slow and overall disc healing is a process that takes place over many months, if not years. Relief from simple low back pain can be surprisingly rapid however, as the introduced movement restores the compliance of the outer ligamentous layers of the annulus and enriched nutrient tides pulled through the posterior annulus by the pressure changes bring about fast repair of scarring here.

Although hands-on treatment from a therapist is necessary initially to physically mobilise a jammed spinal segment free, no amount of practitioner-based intervention can bring about the quantum exchange of discal fluid required to bring about repair and reduce pain. Self treatment on a daily basis can achieve incomparably more.
The bottom line is that patients are best at fixing their own backs!