A Different Perspective On Back Pain

A Different Perspective On Back Pain

By Bill Amos, P.T.

Many studies of back pain indicate that 4 of every 5 American adults have had to deal with its effects at some time in his or her life. Back pain costs billions of dollars in medical care and lost productivity. It’s as common as the common cold and about as easy to prevent—but far more difficult having to live through it.

The disc between the vertebrae seems to get the blame for most low back pain. The disc is unable to maintain its support in between the vertebrae. It gets squashed and its insides ooze out. It’s described as if you were stepping on a jelly donut. It is pushed against the nerve root, or even the spinal cord itself, compressing it, and causing much pain in the back itself and/or other problems down the back of the leg. A sufferer experiences symptoms like tingling, pins and needles, numbness, and, on occasion, weakness of the leg muscles themselves.

The difficulty with placing the blame on the disc is further research has found that only 1 in 10 patients with low back pain have been shown to have pain generated by a compressed disc. As a physical therapist, my tendency and perspective is to look at the entire body. Everything is connected to everything else. We are more than just discs and nerves. We are bones and joints and muscles and ligaments and other kinds of tissue, all interacting together to allow us to live and move and feel.

With 40 years in practice, I have noticed that when I ask patients to show me where they hurt, they generally tend to point at their waistlines off center, behind them. It’s not that they can’t reach the right spot in the middle, where the spine is, but that the pain is being generated away from the center—the spine may not be where to pain is originating.

So if the spine is not where the pain is being generated, what is this spot? Where they are pointing? (By the way, this is called the Forten Finger test.) This area is the joint line where the sacrum bone (the triangular bone at the bottom of the spinal column) joins the ilium bone, where your hips connect. This is the sacro-iliac joint, also known as the SI joint. And the SI joint is the spot people with low back pain point to when they want to show where it hurts.

Why here? It’s a very complex joint in shape. It’s not smooth and made for movement like the hip socket. X-ray studies show the SI joint only moves from 2 to 6 degrees normally. That’s next to nothing, and therein lies the true problem. The huge majority of patients I have seen with complaints of low back pain also happen to have very stiff spines and limitation of other major joints. They often don’t twist more than 30 degrees—and quite often less than that. When it comes to leaning forward to touch your toes, about half are very proud to demonstrate that they can, even though they also have low back pain. When it comes to touching toes, most people combine trunk forward movement with hip forward movement to get that low. Those joints share that movement, meaning both movements are limited.

I have also found that most people with low back pain cannot cross their legs very easily. Their hip rotation is quite limited. So if we look at this as strictly a mechanical problem, if the spine is stiff and tight and the hips are stiff and tight and the SI joint is in the middle between them, who is going to have to do all the work? The guy in the middle of course—the SI joint. This begs the question, what is preventing the bones from moving as much as they should?

Let’s move the perspective a little more, from just bones and joints to adding muscles to the picture. Muscles are the only things that move bones. Bone movements are limited when muscles are tight and refuse to relax. This affects the other muscles attached to those bones to move in the opposite direction.

Now more specifically, let’s add the core muscles. No, that would NOT be your six-pack, but the muscles underneath that layer, and beneath your stomach and intestines also. These are the hip flexors, which really drive your entire body. They attach to the front of your lumbar vertebrae all the way up to the top most lumbar vertebra. They then connect to the other lumbar vertebrae, then attach down high on the inside of your thigh. This means your core directly controls your lower back, your pelvis, your hips and down to your knees; and then, indirectly, the rest of the way up and the rest of the way down your body.

If these core muscles are in spasm, meaning they are turned on and have no off switch, something is not going to be allowed to move. What that “something” turns out to be depends on the rest of your body. The weak link loses. Since your core controls either directly or indirectly most of your body, that could be anything from your neck to your feet, inclusive. This also includes your posture and your gait.

So the easiest way to minimize most body pain is to keep your hips and spine mobile. Don’t just walk—walk backwards and sideways! Dance! Swim! Move in different ways so you don’t just move your body into a rut.

A physical therapist can evaluate your entire body, find where your problems are with limited movement in the various joints, perform hands on treatment, and instruct you in specific exercises for your problems to control and eliminate symptoms.

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