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Back Pain

The Problem:
The lower back, or “lumbar spine” is a stacked collection of 5 bones, or “vertebrae,” each separated by discs, and all are bound together by supportive ligaments. Muscles attached to vertebrae help to move the trunk. The discs are fibrous gel-filled shock absorbing structures that keep the bones gapped or spaced evenly and provide shock absorption to the spine during movements or loading. The lumbar vertebrae have a longitudinal vertical channel contained within them to allow for the passage of nerves (the spinal cord) from the brain to your legs. Most causes of lower back pain are either from stretch or strain of the ligaments or muscles joining the bones together, from arthritic rubbing of one vertebra against another, or from stretch or rupture of the walls of the disc. Muscle, ligament, bone, or disc wall injuries in the lower back produce low back pain alone. But if disc spaces collapse, and adjacent vertebrae drift closer to one another, this might cause bone or disc wall crowding of nerves traveling within the spine. Signs of nerve impingement include pain shooting down the leg, or “sciatica,” sometimes accompanied by leg or foot numbness or weakness. Disc spaces and the nerves themselves are easily seen on MRI images of the lumbar spine.

The Solution:
When you have acute lower back pain, it is best to avoid heavy lifting or loading to the spine. And it is generally a good idea to keep your spine straight while lifting, or when retrieving things from the ground. The disc itself is strong if the loads to your spine are direct and vertical.  But if you bend forward, this places a focal downward pressure on the front of the disc, pushing the gel within the disc towards its back wall – stretching or even “herniating” the back wall of the disc.  Posterior disc bulges are almost always caused by loading of the spine while you are bending forward, and there are some benefits to arching or extending your back to reverse this disc bulge and its associated pain. McKenzie Exercises are a tool to reverse or normalize some of these painful disc disorders, and Robin McKenzie, the author of these techniques, has written two books to explain the basic principles of self-help:  Treat Your Own Back, and Seven Steps to a Pain Free Life, both of which are available in your local library.  Associated lower back joint stiffness or swelling can also be naturally minimized by low-impact exercises, which “pump” the joints free of excess fluid collections.  Swimming is an excellent form of low-impact exercise for the spine.  Anti-inflammatory or narcotic pain medicines can lessen pain temporarily.  Prednisone (a Cortisone product) can also lessen joint or nerve related swelling. Cortisone can also be injected into the spine (Epidural or Caudal blocks). Surgery is sometimes necessary, especially when nerve or sciatica pains persist, to decompress the tight crowding of the spinal nerves.

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