By Tammy Mugavero MS, LATC, CSCS Oh My Aching Back By Tammy Mugavero MS, LATC, CSCS

Most of us will experience back pain at some point in our lives Stats on Pain 2 out of every 3 adults in the US experience at least one major incidence of back pain. About 35 million Americans suffer from some sort of chronic musculoskeletal pain

Types of Back Pain Acute Chronic Sprains & Strains Herniated or Ruptured Disks Fractures Arthritis DDD (Degenerative Disk Disease) Bulging or Herniated Disks Spondylosis & Spondylolisthesis Stenosis (central canal & foraminal)

Inflammation/ degeneration of the Facets Arthritis Inflammation/ degeneration of the Facets Classic symptoms include pain and/or numbness in low back and down the leg, but not usually below the knee. Spinal arthritis is inflammation of the spinal facet joints. This is the most common cause of low back pain in people over 50 Causes: 1) These small joints are prone to injury because of the amount of body weight that they bear and the resulting stress and strain. The accumulation of stress and injury over time causes the joints to break down or degenerate. 2) A second cause of injury comes from the breakdown of the disks… the shock absorbers of the spine. When the disks break down, excessive force is transmitted to the facet joints. Stiffness and pain tend to be worse in the morning and then again in the evening Treatment: Treat symptomatically. Facet joint syndrome is typically made worse with low back extension (bending backward). Do flexibility and stabilization exercises daily . It may be helpful to use a heating pad for 20 minutes prior to stretching and ice for 20 minutes after exercise or when painful.

Degenerative Conditions of the Spine Are Not Completely Avoidable Age Related Changes Age-related changes cause the discs to “dry out” making them weaker; makes them more prone to damage This causes the disk space to narrow or deteriorate allowing changes in the structural integrity of the spine; degeneration increases instability The body tries to restore stability by making fibrous and bony changes to the spine

Spondylosis, Spondylolysis & Spondylolisthesis What is it? A “spondy” is a defect in a portion of the spine called the pars interarticularis (a small segment of bone joining the facets- where one vertebrae stacks on another.) Spondylosis refers to the separation of the pars interarticularis. Spondylolisthesis refers to the anterior slippage of the vertebrae over another. The slippage is graded from I – IV. The underlying cause has not been firmly established. Some physicians believe that repetitive trauma from certain sports may either cause or contribute to its development. Treat symptomatically. Rest or avoiding certain activities is not necessary unless the condition is symptomatic. Extension-type activities may aggravate this condition.

Stenosis What is it? Stenosis is a narrowing of the spinal canal (central canal) or the foramin (foraminal). It is generally a degenerative cascade that commonly occurs in the lumbar and/or the cervical spine. When the spinal canal is narrowed, the spinal cord and other nerve structures can be irritated. There is often a radiating pain or numbness in one or both of the arms or the legs depending on the level of the stenosis. Causes: Herniated disk materials, bone spurs Treat symptomatically. Avoid extension-type exercises/ activities and prolonged standing or walking. Biking and swimming are good modalities for exercise for someone with stenosis.

Where does Sciatica Fit In? Sciatica is a catch all term that describes symptoms that go down the back of the leg There can be a number of causes, but Sciatica is a symptom, not an underlying condition Sciatica can cause pain all the way down the leg: from the buttocks down to the toes

Treatment for Low Back Pain Modern medicine and physical therapy tend to address the symptoms of pain and often don’t address the underlying cause of the pain. But, the site of the pain is rarely the site of the problem so eventually, you must look at the body as a whole!

The Postures of Chronic Pain Getting Rid of the Pain The Postures of Chronic Pain Reduce Pain & Inflammation Ice or heat? NSAID’s TENS Gentle stretch Restore function Fix the dysfunction Any deviation from “ideal posture” can be the source pain & dysfunction

Posture’s role in chronic pain The body does have a standard design Without proper design motions, we are looking at the posture of chronic pain The “S” curve of the spine gets pushed, pulled, and compressed until it starts looking more like an “I”, an inverted “J”, or a “C”

Identify the Dysfunction Condition 1 This condition is characterized by excessive tightness, especially in the hip flexors. They walk using their hip flexors rather than their leg muscles (which causes tightness in the hip flexors). This causes the excessive arch in the lumbar spine (an anterior tilt). To ease the pressure on the low back, the upper body rounds. To relieve tension in the hips, the femur externally rotates. Based on the Egoscue Method by Peter Egoscue

Identify the Dysfunction Condition 3 This posture is considered the most dysfunctional posture of all. It is not easily corrected and is characterized by a tilting under of the pelvis. It is considered a condition of weakness. Based on the Egoscue Method by Peter Egoscue

Identify the Dysfunction Condition 2 This is a condition of asymmetry or using one side of the body more than the other. Sports and daily activities that favor unilateral dominance create a condition 2 posture. You must correct this posture before you address either of the other 2 conditions. Controlling the rotational factors in a joint/ joints that are designed to flex and extend may cause chronic pain and may be responsible for degeneration of joints and cartilage. Based on the Egoscue Method by Peter Egoscue

Fixing the Dysfunction for Condition 2 Posture Standing Arm Circles Gravity Drop Downward Dog Runner’s Stretch Frog Supine Groin Stretch Standing Quad Stretch Abdominal Crunches Supine Foot Circles & Point/ Flex Crocodile Pelvic Tilt Spinal Twist Airbench

Fixing the Dysfunction Condition 2 Posture Frog

Fixing the Dysfunction Condition 2 Posture Doing strength training on a dysfunctional body only strengthens the dysfunction. Resources: Pain Free: A Revolutionary Method for Stopping Chronic Pain by Pete Egoscue, Roger Gittines, 2000 The Egoscue Method of Health Through Motion by Pete Egoscue, Roger Gittines, Jack Nicklaus, 1993

Final Thoughts Losing weight and maintaining a healthy weight plays a key role in managing joint pain. When your body carries extra weight—especially around the midsection—that weight pulls your pelvis forward. Every extra pound adds strain to back muscles and ligaments. Over time, the spine can become tilted and develop an unnatural curvature. Research has shown that obesity poses more than a mechanical stressor on joints: excess body fat also produces chemicals that contribute to joint damage. The combination of weight-related risks can cause a range of damage to the spinal discs and other structures. When your weight slips into an unhealthy range over time, the risk of degenerative disc disease increases by 30 to 79 percent. Extra weight doesn’t just increase wear and tear on your back and joints, it also makes injury more likely. People who are overweight are 15 percent more likely to sustain musculoskeletal injury, and people who are obese are 48 percent more at risk for injuries. Dropping just a few pounds can make a big difference to your back. For every four pounds you lose, you remove 16 pounds of pressure from your spine. In one study, the risk of developing osteoarthritis dropped 50 percent with each 11-pound weight loss. Stats taken from Summit Orthopedics, Minneapolis, MN