The Anatomy of Low Back Pain

Understanding the anatomy of the lumbar spine is key to understanding and managing low back pain.

The lumbar spine, commonly called the “low back”, consists of 5 vertebrae, and is located between the thoracic spine (which articulate with ribs) and the sacrum. The vertebrae themselves are given numbers by which they are identified, for example – Lumbar Vertebra 1 = L1, Lumbar Vertebra 2 = L2 and so on.

The normal lordotic curve of the low back is known as a secondary curve, and starts to develop in infancy due to weight bearing caused by learning to sit up and walk.  The low back is especially vulnerable to injury due to its weight bearing task and mobility.

Between each vertebrae throughout the whole spine (except for C1 and C2) is a intervertebral or fibrous disc. The purpose of the disc is to provide cushioning and shock absorption from weight bearing and movement. The intervertebral disc is comprised of the annulous fibrosis and the gel-like centre called the nucleus pulposus – these structures are work together to provide the shock absorption, and are both implicated in disc dysfunction and neurological symptoms.

Facet joints are the articulating surfaces of bone between vertebrae. These synovial joints are known as “plane” joints because their flat surfaces glide over each other. These joints may become inflamed due to injury to the joint or joint capsule itself, or due to compression of the intervertebral discs, forcing them to interact in a “close-packed” position. This close packed position means that the joint surfaces are forced closer together than normal, and will irritate the bone and cartilage during movement as they contact each other and create friction.

During an acute injury, the inflamed tissue in the joints may irritate the nerve roots as they exit the spinal cord via the intervertebral foramina. Eventually, if facet irritation is untreated, bony spurs may develop due to chronic inflammation and cause spinal stenosis – a decrease in the size of the “vertebral foramen” or spinal canal.

In the case of a “bulging” or herniated disc, pressure is exerted on the nerve root as it leaves the spinal cord via the intervertebral foramina. This pinching or pressure on the nerve root will cause sharp, shooting pain, especially when the patient leans forward (flexes) from the hip.  Symptoms will present in the areas that the compromised nerves supply.

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www.whymassagetherapy.com
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Core Muscle Stability and Back Pain

Forget abdominal crunches, use a balance ball to strengthen your core and relieve back pain.

Back pain can be a mysterious complaint, and for some seems to come “out of nowhere” – leaving us scratching our heads at this mysterious development in our health. As a massage therapist for 9 years, I can testify to the fact that back pain is one of the most common and debilitating conditions afflicting humankind, and idiopathic back pain (meaning no discernable cause) is seldom a result of just one factor.

Now that I’m a “little” older, it has come to my attention that the body I remember having when I was a youngster of 25 was a lot firmer and stronger than the body I’m inhabiting now. What I’m trying to say, in a roundabout way, is that our bodies change over time. Life happens, we get married (or not), have children (or not) and often because we feel good, we don’t recognize that our bodies lose strength. Many of us sit at desks all day, and we forget that our bodies are designed to move, not be stationary in one position for any length of time. We take for granted that we will always be as strong and fit as we remember, and that’s just not the case. This sedentary lifestyle can happen easily, and before we know it we have a niggling little pain in our back that can quickly take a turn for the worse if left untreated.

One of the most common reasons for back pain is weakness in the transversus abdominus, the most famous of the “core” muscles. The transversus abdominus is also known in therapeutic occupations as the TA, and is responsible for acting like a support for the trunk of the body and for “containing” the internal organs. It attaches at the back on the spine of your low back, and like a weight belt or girdle, wraps around your body and attaches to the linea alba, a fibrous band that runs from the xiphoid process of your sternum to your pubic bone.

How does this muscle get weak? Lack of movement/exercise and injury are 2 common reasons, and for our purposes today, we’ll focus on how exercise can strengthen this important muscle and help relieve back pain.

It is very important to learn how to consciously engage this muscle – that is, to contract the muscle at will. The issue here is that many people are not very body-aware, and to learn this can take some time. Often people who are very weak through here may have never been very strong, and will have to take their time. Rome, after all, was not built in one day.

How can the transversus abdominus be strengthened? I do recommend starting slowly, challenging the muscles gently by sitting on a balance ball, which is much harder than it looks. When we are seated on an unstable surface, our small “intrinsic” muscles of the spine as well as the TA must continually contract, relax and adjust to keep us upright.

The important thing to remember is that your feel should be flat on the floor, your thighs should be a 90 degree angle to the trunk, and the knees should also be bent at 90 degrees. Any more of an angle and the ball is too low, any less of an angle the ball is too high. (see picture to the right of a Gaiam Balance Ball Chair). This deceptively simple exercise can be very tiring, but works wonders to strengthen the core and relieve low back pain.

Personally, having had a serious back injury myself, I don’t recommend doing adbominal crunches, and certainly not on a stability or balance ball, until you have regained strength and conscious control of the transversus abdominus. Crunches also primarily exercise the rectus abdominus, which run vertically from the pubic bone to the sternum (on both sides of the linea alba). Have you ever seen a person walking, looking like he or she has the bum tucked under their body? Strengthening the rectus abdominus to the exclusion of the other muscles of the body causes this tucking, and takes the natural lordotic curve out of the low back.

What I would suggest is that the transversus abdominus be challenged gently and frequently.

How, you wonder, can I do this at work all day?

Well, it is very common to see people at their desks sitting on balance balls, and I have even performed therapeutic massage while sitting on one. The drawback to this is that it’s hard to move around – for example, from your computer to the printer a few feet away. (for me, it was moving from a clients head to his or her arm or side) You can get the same benefit of sitting on a balance ball with much more versatility if you invest in a Balance Ball Chair. This “chair” is basically a removable balance ball sitting on a frame with lockable castor wheels. It also has a back on it and comes with an air pump and an exercise guide.

This works because you are still sitting on a squishy, moving surface, and any shift in your weight will cause muscles to activate to maintain your upright position. At the end of the day, you can take the ball off of the frame or setting and do more exercises.

Stay tuned for many more posts on back pain.

© Copyright 2008-2009
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.

Massage Therapy and Anatomy – Cervical Vertebrae C1 & C2

Question of May 5th

Q: If the thoracic and sacral curves are considered primary, what spinal curves are considered secondary? What is a factor in the development of secondary spinal curves?

Answer: The cervical and lumbar lordotic curves are considered secondary. Weight bearing is the main factor in development of these curves – the cervical lordotic curve will develop first as a baby starts to move his or her head; the lumbar lordosis will develop when he or she learns to sit up and starts to bear weight.

Question of the Day
The C1 and C2 vertebrae are considered “atypical”. Why is this, and explain how the 2 vertebrae relate to each other.