What Is A Stiff Spinal Segment

In the well-oiled spinal chain, a stiff spinal segment is a sluggish vertebra which participates less willingly than the others in overall spinal movement. More often than not the stiffer one causes no trouble it just sits there being coaxed along by other more vigorous neighbours and also being compensated for by them. When the spine performs its usual grand-scale activity, each segment contributes a tiny bit more to make up for the stiffer one doing a little bit less. Most spines have a...

The facet joints

Each motion segment has two facet joints forming the back compartment. These are the junctions formed where the vertebrae notch together at the back of the spine. They flank the back corners of each disc, across the gulf of the vertebral canal. The bony notching of the facets provides a primitive interlinking chain down either side of the spine which slots the spinal segments together. If they were not there the vertebrae could roll around on their discs and the neurocentral core could tie...

The Way Ahead

Cancellous Compartment Vertebrae

The good news is that the right therapy almost anywhere along the route of spinal breakdown can stop it in its tracks and turn it around. Often curing a problem employs in reverse the same principles of destruction which brought it about in the first place. The linear progression through increasingly complex syndromes is just as straightforward in reverse. The other good news is that you can do most of the rehabilitation yourself. Phase by less-painful phase you can steer yourself back out of...

Causes Of Segmental Instability

Primary breakdown of the disc Primary breakdown of the facet joints Incompetence of the 'bony catch' mechanism of the facet joints Weakness and poor coordination of the trunk muscles In the later stages of breakdown of a stiff spinal segment, the disc degrades to such a degree that it becomes like an inert flattened washer. It dehydrates and loses its buoyant ball of nucleus at the centre which should act as a pivot. The nucleus so lacks internal hydrostatic pressure that it cannot prime the...

The Disc Breaks Down

As your back gets progressively less mobile the changes to the lower discs become more difficult to reverse. The diminished water content allows the vertebrae to settle closer together and the fibrous walls of the disc bunch down and become less stretchable. When this happens the buoyant nucleus become imprisoned by the hardened mesh walls, rather like the four wing-nuts in each corner of a flower press screwing down the plate. The once-robust bouncing-back nucleus is kept penned inside where...

What You Can Do About It

The aims of self-treatment for an acute locked back The immediate aim in treating an acute locked back is to quell the alarm, so at the very least you can move your limbs without pain and turn over in bed. After the crisis has passed, it is important to deal with the joint sprain, and then bind up the problem joint with good muscle support so it does not happen time and again. Getting the muscle spasm to relax is best achieved by muscle relaxant drugs and strong painkillers, both administered...

What Is Segmental Instability

An unstable spinal segment is the antithesis of a stiff spinal segment. It comes about when the two main stabilising structures of a motion segment the intervertebral disc and facet joints become stretched and weakened, usually as a result of the degenerative process. Fullblown segmental instability is rare, and can be testing to cure by conservative means because so many systems are in trouble at once all fuelling one another and the sources of pain may be multiple. There is always fleeting...

The muscles which work the spine

Multifidus Muscle

As superbly designed as the spine is, it amounts to naught without the dynamic contribution of the muscles. In the way a puppet is a flummoxed pile of sticks on the floor without its working strings, the human spine and its segments are an inert, toppling pole without its muscles. The muscles of the human body work just like the strings of a puppet. They pull on levers and make the body move. They allow us to keep the thinking, top part of the body up there and active so we can operate...

Contents

1 How a normal spine works 13 The muscles which work the spine 41 2 The stiff spinal segment 50 What is a stiff spinal segment 50 Causes of a stiff spinal segment 52 Unremitting spinal compression reduces disc metabolism 52 Gravity squeezes fluid from the discs 53 Abdominal (tummy) weakness allows the spine to 'sink' 55 Sustained postures accelerate fluid loss and poor varieties of movement prevent fluid replacement 56 Chronic protective muscle spasm compresses the problem disc 62 Abnormal...

What Is Facet Joint Arthropathy

Facet Joint Arthropathy

The term 'arthropathy' covers the wide range of this disorder, from fleeting joint sprain of the capsular ligaments, right through to frank arthritis of the joint. Breakdown of the facets comes about in several ways when the disc between two vertebrae flattens, causing the upper vertebra to settle down on the one below and jam the back compartment, just as letting air out of a car tyre makes it run along on its rim. It also develops when the facets have to overdo their preventative role, either...

What Is A Prolapsed Disc

Friction Bulge

A 'slipped' disc is a localised bulge in the back wall of a disc. It is caused by the devitalised nucleus losing cohesion and trying to escape through a chink in the cracking disc wall (anulus). The condition needs explaining because for years it has taken the blame as the main perpetrator of back mischief. In the 1930s, 'slipped discs' were nominated as the chief cause of back trouble, and this limited view of what goes wrong has held sway, almost to the present day. It was thought that a disc...

The intervertebral discs

Psoas Crooked Pelvis

The intervertebral discs are resilient, water-filled pillows between the vertebrae. They have scant nerve supply and no blood supply indeed discs are the largest avascular structures in the body. This also means that other mechanisms must be utitilised to transport raw materials and waste products to keep the discs alive, which will be discussed below, but even at the best of times discs struggle to remain viable. Discs are designed to give us flexibility at low load and stability at high load...

The Way This Back Behaves

The high-pitched crisis of acute facet inflammation usually follows a wrenching of the spine which provokes a slower brewing problem. A dormant stiff facet sets itself up for being hurt by not accepting shock as readily as its neighbours above and below or even its facet partner on the other side. The cause of the flare-up can be hard to pinpoint but in a matter of hours the injury can be literally crippling. It is usually something awkward but not disastrous, such as moving a pot plant which...

Causes Of A Stiff Spinal Segment

Thinning Spinal Disc

Unremitting spinal compression reduces disc metabolism Gravity squeezes fluid from the discs Abdominal (tummy) weakness allows the spine to 'sink' Sustained postures accelerate fluid loss and poor varieties of movement prevent fluid replacement Chronic protective muscle spasm compresses the problem disc Abnormal postures increase neurocentral compression and reduce metabolic activity of the discs Injury can rupture the cartilage endplate between vertebra and disc Unremitting spinal compression...

Causes Of Facet Arthropathy

Lower Lumbar Facet Arthropathy

Disc stiffening allows the facet capsules to tighten Disc narrowing causes the facet joint surfaces to override A sway back causes the lower facets to jam Weak tummy muscles can jam the facets A shorter leg invokes a greater restraint role of the facets Disc stiffening allows the facet capsules to tighten The earliest form of stiffness of a facet joint may be nothing more than a fleeting protective spasm of its overlying multifidus muscle. A fluke odd movement or an awkward posture for a...

Causes Of An Acute Locked Back

Facet Locked

A natural 'window of weakness' early in a bend Segmental stiffness predisposes to facet locking Muscle weakness contributes to facet locking A natural 'window of weakness' early in a bend All spines experience a natural vulnerability on bending until they get themselves properly braced. I believe that facet locking occurs when the spine is caught momentarily ill-prepared as it passes through a fleeting 'window of weakness' in the early part of range. Bracing happens when the muscles at the...

Exercises For Treating A Bad Back

Core Back Core

Once the stage is set with adequate rest and any necessary drug therapy, the following exercises reverse the structural and physiological changes of the motion segment. Basic theoretical treatment regimens, using various combinations of the exercises for specific back disorders, are in Chapters 2 to 6. This is the ultimate 'appeasing' exercise. It is the least taxing and therefore least frightening exercise in the early loosening of a jammed segment. It is performed in the horizontal supine...