Contents

Foreword v

Introduction 1

The way it might be 1

The way it goes wrong 5

1 How a normal spine works 13

What is a spine? 13

The lumbar vertebrae 15

The spinal ligaments 19

The intervertebral discs 23

The nutrition of the discs 28

The vertebral movements 30

The facet joints 33

The bending human spine 36

The spinal nerves 40

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 postures increase neurocentral compression and reduce metabolic activity of the discs 64 Injury can rupture the cartilage endplate between vertebra and disc 69

The disc breaks down 71

The way this back behaves 74

The sub-clinical phase 74

The acute phase 74

Acute palpation 76

What causes the acute pain? 76

The sub-acute phase 77

Sub-acute palpation 78

The chronic phase 78

Chronic palpation 78

What causes the chronic pain? 79

What you can do about it 80

Aims of self-treatment for segmental stiffness 80

A typical self-treatment for acute segmental stiffness 81

A typical self-treatment for sub-acute segmental stiffness 82

A typical self-treatment for chronic segmental stiffness 83

3 Facet joint arthropathy 85

What is facet joint arthropathy? 85

Diagnosis by manual palpation 89

Causes of facet arthropathy 91

Disc stiffening allows the facet capsules to tighten 91

Disc narrowing causes the facet joint surfaces to override 92

A sway back causes the lower facets to jam 94

Weak tummy muscles can jam the facets 97

A shorter leg invokes a greater restraint role of the facets 98

Golf clinic 101

The way this back behaves 101

The acute phase 101

Manual diagnosis of an acutely inflamed facet 102

What causes the acute pain? 103

Interrupting the pain cycle 104

The chronic phase 105

Lessening the pain 105

What causes the chronic pain? 107

What you can do about it 109

The aims of self-treatment for facet joint arthropathy 109

A typical self-treatment for acute facet joint arthropathy 110 A typical self-treatment for sub-acute facet joint arthropathy 111

A typical self-treatment for chronic facet joint arthropathy 112

4 The acute locked back 114

What is an acute locked back? 114

Causes of an acute locked back 117

A natural'window of weakness' early in a bend 117

Segmental stiffness predisposes to facet locking 119

Muscle weakness contributes to facet locking 120

The way this back behaves 122

The acute phase 122

What causes the acute pain? 123

The sub-acute phase 124

The chronic phase 125

What you can do about it 126

The aims of self-treatment for an acute locked back 126

A typical self-treatment for acute locked back 127

A typical self-treatment for sub-acute locked back 128

A typical self-treatment for chronic locked back 129

5 The prolapsed 'slipped' intervertebral disc 132

What is a prolapsed disc? 132

Diagnostic techniques 137

Disc surgery 139

Causes of a prolapsed disc 141 Pre-existing breakdown alters the properties of the nucleus and weakens the disc wall 142

Bending and lifting stress breaks down the back wall of the disc 143

Intensifying the breakdown 144

The way this back behaves 146

The acute phase 146

What causes the acute pain? 148

The chronic phase 150

What causes the chronic pain? 153

What you can do about it 154

The aims of self-treatment of a prolapsed disc 154

A typical self-treatment for acute prolapsed disc 155

A typical self-treatment for sub-acute prolapsed disc 156

A typical self-treatment for chronic prolapsed disc 157

6 The unstable spinal segment 158

What is segmental instability? 158

Diagnosis 162

Spinal surgery 164

Causes of segmental instability 165

Primary breakdown of the disc 165

Primary breakdown of the facet joints 168 Incompetence of the 'bony catch' mechanism of the facet joints 169

Weakness and poor coordination of the trunk muscles 171

Some speculation 172

The way this back behaves 173

The acute phase 173

What causes the acute pain? 174

The sub-acute phase 174

The chronic phase 176

What causes the chronic pain? 178

What you can do about it 178

The aims of self-treatment for segmental instability 178

A typical self-treatment for acute instability 179

A typical self-treatment for sub-acute instability 180

A typical self-treatment for chronic instability 181

7 Treating your own back 183

Helping yourself 183

Preliminary thoughts 184

The procedures 186

Bed rest 186

Medication 188

Painkillers and NSAIDs 189

Muscle relaxants 190

Exercises for treating a bad back 192

Rocking the knees to your chest 192

Rolling along the spine 195

Legs passing 198

Reverse curl ups 199

The BackBlock 202

Segmental pelvic bridging 208

The Ma Roller 210

Squatting 212

Toe touches in the standing position 214

Diagonal toe touches 216

Floor twists 218

The Cobra 219

The Sphinx 222

Spinal intrinsics strengthening 223

Reference reading

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