By Dr. R. Greg Lusk, DC
In my last article in January, I discussed
the value of applying a "functional" diagnosis to a complaint such as
low back pain. To refresh, it is the process of identifying movements and/or activities
(i.e. functions) that produce or aggravate symptoms, as well as those that may
reduce or even abolish symptoms. Aiming for this better understanding of
factors that influence pain offers great value to patients, beyond the
anatomical diagnosis, as they can independently modify behaviour and movement
to modulate pain, in addition to the traditional approach of receiving a form
of treatment to manage and/or mask the symptom of pain.
With respect to neck or low back pain, flexion (i.e. bending forward) is by
far the most common direction which produces, aggravates, and perpetuates pain.
This is not surprising as most of us have a posture that tends toward slouching
versus sitting straight up and many of our activities of daily living involve spine
flexion - sitting, driving, computer use, looking down at our phones, washing
dishes, putting on socks, etc. Conversely, how many things do you do throughout
the day or how much time do you spend in positions that involve bending your
spine backward or extending your neck to look up? Not many and not much would
be my guesses. If you consider that most clients that present to my office with
neck or back pain also report no trauma or specific mechanism resulting in
their pain, this points to a more repetitive, cumulative, or sustained source
of strain as the culprit.
Ironically, although spine flexion can be
implicated as a functional source of pain in many cases, patients will often
describe prior relief efforts that have been largely flexion based. For
example, for low back pain, I often hear people tell me that they've been
bending forward or lying on their back and pulling their knees up to their
chest, to stretch the "tightness" in their back. I understand the
reasoning that led to this as those positions would stretch the muscles of the
back by lengthening them as you bend away. However, other than a temporary
sense of relief that is achieved by stretching the tissues, there is often no
prolonged benefit noted. Similarly, many patients will report that resting in a
recliner-style chair with their legs up is comfortable....until they go to
stand up. The common denominator - the low back gets rounded forward in all of
these positions and flexion stress can accumulate. I've heard Dr. Stuart
McGill, a world-renowned spine researcher, comment previously that if spine
flexion is what someone needed to get better then their daily life would simply
make them better due to the volume of spine flexion done daily. There is wisdom
there that demands considering a different approach.
Practicing "spine hygiene" is a
valuable part of that strategy as it involves sparing the spine from
aggravating loading patterns, by modifying how we move while bending, rising
from a seated or lying position, brushing our teeth, etc. A future article will
address these things in more detail so stay tuned. While flexion is commonly
not well tolerated, I do want to stress that it isn't bad 100% of the time and
will happen naturally during many activities. Sometimes we just do too much of
it which results in degenerative changes over time and a sensitization to
biomechanical forces in that direction. By limiting this sort of functional
intolerance often a longer duration of pain relief can be achieved.
This article
is for general information purposes only and is not to be taken as professional
medical advice.
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