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The side view of the human body in the standing position shows that there is an inward curve in the small of the back just above the pelvis. This hollow in the low back is called the lumbar lordosis. The lumbar lordosis is a natural feature of the lumbar spine in all humans, having been formed during the evolutionary process. Our understanding of the function of the lumbar lordosis is an important feature.
When standing upright, the lordosis is naturally present, though varies from person to person. The lordosis is lost whenever the Iow back is rounded, and this usually occurs during sitting and bending forward. If the lordosis is lost often and for long enough periods, then low back problems may develop. The ligamentous stays become fatigued or over stretched, and may result in a painful episode.
This section on mechanical pain is very important, as it explains exactly why you hurt when you do. if you take the time to well understand this you will be more than halfway toward solving your problems. Research has found that the better the patient understands the problem, the better will be the results of treatment.
Pain of mechanical origin occurs when the joint between two bones has been placed in a position that overstretches the surrounding Lordosis ligaments and other soft tissues.This is true for mechanical pain in any joint of the body, including the spine. To help you understand how easily some mechanical pains can be produced, you may like to try a simple experiment.First, bend one finger backward, until you feel a strain. If you cause the finger to remain in this strained position, you will initially feel minor discomfort only,but, as time passes, pain will eventually develop. In some cases,pain caused by prolonged stretching may take as much as an hour to appear.
Try the experiment once more,but now keep bending the finger past the point of strain until you feel pain. The sensation of pain is immediate. You have overstretched, and your pain warning system is telling you that to continue movement in that particular direction will cause damage.
Should you ignore the warning and continue to overstretch,damage will occur. Of course, the pain warning tells you to stop overstretching,and when you do so,the pain ceases immediately. No damage will have occurred to your finger and the pain will have gone.No lasting problems will arise from this short-lived strain providing you take note of the pain warning system.
If you fail to heed the warning and keep the finger in the overstretched position, the ligaments and surrounding soft tissues that hold the joint together will be tom. This tearing will result in an ache which continues even when you stop overstretching. The pain will continue even when the finger is at rest. The pain will increase with movement and reduce at rest but it will not cease until some healing has occurred. Healing may take several days but will be prolonged if, every day, you continue to apply the same strains to the finger.
MECHANICAL LOW BACK PAIN
- If an engineer were to examine which area in the back is subjected mostly to mechanical stress, he would conclude that most strain must be placed on that part of the spine which is located just above its junction with the pelvis. This conclusion is correct, for statistics show that back problems arise more often in the low back than in any other part of the spine.
- Low back pain is not caused by draughts, chills, or the weather. It. was once believed that these weather-related phenomena were responsible for back and neck pains. Today our understanding is better, and it is generally agreed by specialists that most backache is caused by mechanical strains, similar to those described in the previous section.It is often thought that low back pain is caused by strained muscles.
- Muscles, which are the source of power and cause movement,can indeed be overstretched or injured. This requires a considerable amount of force and does not often happen.
- Moreover,muscles usually heal very rapidly and seldom cause pain lasting for more than a week or two. On the other hand, whenever the impact of the injuring force is severe enough to affect the muscles, the underlying soft tissues and ligaments will be damaged as well.
- In fact, usually these tissues are damaged long before the muscles.
- Most low back pain is caused by prolonged overstretching of ligaments and other surrounding soft tissues. Just as pain arises in the overstretched finger as I have described above, pain can also arise in the lower back when ligaments in this region are overstretched. Pain produced by overstretching in this manner is common and arises particularly when we develop poor postural habits.
- Whenever we remain in a relaxed position, be it standing, sitting, or lying, prolonged overstretching can easily occur.
- When pain arises because we have allowed our posture to slouch,it is really our own fault and we have no one to blame but ourselves.This type of strain is easily avoided, and once we have been properly educated, the prevention of pain produced in this manner becomes our responsibility.
- However, mechanical pain may also be caused by over stretchingof such severity that some tissues are actually damaged. Over stretching causing damage may occur when an outside force places an excessive strain on the low back. For example, this type of strain can occur due to a fall while playing tennis, or from a contact sport such as football where severe forces develop when players are tackled.
- Lifting excessive weights is also likely to cause overstretching and damage to the supporting ligaments of the spinal joints. These types of injury cannot easily be avoided as they occur unexpectedly and without warning signs.
- When soft tissues surrounding a joint are overstretched, it is usually the ligaments that first give rise to pain. When the spinal joints are considered, there are additional factors, for the surrounding ligaments are also the retaining walls for the soft discs that act as shock absorbers between the vertebrae.
- Overstretching of these will, under certain circumstances, affect the discs. This may significantly influence or alter the intensity of the pain that you have, the distribution of the pain you feel, and the behavior of the pain, which may be made better or worse by certain movements or positions.
- Complications of another sort arise when the ligament surrounding the disc is injured to such an extent that the disc loses its ability to absorb shock and its outer wall becomes weakened.
- This allows the soft inside of the disc to bulge outward and, in extreme cases, to burst through the outer ligament, which may cause severe pain. When the disc bulges far enough backward, it may press painfully on the sciatic nerve. This can cause some of the pains or other symptoms (numbness, sensation of pins and needles,, weakness) that may be felt well away from the source of the trouble, for example in the lower leg or foot.
- Should the soft inside of the disc bulge excessively, the disc may become severely distorted. This will cause the vertebrae to tilt forward or to one side and prevent the vertebrae from lining up properly during movement. In this case some movements will be blocked partially or completely and any movement may cause severe pain.
- This is the reason why some people with severe back pain are forced to stand with the trunk off-centre or bent forward. Those of you who experience a sudden onset of pain and following this are unable to straighten up or move the back properly are likely to have some bulging of the soft disc material. This need not be cause for alarm. Once soft tissues are damaged, pain will be felt until healing is complete and function is fully restored. It is important that during the healing process you avoid movements that pull the healing surfaces apart.
- For instance, if you have overstretched ligaments of the lower back by bending forward, it is likely that any repetition of this movement will continue to open and separate the healing tissues, and this will further delay the repair of the damage. If, on the other hand, you avoid bending forward and instead keep a
- hollow in the lower back, the damaged surfaces will remain together and healing will not be interrupted.It is difficult perhaps to visualize this process occurring in the lower back. Using the finger once more as an example may help understanding. Let us imagine that you have accidentally cut a the back of your knuckle with a sharp instrument. If you are to bend the injured finger joint every day, you would open up the wound and delay recovery. However by keeping the finger straight for about a week, you would allow the healing surfaces to remain together and complete healing would result.
- You could then commence bending the finger without risking any further damage.The same strategy works for the problems arising in the lower back.
- When tissues heal they form scar tissue. Scar tissue is less elastic than normal tissue and tends to shorten over time. If shortening occurs, movement may stretch the scars and produce pain. Unless appropriate exercises are performed to restore normal flexibility,the healed tissue may produce a continuous source of back pain and/or stiffness. Such problems can persist for years.
- Even though the original damage is repaired, the scar itself restricts movement and causes pain when stretched .