“As a physiotherapist, if I could boil down all the information that’s available to help people find low back pain relief and put them into 5 simple points, what would they be?”

1. The first step is always to figure out what’s the cause of your low back pain. And by cause, I don’t mean the irritations, the bulging discs, the inflamed tissues or any other item that may be considered the source of the pain (click here to read my post differentiating cause versus source). By cause, I mean truly find out what it is that you do everyday (e.g. repeated movements or prolonged postures) that puts your body at risk for injury or keeps it there.

2. Once you’ve figured out the first step. The second step is to remove or reduce that cause. Unfortunately, these are usually well-entrenched, well-engrained habits that you’ve probably been doing for years. For example, think of your daily postures.  Removing the cause of your low back pain will often require you to change your postures often (the best posture being the one you’re not currently in!) or necessitate that you decrease certain, repetitive motions (e.g. repeated forward and backward bending). Fighting to change these long-term habits is no easy task!

3. The third step is to re-train and re-educate your body. This is the motor control side of things. After the first two steps which fall into the realm of knowledge (the acts of learning and understanding what gets you into pain) the next few are designed to keep you out of it. Motor control encompasses postures, movement patterns, mobility concerns and muscle imbalances. By addressing each of these areas, you can work towards removing painful postures, correcting faulty movement patterns, improving mobility where needed (e.g. hips), increasing stability where required (e.g. lumbar spine) and creating an environment for optimal muscle balance and function.

Stable Spine + Mobile Hips = Healthy Spine

4. The fourth step is based on removing any ill effects from de-conditioning. When you’re de-conditioned, your body can’t tolerate the stresses placed upon it in the same manner as if you were in top form. Think of it this way, if you’ve been working yourself into the ground, putting in lots of overtime at work, eating poorly, sleeping just a few hours a night, your body more than likely feels drained and exhausted. You’re more prone to colds and other illnesses. In the same manner, if your body system is out of shape from lack of quality exercise, it won’t be able to deal with the various stresses that it faces everyday, from your morning commute to your prolonged postures. Eventually, something in that system will fail and lead to low back injury and pain.

Just move.

5. While I’ve listed this as the 5th step, it could just as easily have been placed as step 1. You don’t need to live with the pain. If you suffer from mechanical low back pain, there are solutions out there. Many of them are simple. None of them are easy. But there are options. Hopefully my blog gives you an idea of some of them.

Yours in movement.

Dev Chengkalath

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In today’s post, I’ll be discussing some of the soft tissues and their involvement in low back pain.

These soft tissues, which include ligament, muscle, tendon and fascia, all play an integral role is supporting, stabilizing and protecting the back from injury and pathology. As well, these tissues are responsible for helping the body create or resist movement.

Ligaments: The various bony structures of the spine are linked together by ligaments of differing sizes, shapes and strengths. These tough bands of fibrous connective tissue are designed to help provide structural stability and support to the spine. Unfortunately, due to their structural make up and limited blood supply, these tissues may be injured by repetitive stresses from “dangerous” postures or movements. Once injured, these tissues may take a significant time to heal.

Ligaments of the vertebrae

Muscles & Tendons: The muscles of the spine are involved in one of three major activities: creating movement, resisting movement, or acting as proprioceptors to send signals to your brain about your body’s positions and movements. Muscles are attached to bones via tendons. By shortening or lengthening (contraction or relaxation), muscles cause, or restrict, movement about a joint. In the case of restricting movement, this has application in the creation of stability in the spinal column. Certain muscles act as proprioceptors (relays movement information to the brain and CNS through specialized cells and receptors). This allows the body to adapt, act, or react to information transmitted from these contractile tissues to the neural tissues.

Muscles of the back

Fascia: Because fascia is a fairly complicated soft tissue, I’ll just briefly touch upon it here. Fascia can be considered a layered soft tissue matrix that surrounds and encapsulates most internal body structures. It’s role ranges from structural support to immune function.

And there you have it.

A quick overview of the tissues involved in “slipped discs” and low back pain.

In part 2 of this series, we’ll move on to the motor control issues and start putting your new knowledge to use.

Yours in movement.

Dev Chengkalath

In the last blog post, I discussed some of the bony and cartilaginous structures that make up the back so today I’ll spend some time discussing the neurological tissues. These include the brain, the spinal cord and the nerves that branch off from them.

Neurology and related disciplines are in constant states of evolution and the study of the human nervous system can be extremely complicated. For the purposes of relieving your low back pain, I’ll keep the information as basic as possible.

You don’t need to know how a car is built to be able to drive one right?

The brain: This is the control centre of your body. It’s the primary component of the central nervous system (CNS) and is responsible for receiving, processing, analyzing, learning, sending, and organizing information from many sources. When it comes to relieving low back pain, this is your most important tool!

The Human Brain: Control Centre

By using your learning capacity, you can start changing the actions, movements or positions (the “causes”) that keep you in pain. And as you know if you’ve been reading any of my previous posts, the easiest way to remove the pain is to remove the cause.

Spinal Cord: The spinal cord is the second component of the CNS. The spinal cord is a tube-like bundle of neurological tissues, supporting cells and associated structures that extends down from the brain through the spinal canal formed by the stacked vertebrae.

Its main functions are to send, receive, and transmit various signals and nerve impulses to and from the brain and other tissues of the body. It’s also able to independently create certain reflex actions or patterns (e.g. the Knee Jerk Reflex: leg kicking out when your knee is tapped by your doctor’s rubber hammer).

Nerves: The nerves of the body originate from the spinal cord and travel throughout the body into the extremities (Bonus Knowledge Bomb: the exceptions are the cranial nerves which originate directly from the brain). Nerves serve a similar function to the spinal cord and their main function is to transmit messages between the various body tissues and systems and the CNS.

Often, but not always, the part of the nerve that originates off of the spinal cord (the nerve root) will be implicated as the source of the pain in various types of  low back injuries such as disc herniations or bulges.

The Lumbar Nerves

So there you have it, a quick and brief overview of the neurological tissues that are involved in low back pain.

In the next post, I’ll go over the soft tissues and their involvement.

Yours in movement.

Dev Chengkalath

In reality there is no such thing. The term is used to represent what is known as a bulged disc or a disc herniation.

In order to understand this type of injury, it’s imperative to understand the anatomy of the structures involved.

In this installment of the “slipped disc” series, I’ll be describing the anatomy in question and how it relates to the pain you may be feeling.

As you’re probably aware, the body is composed of a variety of different tissues and structures that all work together to create or resist movement. The back is no different.

It is made up of bones, muscles, tendons, ligaments, cartilage, fascia, neural and other connective tissues.

Muscles of the back

The idea behind this post isn’t to bombard you with all the intricate details of human anatomy. Rather, you should use this info as a knowledge foundation of how your anatomy may be placed under undue stress and injured.

Again, as a reminder, carefully note the difference between “cause” and “source”. This is very important as the anatomy of the back is usually related to low back pain as being the source of the pain, rather than the cause of the pain.

Now that the rationale for needing to know the anatomy has been presented, let’s get down to the business of learning the anatomy.

One of the easiest ways to understand how the spine and its components work is to separate it into three major components:

1.   The Spinal Column (Bones & Discs)

2.   The Neurological Tissues (Brain, Spinal Cord  & Nerves)

3.   The Soft Tissues (Ligaments, Muscles, Tendons & Fascia)

Today, we’ll spend some time on the  first component (the spinal column) which for our purposes will include the vertebrae (the bones) and the intervertebral discs (cartilage between the vertebrae).

The Vertebrae: The vertebrae are made up of the living, dynamic bony tissues that interconnect and interact to make up your spinal column and give it its distinctive shape and curvatures. The vertebrae sit atop each other, create specific curves for each region, and attach through articulations called “facet joints”.

stacked spinal vertebrae

There are five groupings of vertebrae, which include: the cervical (neck), thoracic (upper and mid-back), lumbar (low back), sacral, and coccygeal (tailbone) vertebrae.

spinal curves

In a broad sense, each of these curves plays an important role is allowing your body to deal with the various stresses that are placed upon it, most notably, the constant, unyielding effects of gravity.

Intervertebral Discs (Cartilage): Sitting between each of your cervical, thoracic and lumbar vertebrae are cartilaginous discs, which act as shock absorbers and allow for spinal movement.

Intervertebral Discs

These discs are composed of a tough, layered outer shell (annulus fibrosus) and a gel-like inner layer (nucleus pulposus). A good way of thinking of these is imagining a jelly filled doughnut. The doughnut itself would represent the annulus fibrosus while the jelly within would represent the nucleus pulposus. These structures are the ones implicated in disc herniation injuries when the inner nucleus pulposus bulges out into, or out of, the outer annulus (the misnamed  “slipped discs”).

disc bulge sequence

Again, to be perfectly upfront about the potential for problems with discs that are bulging do bear the following in mind: these discs are often affected by processes related to aging and injury (e.g. degenerative disc disease) and may show signs of wear and tear without demonstrating any clinical symptoms of pain or dysfunction.

Hopefully the above gives you a little better understanding of the bony and cartilaginous structures of the low back.

In the next post, we’ll cover the neurological and other soft tissues.

Yours in movement.

Dev Chengkalath

This ubiquitous moniker is a fairly common one.

It’s flashed in eye-catching headlines in low back pain articles. It can be heard reverberating through the halls in hospitals and overheard being discussed in great detail in locker rooms. It’s unfortunately (mis)used all the time  by medical health professionals (physical therapists included) as either an umbrella category for a host of back pain issues or as a misnomer for the actual injury at hand.

In reality, there is no such thing as a slipped disc.

That’s right.

Slipped discs don’t actually exist.

So if the disc hasn’t slipped, what’s the problem?

In most cases, what’s happened is that the intervertebral disc has herniated to some degree and the ensuing tissue pathology has started to cause irritation on the local spinal nerve root.

So if you’re still with me after that last sentence, you get a gold star because that was the technical, mumbo-jumbo way of saying a part of your spine has bulged and is putting pressure on, or causing inflammation around, a nearby nerve. This then becomes the source of your pain, discomfort and dysfunction.

Over the next few blog posts, I’ll delve a little deeper into the “mysterious” world of disc bulges. In order to make this journey easier on you, here’s the agenda for the next few posts. As you’ll see, everything still follows the 3 key issues related to low back pain (which also happens to be the same 3 key issues related to most musculoskeletal issues!).

Part 1: Knowledge

In part one of this series we’ll spend some time on the function and anatomy of the spine. Having this knowledge is paramount in conquering this, or any other form, of low back pain. Knowing and understanding the structures that are involved will give you a better idea on how to protect them or help them do what they do best, heal.

Part 2: Motor Control

In part two of this series we’ll check out some of the motor control issues that lead to, or worsen disc bulges and their painful effects. This includes postures, positions, habits, muscle imbalances, mobility issues or movement patterns that all play a role in disc bulges, whether good or bad.

Part 3: De-conditioning

In the final part, we’ll talk de-conditioning and how you can reverse this process. And, as always, we’ll do all this while keeping your back happy and healthy, using the right kind of exercises, in the right way. Safely and efficiently.

So in the next post, we’ll get the knowledge base laid and then build up on it.

After everything is said and done, you should be better able to understand the true causes and potential cures for your disc herniation (formerly known as “slipped discs“).

Yours in movement.

Dev Chengkalath