Low Back Segmental Stiffness

When we have our first episode of low back pain our back is rarely stiff unless we are just like that, having a tendency towards stiffness. Mostly our back moves like the well designed machine it is. The discs separate the vertebrae and allow movement to occur, with thicker discs in areas of greater movement. The facet joints control and limit movement of the segments and prevent abnormal displacement of the spine under the shearing loads it must cope with. The muscles are all in good condition and working in the most functional patterns. Until, at least, an episode of back pain occurs and it all changes.

An acute episode of low back pain inhibits the core stabilising muscles from working well and can cause wasting of them with time. Segmental loss of stability control can make the occurrence of further low back pain episodes at the same level more likely. As time and injuries change the spine, degenerative changes can occur in the facet joints and discs, leading to segmental stiffness and chronic back pain. The force of gravity pushes fluid from the discs by compression and is opposed by a chemical absorption of fluid which is more powerful in lying.

If over time the compressive force gets the upper hand, the disc loses some of its hydration and eventually narrows. Narrowing can be seen on x-ray but the disc can start to become troublesome before it is changed enough to show up on the x-ray. In the spine two vertebrae and the intervening disc are known as a segment and it is the segments with altered discs which become stiff, preventing normal movement and forcing anatomical structures to take abnormal loads in abnormal positions. The vertebra above a stiff segment is unable to participate in normal movement and this stiffness can be felt by a physiotherapist.

Muscle spasms are a typical reaction to an acute injury and has a protective function, stopping the damaged segment from moving while it is so inflamed and thereby giving it some freedom to heal. As the pain settles and the injury heals the back spasms should gradually settle and allow normal movement to be restored. Unfortunately this does not always happen, with some muscles remaining over protective and eventually forming a contracture, an abnormally shortened tissue structure which maintains an abnormal joint position.

Segmental stiffness can also be contributed to by sitting too much with its increased spinal compression forcing fluid from the discs. Avoiding flexion for many of us has led to a loss of this useful and disc-maintaining movement which increases fluid throughput to the discs and keeps them healthy. Other contributors are maintaining abnormal postures and weakness of the abdominal muscle group.

Having a series of acute episodes of lumbago can predispose to developing a segmental stiffness problem, often with the stiff or abnormally moving segments of the spine having been present for a long period before they start to give pain symptoms. Actions which make this syndrome worse will tend to hold the spine in flexion for long periods or at end ranges, such as sitting for extended times and bending forwards repeatedly, actions which push joints further than their limits of comfort. The spinal facet joints develop an extension dysfunction and the spinal segment can become adaptively shortened, compromising its movement ability. My own lumbar spine has some of these back problems and limits my ability to do repeated lifting or bent over work.

However, I have been significantly improved by following Sarah Key’s method of back care, popularised in her book Sarah Key’s Back Sufferers Bible. While it is hard to agree with all the assertions she states in her book (as she herself admits), there is no doubt she has some very good ideas on how to practically manage low back pain. She describes the chronically stiff segmental back along with several other back pain syndromes and prescribes an exercise and management regime for treating them. The regime is not difficult but has very good results, particularly in my case where I felt I was stuck with my lower back pain and now realise this may not be the case.

Tagged with: alternative medicine • back injury • back pain relief • back-pain • Frozen Shoulder • health • Health & Fitness • injury management • pain-management • physical fitness • physiotherapists • physiotherapy • Piriformis Syndrome • Sciatica

Filed under: Health & Fitness

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