Good spine health heavily replies on your daily posture. Even though you are healthy, if you spend too much time in a slouched posture on the chair or sofa, you cannot get away from pain in your back or neck. If your spine is not in a proper position or being overused, your paraspinal muscles holding you against gravity begin to get fatigued and become unable to support your spine any more. In this case, in mild to moderate cases, your muscle will make myofascial tightness and trigger points, and in moderate to severe cases, it will cause discogenic back pain from the herniated disc between your vertebrae.
Posture and Spine Health
What are the most common causes of neck and back pain?
1. Disc Herniation/ Bulging disc (with/without radiating pain)
Spine has a cushion between each vertebra called disc. The disc absorbs stress applied on the spine and makes the spine more flexible as it is not a solid structure. The healthy disc has lots of water contents in the core part in it (nucleus pulposus).
The spinal disk is protected by the ligament and surrounding muscle groups. When the muscles and ligaments are not supporting the spine enough or being strained/sprained by the forces from outside such as a car accident, the discs can slip backward which is called herniated disc. Also, sitting for a long time with a slouched posture is one of the most common causes of disk herniation. The bulging disc increases pressure and inflammation in the nerve roots which increases pain in your neck or back with radiating pain to your arm or leg.
2. Poor muscle quality with trigger points (Superficial level)
We are always using connective tissues such as muscles, tendons and the surrounding fascia in order to maintain our posture and move our body. The quality of the connective tissue becomes poor when it is overused, fatigued and does not have good stretching and relaxation. The tissues are getting thick, tight, and eventually developing trigger points (irritable muscle knots).
The trigger points are the most common source of pain we are experiencing. It increases pain, tension and strange sensation even in the other body parts. If we understand trigger points well, we are approaching a better quality life without feeling unnecessary pain. Please refer to the basic information about Trigger Point Release and Myofascial Release Therapy below.
3. Myofascial system dysfunction (Deeper level)
Human body consists of numerous different systems such as muscles, organs, nerves, blood vessels. And all of these tissues and organs are encased by the connective tissue called “Fascia”. It is one continuous structure that exists from head to toe without interruption.
Any physical and emotional stress and trauma can create restriction and tension in the myofascial system and it deteriorates body function, flexibility, strength and increases pain level in your body.
For example, deep abdomen myofascial restriction increases compression force in your spine so you can easily develop bulging disc or spinal stenosis. It also diminishes blood circulation and nerve conduction since the fascia is the pathway of blood vessels and nerve bundles. (refer to the link above)
4. Spinal stenosis
Spinal stenosis refers to the condition decreasing the nerve space (spinal cord) between each vertebra. As you are aging, the space has been decreasing with degenerative changes. However, there are more important causes of the decreased spinal space. It is the increased compression force from stiff joints and tight muscles. The more inflexible your neck and back are, the more chances you will have spinal stenosis in the future. In addition, deep layer myofascial tightness in the abdomen and diaphragm area are the main culprit increasing the compression force in your spine. Clinically, even though the patient was diagnosed with stenosis, we should not overlook herniated disks since the protruded disk also takes up the space and narrows the spinal canal.
5. Spondylolysis and Spondylolisthesis
Spondyloysis is defined as a stress fracture defect of the pars in the vertebra. The vast majority of these injuries are at the lower part of the back (L4,5). Spondylolisthesis is the ‘slippage’ or forward displacement on one vertebra over another due to the fracture in the vertebra. Athletic activities that require repeated excessive movement (hyperextension, rotation, repetitive flexion-extension) can develop this stress fracture in the spine.
In most cases, it is a stress fracture or low grade of spondylolisthesis and the prognosis is good if the patient can detect this condition early and have proper treatment. This condition makes the spine structure unstable.
6. Piriformis syndrome
Tight hip external rotator muscles (especially Piriformis muscle) can compress the Sciatic nerve coming from the lumbar spine leading to radiating pain to the lower leg.
7. Facet Joint Pain with Movement
Facet is the joint connecting each vertebra. When the joint is locked, it does not allow the smooth movement with increased sharp pain.
What is Sciatica?
Sciatica is an umbrella term (Unspecific term) describing the symptom of radiating pain down to the upper or lower leg.
What causes sciatica?
If it is caused by mechanical issues (if not caused by systemic problems such as neuropathy from diabetes or poor circulation), there are 2 major sources of Sciatica.
1. Herniated disc compressing/ irritating spinal nerve root in lumbar spine
2. Tight hip muscles (esp. piriformis syndrome) compressing/ irritating Sciatic Nerve in the back of hip joint
Thus, for successful treatment, the cause of the Sciatica should be distinguished by the thorough exam at the beginning of the treatment.
The most efficient treatment program for each condition
1. Herniated disc/ Bulging disk
Extension based exercise program (Mckenzie exercise) will be emphasized since the position of the disc is changing depending on the pressure distribution. Manual therapy is also crucial to release the tension around the spine. Myofascial release therapy and trigger point release will be applied in the main muscles (hip flexor, quadratus lumborum, paraspinals, abdomen fascia)
Once the herniated disc is repositioned, flexibility and core exercises will be emphasized in the treatment program.
2. Muscle-origin pain
Check the main muscle groups causing back pain and apply myofascial release and trigger point therapy. The most common muscles causing back pain are Quadratus Lumborum, iliopsoas (hip flexor), paraspinals, piriformis, gluteus medius). In addition to releasing dysfunctional muscles, it is also important to release myofascial adhesion between the muscles in order to improve gliding movement. Once successfully released, stretching and core exercise programs will be emphasized.
3. Spinal stenosis
The patient suffering from spinal stenosis has stiff and inflexible joints with tight connective tissues 3 dimensionally (front, back, side and deep abdominal fascia). In order to increase the space of the spinal canal, your spine should be decompressed by releasing tight surrounding muscles and deep abdominal fascia. Myofascial release and trigger point therapy will be applied. In addition, improving flexibility in the spine, hip and pelvis is very important. Stretching and mobility exercise programs will be educated and the patient will continue to practice it at home as home exercise program.
4. Spondylolysis and Spondylolisthesis
The reason for the fracture of the spine is excessive movement or poor posture while doing exercise or movement. Also, there are high chances that the surrounding muscle quality is poor due to myofascial tightness and adhesion. The muscle quality should be improved with myofascial trigger point therapy in order to activate more core muscles to support the spine. Core exercise intensity will be progressively increased depending on the progress. Excessive extension movement will be limited until the fracture is fully healed. The prognosis is usually good and people go back to playing sports once it is fully healed with good core muscle activation.
5. Piriformis Syndrome
It is very common that tight hip external rotators cause radiating pain in the lower leg. It happens often for the people sitting for a long time, and not doing stretching regularly. The treatment consists of manual therapy using the elbow or the vibration machine to release tight muscles, nerve mobilization exercises and stretching exercise programs. Strengthening exercise will be added in the later stage of rehabilitation.
6. Facet joint pain with movement
This pain is increasing when the joint is not opening while moving the joint. Joint mobilization technique in manual therapy is effective to open the dysfunctional joint. This technique can be performed when the patient is doing the movement causing the pain. Facet joint pain often results from myofascial tightness around the joint. Thus, the tight connective tissues should be released with manual therapy.