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unknown user
02-02-1998, 10:45 PM
Andrew,

I take issue with your assertion that injured muscles are the common cause of
acute low back pain. Do you have any data to substantiate this? Muscle
strain is not a reasonable explanation for episodes of acute low back pain.
We will frequently find muscle spasm or tightness in individuals with acute
back pain, but we should not make the assumption that these muscles are the
injury. This is likely to be a protective spasm in the body's attempt to
splint the area to prevent further injury.

Patients who have injured their back and there are no signs of disc or other
more serious pathology are frequently told that they are suffering from a
strained muscle (lumbar strain). However, this is a very subjective
diagnosis that cannot be verified by any accurate tests, such as MRI scans.
At the present time, the existence of muscular lesions have yet to be
demonstrated to be detectible by palpation with either inter or intra-examiner
reliability. (Bogduk N. "The Anatomical Basis for Spinal Pain Syndromes,"
JMPT, 1995, 18: 603-4).

Another reason to question the back muscles as a source of back pain is that
there has been little observable evidence of muscle damage (such as tears or
hematomas) found during back surgery. Also, if strained or overused muscles
are the cause of back pain, why does back pain typically last so much longer
than the pain of strained muscles in other regions of the body? A study that
investigated the origin of back pain from various tissues concluded that the
back muscles were only rarely a source of back pain.(Kuslich SD, Ulstrom CL,
Michael CJ, "The Tissue Origin of Low Back Pain and Sciatica," Orthopedic
Clinics of North America, 1991, 22: 181-7.)

The patient with acute back pain frequently presents in a slightly bent over
position. If the back muscles were injured, that patient should present in a
leaning backwards posture with an arched back. When does a runner with a
hamstring pull come in to their trainer with a straightened knee, unable to
flex their leg? It is more reasonable that the patient is unable to
straighten to avoid compressing the posterior disc or the facet joints, which
have become injured.

Ben Weitz, D.C., C.C.S.P., C.S.C.S.
LHBWeitz@aol.com

"A child of five would understand this. Send someone to fetch a child of
five."
Groucho Marx

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