No announcement yet.

Re: Flat back paradox

This topic is closed.
  • Filter
  • Time
  • Show
Clear All
new posts

  • Re: Flat back paradox


    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.

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