Back Pain, Herniated Disks, Spinal changes, and More

How many people do you know that have back pain, or have had it at some point in the past?  I am guessing quite a few.  You may also know people who have talked about having a herniated disc – or perhaps you have received this diagnosis yourself after undergoing an MRI.  While the MRI is an invaluable tool in diagnosing medical conditions, it sometimes doesn’t provide the clearest picture when it comes to back pain.  One of the most fascinating things I have seen in my 20 years working as a physical therapist is that many times patients with severe or significant back pain have MRI results that are normal or with minimal findings.  On the other hand, I have also seen cases in which the MRI detects severe herniations, however the patient exhibits minimal to no symptoms.

Why are my MRI results mismatched with my pain?

Simply put, disc herniations are not the only cause of back pain.  Back pain or radiating symptoms often arise from a different source of dysfunction that is quite common – muscle imbalances.  A quote from an article in the Journal Diagnostic and Interventional Imaging states that “the associations between abnormal findings and signs and symptoms have not been well established.” This uncertainty is one of the reasons I pursued tools and skills beyond traditional physical therapy to expand my capacity for treating my patients’ pain or symptoms.  Read on to understand more about the spine and common spinal alignment patterns, muscle imbalances, herniated discs, the role of our lifestyles and habits in spinal alignment, and how posture alignment therapy can help you with some pain relief. 

What are spinal curvature deviations and why may they lead to pain?

Let’s first go over some basic anatomy.  The spine is made up of 33 individual vertebrae, some of which are fused to form the sacrum and tail bone at the bottom.  There are natural curves created by the flexibility in the spine and the pull of the muscles which create a stretched ‘S’ curve.  This ‘S’ shape allows humans to have more flexibility than other vertebrates.  People with back pain typically do not have full movement of their spine in each area, causing decreased flexibility and an overall change in the ideal, elongated ‘S’ curve of the spine.  These changes no longer allow the body to function optimally.

There are several common spinal patterns that tend to emerge once the spine begins to lose flexibility:

• ‘C’ shape – in which the buttocks tuck under, the back rounds, and the head juts forward.  

•  Smushed ‘S’ shape – in which there is too much backward curve in the upper back (kyphosis) and too much forward curve in the lumbar spine (lordosis).

• Loss of lordosis – in which an area of the spine is too straight, sometimes referred to as a reversed neck or low back curve.

When the spine deviates from its natural stretched ‘S’ curvature, the body’s weight begins to distribute unevenly from either front-to-back, side-to-side, or a combination of both.  These uneven forces may result in pain, tingling, and/or radiating sensations in the legs or arms.  Why does this happen?  While some vertebrae of the spine are not moving enough, others experience a more complete lack of movement, diminishing the all-important flexibility of the spine.  This reduction in flexibility compromises the spine’s normal functioning and reduces its natural shock-absorbing capacity.  

How and why do these changes happen to the spine?

Our daily movement patterns are important.  Spinal shape does not change simply because of aging but because of muscle memory -- the body adapts to the life we live.  Gravity, along with our daily actions and habits, creates muscle responses that adjust to our movement patterns and may result in the reconfiguration of the bones to a different alignment.  This is how the muscles of the body become uneven and imbalanced as the spine compensates for uneven loading by altering its shape.

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What is disc herniation?

A spine with an altered shape can result in a condition called disc herniation.  A person’s posture, movements, and habitual patterns can create a pulling action in the related muscles that surround the spine.  The spine has soft cushions, known as discs, that sit between each vertebrae of the spine. The discs and vertebrae both sit within the spinal canal which has very limited space.  As the vertebrae are pulled by the muscles, increased pressure and forces are exerted on the discs.  When the soft center of the disc pushes outward or further ruptures from this uneven pressure, it can start to press on the spinal nerves and cause pain.  In some cases, although a herniated disc may be present, it may not be the only cause of the patient’s pain.

If it is not only the herniated disc, then what is causing my pain?

It can be very frustrating when your back pain symptoms don’t match your MRI or X-ray results. Often times the pain has to do with a deficiency in the body’s overall alignment.  As I’ve mentioned, a person’s daily movement (or lack of movement) habits contribute significantly to the spine’s shape and can cause the entire body to compensate, creating muscle imbalances.  These muscle imbalances must be corrected in order to reduce pain and restore proper function.

What is whole body alignment and how is it related to muscle imbalances?

Correct body posture, or whole body alignment, means that all eight of our load joints (shoulders, hips, knees, and ankles) must be stacked vertically on top of each other. When they aren’t, our muscles are also out of balance. When a muscle on one side of your body is short and tight, the matching muscle on the other side of your body is long and likely has tension on it.  Either one of these muscle dysfunctions can cause pain by pressing on a nerve, decreasing blood circulation, or creating a trigger point aggravation of a symptom.  In an area with increased pain, muscle spasms can also occur to protect the area – which does not feel good.  Think about this:  If you have a herniated disc with associated pain that isn’t present all the time, something else is likely causing your additional symptoms since the disc does not all of a sudden become un-herniated. This is why many times a massage, heat, or ice to the area helps only temporarily to relieve the symptom. The key to managing all your symptoms is not only by balancing the muscles at that level but throughout the body to create the stacked body posture required for optimal overall function.  

How can I improve my body alignment?

First, pay attention to how you are sitting, standing, and otherwise holding your body throughout the day.  Try to avoid leaning your head forward, slouching in chairs or on the couch, rounding your back, tending to hold tension in your midback with ribs forward, tilting your head sideways, or standing with a hip jutted out and more weight on one leg than the other.  Once you become aware of some of your habits, practice sitting up tall by gently rolling your hips forward from the front, not your low back, and then relaxing your upper shoulders and raising the top your head gently to the ceiling.

To receive a few exercises for relief by creating more balance in your hips send us your email. We are happy to help you get started.