| simple explanation | prof. explanation |
Low back pain - simple explanation
The classic explanation given for LBP is that the cause must primarily be attributed to the displacement (protrusion) and/or rupture (hernia) of an intervertebral disc on the level of one of the lower vertebrae. The protrusion of this disc material causes a local inflammation of the joints. The irritation of the surrounding nerves makes the patient aware of the LBP.
As a reaction to this nerve irritation, the muscles in the lower back tense up (hypertonia). After a while they shorten with the result that the patient feels himself stiffening up.
According to the classic concept there are a number of factors that explain the occurrence of LBP.
Mechanical strain -> the disc protrusion worsens -> inflammation of the joints -> irritation of the surrounding nerves -> tensed back muscles -> stiffness and pain in the lower back.
Most classical therapists concentrate on the neutralization of the disc protrusion by means of
- exercise therapy (abdominal and back muscle exercises)
- manipulation (chiropractic, osteopathy, orthopedic medicine) and/or traction
- at the same time it is attempted to suppress the inflammatory reaction by administering anti-inflammatory drugs.
Our point of departure differs largely from the classic view of LBP
In our interpretation the cause of LBP lies in the occurrence of
- proliferating connective tissue in the back muscles (myofibrosis)
- the swelling of the back muscle compartment
- entrapment of sensory nerves by myofibroses
- muscle strain (e.g. after protracted slight bending forward in an upright posture)
-> leads to connective tissue adhesions after muscle damage (Fig.1)
- sudden stress situations (e.g. the discovery of deceit) -> as a result of an increase in blood flow caused by increased muscle tension the water balance within the muscle changes (fig.2)
- after going through an angina (viral or bacterial) -> an inflammation (oedema) is present in the back muscle compartment (Fig.3)
In case of muscle soreness the fibrous swelling in the back muscle compartment is generally greatest on the third day and decreases again after 10 days (two weeks at most). In case of sudden stress situations as a result of increased blood flow the swelling in the back muscle compartment may develop within a few hours. In case of angina the bacterial and/or viral shift of the inflammatory process (incubation) through the lymphatic vessels takes from one week to ten days. The swelling itself in the back muscle compartment may develop in an explosive way within a few minutes. The sudden stab of pain in the lower back is caused by the fact that the back muscle has not been heated up e.g. when the patient picks up something from the ground in the morning.
Protracted or chronic low back pain (CLBP)
Protracted or chronic low back pain does not necessarily manifest itself on a daily basis. Neither does it have to be present the whole day. We usually refer to the condition as CLBP if after a period of at least 7 weeks LBP occurs on a regular basis. The back pain manifests itself moderately in the following situations:- · when getting up and/or the first few hours after getting up (stiffness in the back)
- · when standing upright for a time (during receptions, ceremonies, ...)
- · when sleeping in a bed the patient is not used to (hotel, ...)
- · when sitting down for a length of time (office work, in the car, theater, ...)
The formation of long lasting scar tissue (muscle granules) inside the back muscles is responsible for the chronic low back pain. As long as these muscle granules have not been loosened up by means of transverse friction (which is why the therapist uses his elbows on the muscles), LBP tends to reoccur.
The protracted back pain can be worsened in cases of:
- colds and/or situations of flu
- conscious stress moments (anxiety, great worries)
- extra strain on the back (moving house, working in the garden, do it yourself jobs, exaggerated practice of sport)
The presence or not of protruding discs (confirmed through medical imaging techniques) is irrelevant in this. What can be seen on the RX-ray is therefore of no importance. Various researchers have shown that in a group of patients without LBP, 50% show signs of disc bulging, 25% of whom even have disc hernia..
It is evident that a serious case of disc hernia, in combination with local inflammation will be responsible for clear neurological symptoms (pain in a clearly defined area and/or tingling sensations in the lower leg, disappearance of the tendon reflex) and clinical signs (difficulty in raising an outstretched leg, abnormal muscle weakness in the lower limbs). Such signs are clearly confirmed by the information obtained through medical imaging techniques: the picture of ischialgia is clear, and has been more than amply described by the literature on orthopaedics.
Psychology of the scientists
Since few or no mechanical causes can in fact be found in a classic case of CLBP, the responsibility for the phenomenon is shifted to the emotional condition (psyche) of the patient. Again and again it is attempted to blame psycho-social causes. Chronic back pain is said to affect the pain behaviour of the patient to such an extent that more attention and/or pity from the people in his environment is obtained.
CLBP cannot, however, be categorized as a learned (conditioned) kind of pain behaviour. A personality with tendencies towards CLBP does not exist either. In addition, not all patients with CLBP benefit from the situation. It is obvious that reference can be made to a changed pain behaviour in such patients, but to claim that many of them exploit the situation is an incorrect viewpoint.
Therapy
The therapy consists simply in applying deep transverse friction with the elbows on the back muscles. Even though simple, this treatment is hard work for the therapist. Even CLBP that started years ago can in the majority of cases disappear within six weeks. (1x a week/ x 5 deep transverse friction treatment)Conclusion
In our interpretation there is a clear distinction between the causes of LBP and ischialgia.Low back pain:
- The classic concept explains LBP as a consequence of a mechanical displacement of disc material on the level of the lower back (including inflammation of the joints). The muscle pain is secondary
- The new concept explains LBP as a consequence of back muscle problems. The concomitant muscle damage, scar formation and/or muscle inflammation are elements that are responsible for swellings in the back muscle compartment. The pain is not expressed at the location of the injury, but on the level of the tendon insertions of the pelvis, which are located lower. Myofibroses may entrap sensory nerves.
Ischialgia:
Ischialgia cannot in our opinion be caused from earlier LBP, i.e. as a consequence of a further displacement of disc material. In such a case ischialgia is a separate syndrome with typical signs of severe disc hernia and local inflammatory signs.
CLBP:
According to the new concept, the cause of chronic low back pain should be looked for in the permanent presence of scar tissue in the back muscles (muscle granules) and the concomitant entrapment of sensory nerves that go to the skin surface (Rr. Dorsalis and NN. Clunii).
Chronic low back pain is not primarily dependent on psychological factors. What we do know is that several researchers have reached the conclusion that stress can influence the formation of connective tissue adhesions in the back muscles.
CLBP can be remedied by means of several treatment sessions of deep transverse friction.
Tip of the day
The absolutely certain way to get CLBP is, after having had a cold for a week, to go in the garden and to rake leaves on a Sunday, and then pick up a tax bill from a letter box placed too low on a Tuesday morning...