A Holistic View Points Toward Skeletal Muscles

It is often stated in conventional literature that the cause of lower back pain cannot be precisely identified. This perspective derives from a mechanistic, non-integrated view of the body which has been our legacy since the scientific revolution. When the body is viewed as a collection of isolated parts rather than an elegant, integrated whole, the cause of lower back pain becomes a bewildering puzzle.

However, a holistic view of the body can begin to sort out the confusion. By evaluating the relationship between the body's overall structure in gravity and it's function in movement, the causes of lower back pain begin to reveal themselves.

A holistic perspective guides us to one of the most overlooked sources, not only of lower back pain, but chronic pain in general. That source is skeletal muscles.

As Drs. Janet Travell and David Simons made explicitly clear in their exhaustive 2-volume work, Myofascial Pain and Dysfunction: The Trigger Point Manual, a vast proportion of chronic pain in the body is not due to problems with damaged nerves, disrupted bursae, and degenerative joints, but dysfunction in the soft tissue, especially skeletal muscles.

The cause of lower back pain can be broken down into five primary problems which interconnect with one another. The following breakdown is adapted from the St. John Neuromuscular Therapy training, a method of postural analysis and clinical massage therapy focused on musculoskeletal alignment and treating compensatory muscular patterns.

Five Primary Problems

1) Ischemia (pronounced: Iz skeem ee ah)

The first cause of lower back pain is ischemia. "Ischemia" means lack of blood. Without adequate blood to provide nutrients and oxygen, soft tissues such as muscles, tendons, ligaments, and fascia build up lactic and other toxins and become painful. Ischemia occurs when muscles are chronically contracted over a period of time. The most prevalent cause of lower back pain, by far, is muscular strain and spasm due to ischemia.<

2) Trigger Points

The second cause of lower back pain is trigger points. A trigger point is an area of the soft tissue which, after chronic contraction and reduced blood flow, becomes an area of high neurological activity. For example, fibers in an ischemic muscle (a muscle with low blood) can become an active trigger point in response to biochemical changes in the tissue. Active trigger points cause referred sensation to other parts of the body. That sensation can be pain, tingling, numbness, thermal sensations (hot or cold), weakness, a general achy quality, or the feeling that "it just doesn't feel right." For example, you might have a trigger point in a muscle of your lower back which refers sensation down into your buttocks, or even down the leg. This is NOT same thing as the referred pain caused by nerve compression and nerve entrapment which will be covered next.

3) Nerve Compression and Nerve Entrapment

The third cause of lower back pain is nerve compression and entrapment. Nerve compression is the pressure put on a nerve by a bone or an intervertebral disc. Nerve compression occurs when the spine becomes misaligned for some reason (faulty movement patterns, injury, chronic muscular tightness) and one of the discs between the vertebrae get squeezed on one side so that it bulges out the other side. If the bulging puts pressure on a spinal nerve, then you've got pain! Nerve entrapment is when a nerve is caught or pinched by the soft tissues. For example, the sciatic nerve (the largest nerve in the body) runs down through the buttocks and can become entrapped by the piriformis muscle when that muscle is very tight. This can result in pain down the back of the leg.

4) Structural Imbalance, aka Postural Distortion

The fourth cause of lower back pain is structural imbalance or postural imbalance. In a sense, this issue is the most significant of all. The reason for that lofty status is due to the fact that structural imbalance is often the root problem responsible for ischemia, trigger points, and nerve compression or entrapment.

If the body is distorted off its center line of gravity, compensating muscular patterns can result. To illustrate the point, put your elbow on the table in front of you with your forearm pointed straight up to the ceiling. Now imagine you've got a bowling ball resting in your palm. If your forearm is completely straight up and down, the weight of the bowling ball will be supported by the bones of your forearm. Theoretically, you could hold that bowling ball there indefinitely.

But if you shifted off that center line, even a tiny bit, then the muscles of your arm would have to engage in order to hold up the bowling ball. Even the strongest human in the world wouldn't be able to hold that ball there for long. This is precisely what can happen with your body. If your alignment is off such that your head is not centered over your shoulders over your hips over you feet, then the core muscles of your body must perpetually engage in order to hold your body up!

5) Dysfunctional Biomechanics

The fifth cause of lower back pain is dysfunctional biomechanics. This is often a secondary result of structural imbalance and is evidenced by faulty movement patterns. For example, if you've got nagging lower back pain you might hold your body in a restricted way, walk differently, or reach for things with limited range of movement. It's logical to do that, and not recommended to fight against your body's self-imposed limitations. It's trying to protect you from pain. Until the structural imbalance is addressed, and the pain is relieved, there's wisdom in those limits. However, repetitive movements can become patterned into your nervous system such that, even after structural and muscular problems have been eliminated, you still move in a limited, protective way. This can revive structural and muscular imbalances. That's why even a minimum regime of daily stretches can be vital to full recovery.

What is sciatica?

Why do I have sciatica?

Is there successful treatment available?

Most work-related sciatica injuries are caused or aggravated by actions such as heavy lifting, vibration, repetitive motion, and awkward posture.

The ordinary low back troubles and other spinal situations that can cause sciatica - pain along the sciatic nerve - include:

1). Lumbar Herniated Disc. A herniated disc happens when the inner core of the disc breaks through the fibrous outer core of the disc and the bulge places force on the nearby nerve root as it exits the spine. In general, it is said that a sudden twisting movement or injury can lead to herniation and sciatica. But, most discs get worse due to recurring stress and then herniation. A herniated disc is usually referred to as a slipped, ruptured, bulging, or protruding disc…or a pinched nerve.

2). Lumbar Spinal Stenosis. This usually causes sciatica due to a tightening of the spinal canal. It typically results from a grouping of one or more of the following: enlarged facet joints, overgrowth of soft tissue and a bulging disc placing force on the nerve roots as they exit the spine.

3). Isthmic Spondylolisthesis. This condition rarely causes back pain or sciatica pain. Caused by a combination of disc space collapse, the fracture, and the vertebral body slipping ahead, the L5 nerve can get pinched as it exits the spine.

4). Piriformis Syndrome. The sciatic nerve can also get aggravated as it runs under the piriformis muscle in the rear. If the piriformis muscle irritates or pinches a root that includes the sciatic nerve, it can cause sciatica-type pain. The most familiar source of sciatic pain and is made when pressure is placed on the sciatic nerve by the piriformis muscle.

5). Sacroiliac Joint Dysfunction. Irritation of the sacroiliac joint at the bottom of the spine can also aggravate the L5 nerve, which lies on top of it, and cause sciatica-type pain. This is radiculopathy, but the pain can feel the same as sciatica caused by a nerve irritation.

If you do not know which one is the culprit, I would start with the fundamentals. Sciatic nerve pain are usually caused by muscle disproportions you have, you should start to see progress right away…and your sciatic pain should subside in a few weeks or less. Sometimes even the next day or two!

Sciatica usually is derived from a traumatic event, muscle disproportion, or a combination of both.

Sciatica soreness is caused by force on the sciatic nerve, normally caused by a tightening and shortening of the piriformis muscle. This is more often than not produced by a disproportion between the inner and outer hip rotator muscles.

There are many different methods of treatment for your sciatica pain…but…unfortunately, most of them don't work.

Many of the specialists just want to schedule another "appointment" for a later time. This is done for a reason.

You can also get prescription drugs that you get from your doctor. This is also a repeatable action. This is also done for a reason.

You might even be in such pain, that you consider very expensive back surgery.

Whatever the treatment, you should consider all of your options at hand.

Here's to getting rid of your sciatica pain,

Samick N. Jack

Low back pain is a usual symptom among the modern civilized people. It affects mainly the middle aged and young adults of both sexes. People who work on the chair with out exercise and those who carry heavy loads regularly are prone to get this complaint. We can hardly find a person who has not suffered from back pain at least once in life. The causes of lower back pain ranges from simple reasons like muscular strain to cancer of spine and hence backache should not be ignored. The pain is felt in lumbar and sacral region and may radiate to nearby sites.

The following are some causes for backache.

1) Backache due to diseases in the back.

2) Backache due to gynecological problems.

3) Backache due to problems in other parts of the body.

1) Backache due to diseases in the back:–

a) Injuries :-

1) Compression fracture of the vertebral column. 2) Rupture of intervertebral discs. 3) Injuries to ligaments and muscles of back. 4) Lumbosacral strain. 5) Intervertebral joint injuries. 6) Fracture of processes of vertebra.

b) Functional backache due to imbalance:-

1) During pregnancy. 2) Pot belly. 3) Diseases of the hip joint. 4) Curvature in the spine due to congenital defect. 5) Short leg in one side.

c) Backache due to inflammatory conditions:-

1) Infection of the bone due to bacteria. 2) Tuberculosis of the spine. 3) Arthritis. 4) Brucellosis. 5) Lumbago or fibrositis. 6) Inflammation of the muscles. 7) Anchylosing spondylitis.

d) Backache due to degenerative diseases in the back.

1) Osteoarthritis. 2) Osteoporosis in old people. 3) Degeneration of the intervertebral disc.

e) Tumor in the spine:–

1) Primory tumour of the bones in the spine. 2) Metastasis tumors from other sites like prostate, lungs, kidneys, intestine ect.

2) Backache due to gynecological problems:-

a) After childbirth. b) After gynecological operations. c) Prolapse of the uterus. d) Pelvic inflammatory diseases. e) Cancerous lesions of the pelvic organs. f) Endometriosis.

3) Backache due to problems in other parts of the body.

a) Renal stones. b) Ureteric stone. c) Cancer of prostate. d) Pancreatitis. e) Biliary stones. f) Peptic ulcer. g) Inflammations of pelvic organs. h) Occlusion of aorta and illiac arteries.

Investigation of a case of backache:-

1) Complete blood count.

2) Routine urine examination.

3) Ultrasonography of the abdomen and pelvis.

4) X-ray of the lumbar and sacral region.

5) MRI of the spine.

5) CT scan of abdomen and pelvic region.

6) Examination of rectum, prostate, genito urinary organs.

Treatment of back ache:-

1) Removing the cause for backache.

2) Symptomatic treatment.

2) Back exercises.

3) Traction.

3) Yoga.

5) Surgery.

7) Homoeopathy.