Spine biomechanics if a field that I feel doesn’t get the awareness it deserves when it comes to helping people get rid of their back pain. Often, it’s the medical doctor’s or physical therapists that get all the attention (positive and negative) and rightfully so, since these are the first people you go to see for back issues. However, the reason these medical doctor’s and physical therapists get results is based on the research spine biomechanists conduct. For example, it’s no secret that Dr. Stuart McGill (Spine Biomechanist) is the leading figure in the back pain community and it’s his work that has helped many (clinician’s and lay person) get rid of back pain.
The advantage that the Spine biomechanist has compared to a physical therapist or medical doctor is that they are explicitly learning about one thing which is how the spine functions in response to different forces, loads, postures and movements. This is something that a physical therapist or medical doctor may have limited learning experience in since they are studying a variety of topics throughout their schooling. Typically, physical therapists will study different manual therapies or corrective exercise for treating a particular injury, whereas a general practitioner will be more ‘likely’ trained in treating symptoms, rather than treating an injury. This can be very limiting to both profession’s when it comes to treating lower back pain because if they don’t understand the mechanics of the spine or don’t decide to pursue this area post-schooling, they can be limiting their skill set in treating low back pain.
A good example could be seen with a neurosurgeon… often they use medical images such as an MRI to make a diagnosis or advise on if surgery is necessary or not. While looking at medical images is good practice, it is significantly limiting if they use only this in their assessment!
Why is this you may ask?
An MRI is usually taken in a static supine unloaded position. This for one is problematic because someone may have low back pain that is related to a specific position under load. For example, someone may have pain with compression and flexion or extension, which may not be indicative of an MRI and only a valid physical assessment would determine this.
What you may end up seeing now is that due to the neurosurgeon not conducting a thorough assessment, they may ill-advise on something such as a surgery, which would leave the patient in an inferior position. The patient may end up with surgery when they never needed it in the first place. However, if the surgeon correctly understood the patient’s physical symptoms through a proper assessment, they could advise on a better solution for the patient. Not an ideal position for the surgeon or the patient, but this is all do to a lack of understanding about spine biomechanics.
Why Understanding Spine Biomechanics is Important
The spine is a unique structure in that in can flex, extend twist and bear load. It’s these exact movements and postures that allow us to through a baseball at over 100mph or deadlift 1000lbs. However, while these movements and postures will enable us to do some incredible things, they also create different loading forces on the spine that could result in various injuries developing overtime such as a herniated disc or pars fracture if one is not careful. For example, repeated flexion activities such as a sit-up will create a disc herniation if enough cycles are performed, whereas repeated extension activities such as performing the break stroke in swimming could lead to pars fracture developing over time. However, what you’ll normally find with these activities is that pain symptoms are almost always movement related. For example, flexion will make a disc herniation worse, and extension will make pars fracture worse. Removing both of these movements would be critical in making a recovery and reducing pain symptoms. (Note: This something that an MRI wouldn’t precisely tell you and only doing a proper physical assessment of one’s pain triggers would).
Also, when it comes to the treatment of lower back pain, spine biomechanics will determine how a joint, disc, or ligament is loaded when it comes to exercise programming. For example, someone with arthritic facet joints would need to be careful with overhead pressing, especially if they compensate by going into extension when they raise their arms over their head. Loading an arthritic facet joint may quickly trigger one’s pain and make them very cranky.
Furthermore, we could look to the example of walking in helping treat lower back pain. Walking can be both therapeutic and detrimental.. and you ask why this is?
Well, naturally, it all has to do with one’s walking technique. How does one walk? Do they walk with one hand in their pocket? Are arms swinging normally? Does one swing more than the other? Does one walk with one foot pointed out a bit? Does one hip drop more than the other? Do one walk at a fast or slow pace? All of these factors should be taken into consideration when walking; because.. while walking can be therapeutic if you’re not walking with proper technique or form or are walking at a slow place.. this could place more stress on the spine then one would want. However, you would probably only know this with a proper physical examination, which often a clinician such as our neurosurgeon above may not give.
The above example shows a poor walking technique. One arm is placed in the pocket, whereas the other is swinging normally. This technique may aggravate low back symptoms in some and will lead to imbalances and poor motor patterns developing overtime.
The above example shows a good walking technique. The arms are both swinging allow for proper motion at the shoulders and hips.
Now, I’m not trying to hate on neurosurgeon’s or physical therapists or any medical doctor’s in this post, but there is a lack of understanding when it comes spine biomechanics by some of these individual’s, and it limits their skill set when treating low back pain. In my opinion, everything needs to be taken into account such as medical images, corrective exercise, nutrition, sleep and of course the topic of this post, spine biomechanics. The more one can develop a holistic approach in treating lower back pain, the more likely they will get results with their patients. Far too often in today’s society, we see individual’s become specialized in one realm, and this is the limiting factor occurs when it comes to trying to help. Remember kinesiology is the study of the human body, and if one neglects one area such spine biomechanics, they are only going to limit themselves in treating lower back issues.
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