Saturday, June 5, 2010

Back pain and the 'Degenerative Cascade'

In his groundbreaking book "Managing Low Back Pain" published in 1983, William Kirkaldy-Willis described what still remains the single most brilliant explanation of how back problems begin and worsen over time.  His biggest contribution was to explain how minor injury and back pain can begin a degenerative process that progresses into severe spinal disease and disability later in life.  To explain his findings, Kirkaldy-Willis introduced the theory of the 'Degenerative Cascade' (see FIg. 1-1), to demonstrate how each stage of back pain, dysfunction and degeneration is related to the other.  He also showed that the two major anatomical structures in the back (discs and facet joints) are closely interrelated such that problems in one of these structures will cause problems in the other.  

The 'Degenerative Cascade' of Back Pain

What causes back pain?
Poor posture and inadequate control of spinal stability are the most common causes of facet joint injury or disc injury that will kick off the degenerative cascade. If back pain is left untreated and the degenerative cascade is allowed to progress, your spine will gradually collapse and lose height as described in A 'tall spine' is a healthy spine! 

The take home point
Once your back is injured or painful, do something about it!  It will take some work to correct the problems that are causing your back pain but it is well worth the effort. More recent research has shown why this is so crucial...  In response to back pain or injury it is common for your spinal stabilizers to atrophy or weaken. Weak stabilizers will allow more stress to be placed on the spine thereby causing pain and more atrophy.  This 'Back Pain Cycle' can be hard to break and is the primary reason why back pain is so stubborn and can become chronic for so many people.  It is also why post-injury physical therapy including spinal stabilization exercise is important for treatment and prevention of back pain. Contact a physical therapist to help you with your back pain or try a POSTURE BELT for Back Pain if you want to work on it at home.


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