This is part 1 of a 2-part series
By Jeffrey Pearson,
After the common cold, neck and back pains are the most common reasons for why patients seek treatment from their primary care physician. Excuses abound as to why we hurt, such as “I slept wrong” or “I must have lifted something that was too heavy.” While these things certainly can happen, they do not account for the majority of patients that I treat.
To understand why we hurt, it helps if we think of ourselves as mechanical structures that move. Our spines consist of a stack of building blocks (vertebrae) that maintain three curves: neck (cervical), upper back (thoracic) and low back (lumbar). Because of these curves, when we attempt to bend sideways, the vertebral segments in the affected region move as a group to permit the motion.
We run into trouble when we lose one of our spinal curves which can occur in common situations such as whiplash injuries or bending down/forward at the waist. In other words, any personal activity where a regional spinal curve is lost. Imagine what happens when you attempt to bend something straight, such as a piece of paper – a “kink” develops. When we attempt to bend sideways in the face of a straightened spinal region, one segment, in essence, “kinks.”
This is, basically, a facet joint locking up. The nerve that supplies the facet joint detects the restriction and sends a message up to the brain which recognizes a need to protect the part, so it sends a reflex message back down to the region for the surrounding muscles to tighten up/spasm in order to splint the area until it can resolve. This can occur within minutes (or over the course of hours) and is often mistaken for a simple “pulled muscle.”
These types of physical behaviors happen every day. Looking down at a smart phone or laptop can cause loss of the curve in the neck. Bending forward to lift/move a box or make a golf putt results in loss of the lumbar lordotic curve. Every once in a while, an attempt to bend a straightened spine region results in neck or back “sprains” with resulting stiffness and restricted range of motion.
Note that none of the above involved the lifting or carrying of heavy objects. One might “pull” (strain) a muscle group from heavy exertion, but the vast majority of the injuries that I see are simply the result of “unlucky” ergonomics, i.e., trying to move in the absence of a spinal curve, such as when picking up a dropped bar of soap in the shower.
This is a simplified view, but one that nicely explains the ways in which we can injure ourselves in the absence of obvious trauma. Incidentally, in the case of overuse injuries, there is usually a delay in the onset of symptoms, sometimes making it a challenge to identify the cause. For example, a weekend of heavy gardening might not bother our backs until days later.
Dr. Pearson is a board-certified family and sports medicine physician practicing in the heart of Carlsbad Village at Medicine in Motion. Besides offering traditional medical care to patients of all ages, as an Osteopathic physician, he’s able to incorporate manipulation techniques into his treatment plan when indicated. He is a past recipient of the Patient Care Award for Excellence in Patient Education and served as the Medical Consultant for the world-renown Golden Door Spa for 25 years. He notes that patients seem to like him. Learn more at www.medicine-in-motion.com.