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Oh My Aching Back!
Your “back” is a pretty loaded term when you think about. What all is there? We know there are bones, a pretty important cord and some muscles but what really makes up your back? Here is the down and dirty from the inside out.
Spinal Cord and nerve roots
The spinal cord is what gives us the signal from our brain to make muscles contract/relax and feel touch/pain. The cord goes down the center of the spine and nerve roots come out at each level that than travel to their respective destination
Vertebra
These are the 24 bones that make up the structure of your spine, plus a sacrum and coccyx. They surround and protect the spinal cord, and help absorb forces with the different curves in each region. They also serve as an attachment point for ligaments, tendons and muscles
Intervertebral Disc
Between each vertebra there is a disc and we have a total of 24 in our body. These discs contain a nucleus in the center and have alternating layers of what are called annulus fibers. These fibers are what allow movement in the spine to be possible. This also makes it a common site to injury
Ligaments
Ligaments connect bone to bone to provide stability. Now remember you have 24 different vertebras that need joining to each other….you can imagine all the ligaments needed. The fibers of a ligament are innervated so when they sprain it is painful, but they do not have a great vascular (blood) supply so healing can take months to years to occur. Once stretched out a ligament can never bounce back to its original shortness thus decreasing stability in the given area forever
Muscles/Tendons
Muscles are the power house that allow and control movement while the tendons are what connect muscle bellies to the bones. Contractions of muscles/tendons allow torque to move the skeleton
Fascia
Surrounding all of these entities is fascia and on top of that is our skin. These two parts help provide stability and protection but can still be injured
Why is lifting and twisting so bad for my back?
Well, let us take a closer look at the spinal segments in the spine, which contain the upper half of one vertebra, the lower half of another and the disc in between them.
Let us look at what happens when we bend our back forwards:
As you can see bending forwards increases the tension and stress along the posterior, back, of the disc. This position pulls at where the tear may have occurred and leaves the space wide open for inflammation and swelling to build up adding to the pain and decrease in motion.
Now remember that the disc has those alternating layers of annulus that run obliquely:
This arrangement means that only 50% of the fibers are able to stabilize against rotation. Now combine only 50% fibers working with the increase tension from forward bending and you can see what a compromised position you are putting on the disc in and how easily the result can be a tear.
So what do you do when you think you tore a disc?
It is always concerning when your back starts hurting, especially not knowing what is hurt or why it is occurring. Getting in to see your physician or other medical professional is always a good idea.
The best position after the back gets injured is to get into a backward bend. This position feels like you are trying to stick your bottom out and shoulders back, almost like a stretch when you yawn. This allows a tear in the back to approximate, decrease room for inflammation to accumulate and allow for quicker healing.
The worst position to get into is forward bending…as in sitting in a recliner in slump position. It may feel good at first, but when you try to get up you may realize that it is hard to stand straight since inflammation may have built up.
Hope this helps you appreciate your back and the many components that make it up. Knowledge is power and the more you know the better you can help yourself stay healthy and happy.
Laura Flaherty PT, DPT, TAI Fairwood Physical Therapy
Oh My Aching Back!
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