by Erik Dalton Ph.D.
founder of the Freedom From Pain Institute®

Most manual and movement therapists today are aware of the pivotal role the low back plays in all daily activities. Through the functional movement work of Janda, Stuart McGill, Gray Cook, Michael Boyle, Craig Liebenson and others, we’ve come to realize that the lumbar spine craves stability….not mobility. So, to avoid a ‘creepy’ back, viscoelastic tissues such as fascia, ligaments, articular cartilages and discs must, through a variety of daily movements, be stressed…but not strained.

Recall that when connective tissue is loaded more quickly, it behaves more stiffly, i.e., it deforms less than the same tissue loaded at a slower rate. Conversely, the greater the load placed on the tissues, the greater the deformation and the faster the rate of creep. A degenerated disc, for example, possesses less viscoelasticity, less creep, and, therefore, is less capable of absorbing attenuating shocks and vibrations. (Fig 2)

According to Bogduk and Twomney, “After prolonged strain, spinal ligaments, joint capsules, and IV discs of the lumbar spine may creep, and they may be liable to injury if sudden forces are unexpectedly applied during the vulnerable recovery phase.” 1 When viscoelastic tissues are strained, they have trouble returning to their original length and are more prone to future injury.

Creep…good or bad?

Although creep is an engineering term, it also applies to human tissue…the lumbar spine in particular. Spinal ligaments, joint capsules, facet cartilages and especially intervertebral discs are viscoelastic and similar in some ways to silly putty?

Leave a ball of putty on a table overnight and by the next morning it’s deformed into a flattened pancake. So be it with humans. We’re taller in the morning than at bedtime, primarily due to disc deformation that occurs throughout the day. Of course, silly putty is much creepier than discs, fascia or ligaments but, in time, gravity will deform and sometimes strain these materials.

Our tensegrity support system relies on viscoelasticity to keep us bouncing along with spring in our step so we won’t end up like flattened silly putty. I find myself scratching my head when reading research that seeks to dismiss the effects of gravitational exposure on human viscoelastic tissues. It’s even more frustrating when scientists and manual therapists downgrade the relationship of distorted viscoelastic structures and pain.

Regardless of what the so-called ‘experts’ tell us, structural abnormalities such as short legs, flat feet, scoliotic spines will eventually cause decompensation somewhere along the kinetic chain. It may not occur in the particular area the researchers are studying, but adaptations will soon cause the body to sacrifice mobility for stability.

For example, in (low back) degenerative disc disease cases, gravity slowly begins squashing the IV discs causing facet joint articular cartilages to bear excessive weight. As the anterior and posterior longitudinal ligaments become lax, hypermobility develops in the joints. This sets the stage for a torsional ‘bending-and-twisting’ or a slow ‘gravitationally-induced’ injury (Fig. 3)

Degenerative Disc Disease (DDD)

When discs are exposed to a constant force such as sustained forward bending or sitting, the nuclear jelly in the center of the disc creeps back against the posterior annular disc fibers which also protrude against the creepy posterior longitudinal ligament. (Fig 4) As the ligament tears away from its firm attachment on the vertebral bodies and disc end plates, tiny tears (microfissures) develop and the internal pressure fills the cracks with calcium, i.e., bone spurs, osteophytes.

Calcium deposits may collect in and around nerve roots (foraminal stenosis) or inside the spinal column (spinal stenosis) and may lead to unwanted nerve or spinal cord compression. But calcium build-up may be beneficial for those with unstable lumbar spines. As the facet’s articular cartilages degrade and calcify, the IV joints can “fuse” causing less strain on sensitive structures and, therefore, less painful movement in the area. That is the primary reason the average age for low back pain is 25-55. Seems it should be 60 to 80 doesn’t it? But no…the body’s innate wisdom has overcome the long-term effects of viscoelastic creep by laying down calcium and, with the added help of protective muscle guarding, “shored-up” a vulnerable weakened area.

There is no separating structure and function…. the only question is which came first and how do we restore proper length/strength balance to creepy or fibrotic tissues. With today’s rehab frenzy centered on functional movement, it appears some authors are determined to undermine the structural/functional relationship scientists from all fields have honored since the days of Hippocrates.

Hands-on therapies such as muscle energy, orthopedic massage, craniosacral, visceral, high-velocity thrust, myofascial release and structural integration will never lose their place in the ever expanding world of pain management. Manual and movement therapies have always thrived together in a comfortable co-dependent relationship and I don’t expect that marriage to end soon.

References:

Bogduk N, Twomney L. Clinical Anatomy of the Lumbar Spine and Sacrum, 3rd edition Edinburgh: Churchill Livingston, 1997.

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