Chronic antalgic positioning can lead to postural dysfunction
Debilitating back pain often precludes patients from enjoying regular activities such as walking or exercising. The first thing to do for a patient suffering from back pain is to find out what is causing it, said Donna Walker, a physical therapist with BaptistWorx.
“Is it a structural or postural issue? Is there a pinching?” Walker said. “Of course, there could be another medical problem going on. The pain is often the result of a mechanical issue, and until you correct the mechanical issue, you’re not going to get rid of the muscular pain.”
Often people who have back pain due to a bulging disc reposition themselves to alleviate the pain.
“A postural dysfunction can result from chronic positioning to get away from a mechanical or structural issue,” Walker said. “For example, a lot of people now have a very slight chronic disc bulge because of sitting at computers. People will laterally shift their pelvises to get the nerve root away from a disc bulge, and that chronic shifting can loosen sacroiliac joint ligaments.”
When this happens, Walker explained, the joint may get restricted and cause more pain than the original problem. “The disc bulge is easy to treat with positioning and movement,” she said. “But you have to correct the positioning of the sacroiliac joint before you can do extension without pain in order to minimize disc bulge. Once the therapist teaches someone how to self-correct sacroiliac joint positioning, then we can teach them the extension movements and posturing and positioning to minimize disc bulging.”
Stabilization of the spine is an important component of treatment. Patients with back pain use muscles that are more peripheral than proximal to the spine to relieve some of the discomfort they are feeling. This contributes to postural dysfunction and inappropriate recruitment.
“The spine is nothing but a column of building blocks sitting on top of each other,” Walker said. “If you want to stabilize a column of blocks, you need to stabilize as close to the column as you can. We don’t want to use muscles three and four layers away from the spine to stabilize it; we want to use muscles that are as close to the spine as possible to stabilize it. So we teach people how to find and recruit the muscles closest to the spine to stabilize it.”
The next step is to neurologically retrain the muscles and wean the patient from the substitutions he or she has been making.
“The bottom line is we have to walk, we have to move, so we will use anything we can to walk,” Walker said. “We retrain the patient on how to properly recruit the muscles, first without gravity and then up against gravity.”
The patient works on walking again using the proper, proximal stabilizers called the inner units.
“At this point the patient should understand all the principles and know what’s appropriate and not appropriate for them,” Walker said. “Once they learn the principles, then they should be able to manage their back and spine a great deal on their own.”
Because every patient is unique and has a different background, the physical therapist must work through all these layers to find the proper program for the individual. Walker says she typically utilizes 12 visits, although for some patients it takes longer. The goal is not just getting rid of patients’ pain.
“You want to teach them so they understand their back and their uniqueness and their pathology so you can give them the principles for them to manage them on their own,” she said.
By Tanya J. Tyler, Associate Editor