Backache: its Evolution and Conservative Treatment PDF
Preview Backache: its Evolution and Conservative Treatment
Backache: its Evolution and Conservative Treatment Backache: its Evolution and Conservative Treatment David P. Evans MSc (Biomechanics), MD Department of Rheumatology University Hospital of Wales Cardiff MT;;!iLIMITED International Medical Publishers Published by MTP Press Limited Falcon House Lancaster, England Copyright © 1982 David P. Evans Softcover reprint of the hardcover 1s t edition 1982 First published 1982 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers British Library Cataloguing in Publication Data Evans, David Backache: its evolution and conservative treatment. 1. Backache I. Title 616.7'3 RD738 ISBN-13: 978-94-011-6674-4 e-ISBN-13: 978-94-011-6672-0 001: 10.1007/978-94-011-6672-0 Contents Introduction vii Part 1 The Normal Back SECTION 1 THE VERTEBRAL COLUMN 1 The locomotion of fish 5 2 The escape from the seas 15 3 The biomechanics ofquadrupeds 21 4 From four legs to two 31 5 The u niqueness of man 51 6 The anatomy of posture 65 SECTION 1I THE MOTION SEGMENTS 7 Building blocks 89 8 Spinal mobility 105 9 The role of the discs 115 10 Stability and strength 125 11 The biomechanics of backache 137 Part 2 The Abnormal Back 12 Spinal stenosis 149 13 Prolapsed intervertebral disc 153 14 Osteoarth ritis of the facet joi nts 157 15 Facet joint malfunction 161 16 Lesions of ligaments 167 v vi BACKACHE: IT5 EVOLUTION AND CON5ERVATIVE TREATMENT 17 Spondylolysis and spondylolisthesis 171 18 The sacroiliac joint 177 19 Muscle spasm 181 20 Muscle fatigue 187 Part 3 Conservative Treatment of the Abnormal Back 21 Bed rest, psychoactive drugs and epidural injections 195 22 Analgesics, acupuncture and TENS 201 23 Posture correction and exercise 213 24 Spinal manipulation 221 References and further reading 229 Index 247 I ntroduction Backache is a frustrating symptom even to those practitioners who specialize in locomotor medicine because of the inability in most cases to arrive at a precise diagnosis. This leads to uncertainty about the best method of treat ment likely to help the patient. Much ofthe confusion arises from misunder standings concerning the nature of back pain and misconceptions abound. The first of these misconceptions is the belief that the spine in man is solely a supporting pillar. Its role in locomotion is neglected. Yet it is the very flexibility allowing locomotion wh ich, when abused, leads to many of the causes of backache. The second misconception is the belief that man has back problems simply because he stands on his hindlegs in an erect posture. A study of evolution shows us that man has been erect for at least five million years but probably only plagued by backache in the last 10000 years-a time that corresponds to his habit of picking things up and carrying them around. Picking up an object, even when done properly with a straight back and flexed knees, is not the only problem. Equal damage is done when we find where to put the object and rotate in order to put it down. A third miscon ception, therefore, is that it is only lifting heavy objects that leads to trouble. Rotating with light, awkward loads can be equally hazardous. The whole subject is fraught with myth and dogma, so we must go back to the very beginning and examine the evolution of the spine to try and find a pathway leading to a rational basis for conservative treatment. In this monograph the chapters are linked bya logical progression of concepts and these are listed in order at the end of each chapter. This is to encourage the reader to become conversant with an overall view of the biomechanics of backache rather than use the text as a reference work. Very few ideas in medicine are original and the contribution of each worker is usually small. My contribution is no exception and lies in the vii viii BACKACHE: IT5 EVOLUTION AND CON5ERVATIVE TREATMENT treatment-end of this story where 1 have tested various treatments advocated for patients suffering from low back pain. 1 rely heavily on other workers for the remainder of the book but rather than paraphrase their writings 1o ften quote them at length (I hope always with due acknowledge ment). The originality lies in the specific selection of ideas from several authors and the order of their presentation. 1 am sure that a completely different story could have been told equally weil by quoting from the same authors but by usi ng other parts of their texts. By careful selection, attention to order and by supplying a (very) few missing links the following story has evolved. It traces the function of the spine through to the normal spine in man (part 1), to the abnormal spine in man (Part 2), and finally to the treat ment of the abnormal spine (Part 3). Part 1 The Normal Back SECTION I THE VERTEBRAL COLUMN 1 The locomotion of fish Our world began 5000 million years ago but life did not exist in any form in the first half of this epoch. Even the first three-quarters of the period since life emerged does not contribute to the fossil record unless high-powered microscopes are used on the fine-grained, flint-like substances called cherts. The last quarter of this period (Figure 1.1), which has lasted for 600 million years, consists of the Paleozoic, Mesozoic and Cenozoic eras and contains the history of life as told by the fossils. Throughout the ages plants have retained the ability to build up organic compounds from simple elements which they obtain from their surround ings. Animals, on the other hand, depend on organic nutrition so they need both a system for movement and well-developed sense organs to seek out Cenozoic (70 million years) -----..., Mesozoic (130 million years) ----, Paleozoic (400 million years) Pre-Cambrian (18OQ million years) Figure 1.1 Extent of the fossi Irecord 5
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