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Spine (backs and necks) continued <--back to "What We Treat" home Some will argue that our backs would be less troublesome if we went around on all fours. Many engineers however say our back have evolved to an upright position and are well suited to it. This rapidly becomes a theological debate but does not alter the fact that mankind has always suffered from back problems. The spinal column is a stack of seven cervical (neck), twelve thoracic and five lumbar vertebrae, intricately locked together and sitting on the five fused bones of the sacrum, attached to which is the coccyx (tailbone). In between each pair of vertebrae is a cushioning disc and each vertebra is tightly interlocked by two joints to the vertebra above and two joints to the vertebra below. As well as the interlocking mechanism linking the vertebrae there are literally hundreds of ligments holding the bones of the spine together. A few of these ligaments also join the sacrum to the part of the pelvis called the ileum. The joints between the sacrum and the bones either side of it which form the pelvis are called the sacroiliac joints. The whole of the above structure is a scaffolding to which the muscles of your back and lower abdomen are connected. The muscles provide the power to hold you in position (postural muscles) and perhaps most improtantly the power to make you move (Motor muscles). The twelve thoracic vertebrae each have a pair of ribs attached. These bucket handle shaped bones form your chest cavity and join together at the front to the sternum (breast bone). To complete the picture between each pair of vertebrae, nerves leave and enter the spinal column. These send signals to the muscles to make them move and send signals back to the brain telling it how the movement is progressing and perhaps most improtantly to you the patient, they also send pain signals to the brain when things go wrong. You will probably by now have recognised a structure which has been implicated by your doctor or therapist as being the cause of your pain. All of these structures can cause you pain. A logicial examination together with careful questioning will lead your therapist in the right direction. Many back conditions are accurately assessed in this way. Only a relatively small number of back and neck problems will require further investigation (xray, MRI etc). There is much mytholgoy about the spine and some of the more common myths encountered are:- Patients often refer to having a vertebra ‘out of place’. Close examination of spinal anatomy shows that this can only happen in a catastrophic event such as a severe fall or car crash, which would in all likelihood, result in paralysis. Similarly discs do not slip (they are stitched to the vertebrae above and below them) however they will break down under load. The edge of the disc can split and its contents prolapse onto near by nerves causing arm or leg pain. (Hence the correct term prolapsed intervertebral disc). Another common expression used is that the patient has a ‘twisted pelvis’. This is poor terminology, as the pelvis is made of bone, and bone doesn’t twist! What is meant by this expression is that the musculature around the pelvis is not functioning evenly and creates an illusion of asymmetry. |
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