Shape Warning Pain
The conclusion of my 23 years work
on low back pain is that there is a central unrecognized trigger or cause,
which is:
that the lowest two discs and this fully
flexed shape
should only flex between
this extended or standing
shape
In the flexed shape, the discs have
not flexed beyond the parallel sides shape. In normal terms this is not a
flexed shape for these discs. It is however the limit of their flexion in this part of the human spine. Flexion
beyond this will trigger the ‘shape warning pain’.
When either of these discs is able
to flex beyond this flexed shape, to what might be looked upon as a normal
flexed shape, a warning pain is triggered, which then sets up all sorts of
muscle pains problems and ultimately damage.
Evolution of Low Back
Pain (book)
Or
Evolution of Low
Back Pain (one pager)
The following is an excerpt from the
book “The Evolution of Low Back Pain”
It is the combination of this warning pain with the sublesations that it
causes
that constitutes the typical episode of low back pain. When a long term
low back
pain sufferer has a continuous ache in the low back from sitting or
lying in bed,
the pain probably comes from the shape warning pain. Acute phases almost
certainly involve sublesations. It is probably worth trying to put
together all the
characteristics of the shape warning pain. These are:
1) It applies at the lowest joints L4/5 and L5/S only.
2) These joints are normally wedge shaped wide end anteriorly and should
not
flex beyond parallel sided.
3) The most likely source of the pain is the nerves in the posterior
annulus -
particularly the postero-lateral corners. These nerves probably detect
chemically
the proximity of the nucleus. This may however not be the case and it
may be shown that the source lies elsewhere. To help explanation, the
following characteristics will be explained assuming that this is the
source.
4) Even when the pain level is very low, (only a slight .feeling.) the
warning pain
can turn on sublesations.
5) When first triggered the ability to turn on sublesations is
particularly strong
and these are very difficult to free up.
6) The pain can also be very severe when it first occurs and can take a
long time
to die away.
7) Eventually in most cases the warning pain and its ability to switch
on
sublesations both die away to a low level. Usually the tendency to turn
on
sublesations persists more than the pain but in other cases sublesations
and spasms are rare and backache is continuous.
8) In this reduced state the warning pain usually only results in bouts
of back
ache and the occasional brief episode of spasms and sublesations. In
this case,
other factors which affect the whole body but have no direct connection
with
back pain may activate the warning pain as a dull ache. These include
influensa, PMT, general tiredness, cold and draughts etc and stress and
these
may appear to be .causing. low back pain.
9) After their initial .bout. some people suffer an ache in the low back
due to
sitting/flexing/or lying in bed which can last persistently for a few
days at a
time.
10) In some cases (possibly in a lot of cases) the shape can have been
wrong from
childhood. In that case the phase of severe warning pain and
sublesations will
not have occurred and the person will simply have a .weak. back with a
tendency to bouts of ache due to sitting, bending or lying in bed.
11) Usually this gets worse with age.
12) In any of these cases an actual injury, for instance in flexion when
lifting, can
tear or crack the posterior disc annulus allowing general access by the
nucleus
to the warning pain nerves and causing severe pain, many sublesations
and
general spasms (and maybe a prolapse as well!).
13) After the initial bout of back pain the level of long term warning
pain seems
to vary considerably. This assumes that any persistent sublesations have
been
cleared either naturally or by osteopathy or chiropractic. In some
people the
pain seems to drop to a level at which it is rare and acceptable whereas
others
seem to spend a lifetime looking for chairs with adequate support to
limit the
flexion and avoid a bout of backache. Whether this is a difference
between
people or reflects the angle of flexion I do not know.
14) It seems to be the transition from not flexing beyond parallel sided
to flexing
beyond parallel sided that causes the most severe pain and sublesations.
15) When it has been activated by this transition, the warning pain does
not only
apply when flexed beyond parallel sided. It is usually worst on flexion
but is
felt all the time. It is particularly severe on movement whether flexion
or
extension. This is entirely compatible with the concept of fluid from
the
nucleus being squeezed about in the area of the pain causing nerves. It
is
frequently worst when trying to return to the fully extended shape. This
is
also compatible with the idea of fluid from the nucleus being in the
posterior
annulus near to the nerves. However if extension pressure is applied to
achieve the correct extended shape repetitively as suggested by McKenzie
then the pain can be almost immediately switched off in some cases. This
too
is compatible with the idea of fluid being squeezed away from the
posterior
annulus.
16) The warning pain is able to spread to appear as a referred pain in
the sacroiliac
area, the buttock, thigh etc as sciatica (note: in most cases the
symptoms
of sciatica are not caused by direct nerve root compression). This is a
normal
characteristic of pain that it spreads in area as it become more severe
e.g. heart
attack producing referred pain in arm etc. It is referred to by McKenzie
physiotherapists as .the centralisation/peripheralisation phenomenon..
Whether sublesations are responsible for this phenomenon or not I do not
know.
These points describe the characteristics of the warning pain and
correspond very
well to the characteristics that one would expect from pain-causing
nerves in the
posterior annulus which are sensitive to the presence of fluid from the
nucleus.
(This does not prove that these nerves are responsible and the warning
pain source
might of course be elsewhere). These characteristics together with the
characteristics
of the muscle spasms caused by sublesations do also correspond to the
known
characteristics of low back pain. I believe that this is strong evidence
for this
interpretation.