Answer to Question 6
In explaining how most sciatica is a part of low back pain, I can’t do better than the start of chapter 2.2 of my book, “The Evolution of Low Back Pain” written in 1992 after five years in chiropractic, (two after qualification.) My experience after twenty-five years as a chiropractor confirms this interpretation but there is no medical research that I know of other than that mentioned in this chapter. In fact, as I have written elsewhere “there is no medical understanding of the problems caused by tight muscles”.
An example of this is to be found in the conclusion of Nikolai Bogduk’s Chapter 13, “Low Back Pain” where he writes “There are no data on underlying pathology that justify the belief that muscles can be a source of chronic low back pain.” (1) As I wrote earlier, medics think that pain must be caused by pathology and have no understanding of the problems caused by tight muscles. I also repeat another of my comments “the whole of alternative medicine is different ways of loosening tight muscles.” In total contradiction to Nicolai Bogduk’s statement, tight muscles are the source of most chronic back pain including sacro-iliac pain and sciatica (as well as being the source of most of the income of most chiropractors!)
“The Sublesation. Chapter 2.2 of The Evolution of Low Back Pain (2).
Although the idea of a warning pain explains some aspects of back pain it does not explain the muscular spasms that are so often associated with back pain.
It seems very likely that these muscular effects are associated with a phenomenon that occurs in the spine of any animal that I shall refer to as a sublesation. The chiropractor refers to this effect as a “chiropractic subluxation” and the osteopath refers to it as an “osteopathic lesion”. I shall avoid both terms because in medical terms it is neither a subluxation nor a lesion because it is within the normal range of joint mobility and because there is no associated tissue damage. I have also avoided the word “fixation” because this includes cases where the joint is “fixed” by adhesions following trauma. The word sublesation should avoid all these ambiguities because it doesn't exist. It is a combination of the chiropractic term subluxation and the osteopathic term lesion. I hope that sublesation will eventually be accepted by both professions and also by the medical profession so that this important phenomenon can receive the recognition and research effort that it deserves. (Note; this was written in 1992. Progress so far? Less than zero. Most chiropractors don’t even use the word subluxation any more because of medical opposition.)
In a sublesation, local muscles around a joint are permanently energised by nerves that are in some way excited by the clamping effect of the muscles. Thus, the effect is self-perpetuating. The mobility of the joint is greatly reduced and it is distorted asymmetrically because the muscle in spasm is only on one side. The osteopath and chiropractor both recognise the characteristics of the sublesation as asymmetry, loss of mobility and local muscle abnormality. The effect can occur in any spinal joint of any animal and has probably evolved in order to allow an injured joint to recover. (This phenomenon is the central point of chiropractic and is also central to osteopathy.)
When the warning pain has been triggered and there is disc damage or potential disc damage, the sublesation is ideally suited to provide muscular immobilisation of the vulnerable part of the spine. It seems likely that the phenomenon of the sublesation has evolved to be a very much more powerful effect in the human lumbo-sacral area. It also seems likely that evolution has used sublesations in the pelvis and sacro-iliac joints to cause muscle contraction in many of the muscles of the lumbar region.”
This muscle spasm is what so many back pain sufferers will recognise. It has to be powerful and painful because it has evolved to stop any very determined proto-human in the last five million years from continuing the activity that is likely to result in a prolapse from the disk straight onto the spinal cord or nerve roots.
The phenomenon of the sublesation applies at all spinal joints, including the four or five sacral joints that are no longer mobile joints. Any nerves exiting the spine can also be affected, so the nerve signal that initially comes from the disk can switch on sublesations in local lumbar or sacral segments. These can cause pain and muscle spasm in any tissues that get their innervation from the relevant segment. Hence sciatica without any physical nerve impingement. Evolution has incorporated all of this into a pain to protect the actual disk; a pain that even a determined proto-person can’t ignore. And all of this occurs without any pathology!”
Just one more anecdotal point; frequently the sacro-iliac pain persists long after the initial low back pain. If the initial pain signal from the disk has died away over time, then the sacro-iliac locking and pain can persist. If so, it is easy for the osteopath or chiropractor to release the sublesation and “cure” the pain. I always say that most osteopaths and chiropractors make most of their money, and reputation, by releasing the sacro-iliac joints. It is therefore not surprising that many osteopaths and chiropractors believe that the real cause of low back pain lies in the pelvis.
(1) Book “The Clinical Anatomy of the Lumbar Spine” Nikolai Bogduk.
(2) The Evolution of Low Back Pain. Book 60 pages. Free download.