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!”
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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.