B a c k / N e c k
Surgical and non-surgical interventions for spinal disorders
B a c k / N e c k
Orthopaedic and Spinal Surgeon
MBBS (Hons 1) MS (Ortho) Dip. Anat FRACS FAOrthA PFET (Spine)
Adjunct Assistant Professor, Bond University, Queensland
P - 0499 NEC BAC
[0499 632 222]
F - (07) 3009 9992
P.O. Box 211 Isle of Capri QLD 4217
Spinal Health
The preconditions to good spinal health and function are both obvious and subtle - the importance of harmony of these different factors for good spinal health is especially apparent when one or more of these factors is absent or dysfunction and pain and disease occur.
MIND
Protective
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Social support
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Mentality of being in control and putting things in perspective
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Positive mindset
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Positive messages about movement
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Pacing and sleep hygiene
Negative
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Lowered mood
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Fearful thinking and catastrophizing
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Feeling out of control or helpless
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Being overly concerned about spinal damage or flareups when not justified
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Substance misuse
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Unresolved conflicts and dissatisfaction
ALIGNMENT
Protective
-
Efficient centre of gravity (ie spine is well aligned, head over hips)
-
Correction of generally poor posture via muscle retraining
Negative
-
Excess attention to mild posture issues
STRENGTH
Protective
-
Good core strength including abdominal, pelvic floor and back muscles
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Good balance and 'proprioception'
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Good strength of compensation assisting muscles such as the glutes
Negative
-
Converse of the above
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Carrying excess weight
FLEXIBILITY
Protective
-
Maintenance of supple joints and flexibility, often with regular stretching or water therapy.
The effect of alignment impacting economical movements and increasing muscle work
ACTIVITY
Protective
-
Regular aerobic exercise
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Regular resistance exercises (e.g. theraband)
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Appropriate activity graduation during rehabilitation phases
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Activity modification in the acute injury or postoperative phase
Negative
-
Withdrawing from exercise
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Laying down excessively
NUTRITION AND MEDICATIONS
Protective
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Balanced diet that promotes stable weight, good muscle strength and healthy immune and nerve function; bone, joint and muscle health.
-
Some nutraceuticals and complimentary medicines have shown promise here or are being researched regarding their evidence include palmitoylethanolamide (PEA), magnesium, tumeric, myrrh, Rosemary, rosehip oil, caryophyllene, B6, alpha-lipoid acid, acetyl-L-carnitine and Fish oil. Consult your general practitioner before any wholesale changes to supplements.
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Usage of simple, non-opioid medications to manage chronic pain. Long acting paracetamol and selective non-steroidal are examples of appropriate first line agents for musculoskeletal pain.
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Consideration for appropriate nerve modulating drugs for nerve pain, respecting the side effects and titrating up slowly.
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Often a trial and error approach with different combinations of medications may be necessary to achieving the right balance.
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Negative
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Excess use of alcohol, tobacco/illicit drugs and pro-inflammatory or gout producing diets
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Excessive reliance on opioids medications and poly pharmacy (mixing too may different types of pain relieving agents)
The four walls (left) that support the lumbar spine - the multifidus muscle (right) is almost always involved (see varied degrees of severity of fatty atrophy- right image) in people suffering low back pain
There is now a large body of scientific research in the last 10 years focussing on the role of multifidus and its prominent role in spinal health and dysfunction - it is an acknowledged target, along with other local muscles such as the gluteal muscles and transversus abdominus, for rehabilitative strengthening. Below are two examples of multifidus strengthening techniques (Lumbar extension machine and Roman Chair).
Managing new (acute) low back pain episodes or 'flare ups'
- Can be trial and error and involve combination of below.
- Emphasis should be on ACTIVE therapies (Gentle exercise e.g. Walking, physiotherapy, hydrotherapy, pilates, Yoga, Tai Qi, Stretching, light resistance activity e.g. Theraband)
- Use of home based stretches and exercises e.g. Exercise section on www.spine-health.com (if symptoms ongoing for more than a few weeks it is recommended to visit a healthcare professional for assessment and supervision)
- Relative rest from temporary activity avoidance of aggravating activities
- Use of heat and paracetamol with judicious use of muscle relaxants and anti-inflammatories has supportive evidence
- For flare-ups lasting more than 4-6 weeks then adding in biofeedback, psycho-neuroeducation and pain education strategies are shown to be helpful
- PASSIVE therapies can be added in and can improve feelings of wellbeing but have generally short term effect and mixed evidence regarding their efficacy (acupuncture, chiropractic/spinal manipulation, mobilisation, needling, massage, traction, laser, ultrasound etc.)
Acute neck pain/arm pain referred neck episodes
- As above
- Temporarily avoid overhead reaching and repetitive above shoulder activity
- Utilise nerve 'flossing' and nerve 'glides'
Prevention and maintenance
- Prevention - keep moving and incorporate some level of resistance whether it be controlled weights, therabands or against water (hydrotherapy/swimming). Core strengthening can be facilitated by performing daily exercises at home using simple aids such as exercise balls and mats with progression ideally supervised or prescribed by a health professional (e.g. physiotherapist, exercise physiologist) if you have been injured recently.
An example of progression through one of the common but many core directed exercises often prescribed is shown above with 'planks' and prone exercises on a Swiss inflatable ball, bridges, bent over rows, single leg extensions, upside down kettle bell and 'Dog-bird' cross arm activation are other commonly used prescriptions. The McGill 'big three' are also evidence based and commonly used. Other evidence based exercises that strengthen core and back muscles are described (and backed by science) in the links directly below for interest:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806175/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345922/
RESOURCES / USEFUL LINKS / APPS:
Mindfulness: Curable app ; noigroup.com
Back strength principles: Back Mechanic by Stuart McGill ; rehabhero.ca ; theprehabguys.com
Pain education : Lorimer Moseley - Explain pain book and tamethebeast.org ; painrevolution.org; painmanagement.org.au
