Intro
Salam fellaz, you may have been wondering where I’ve been… No?
Well… all 14 of you should be kindly informed that I have only just turned a corner on the plague of Zeus and thus recovered sufficient lung capacity to recommence my Magnum Opus - “The Thpinal Series.”
We left the series with a fairly unentertaining and dispassionate run-down of the structure and function of the spine and how it (classically) gets messed up in overactive fuckwits.
This week, we’ll get into the meat and veg of working out what the issue is. Let’s run it.
Determining the cause of the injury
You will recall from last time that every spinal injury has a cause. Therefore, there is no such thing as a non-specific back injury.
By deduction, we can surmise that there should be no such thing as a non-specific rehab programme.
As such, the minute Joe Jacked in the gym starts asking you - “you done yoguhhhh??” - this is exact moment when you start raising an eyebrow, in a way not dissimilar to Don Carlo on a Champions League night.
Indeed, generic solutions will only yield meady results.
Every back injury has a cause, that cause can AND MUST be traced and once traced - a rehab programme can be established.
Take your history
You’re gonna have to go full Doctor Thpinal if you want to work out the issue. Grab a piece of paper and write down every knock, every tweak and every tight spot. Then, write down a generic list of activities that increase your pain. Start from the moment you wake up until the moment you wake up the next day.
Does your spine hurt whilst sleeping? Whilst picking up the shopping? Whilst brushing your teeth? Whilst sitting for prolonged periods? Whilst tying your laces?
What makes the pain worse? When is the pain worst? Morning or night? Where is the pain?
Next, right down a list of activities that don’t give you trouble - Walking? running? Standing straight for sustained periods?
If the above exercise is done thoroughly - slowly but surely a picture of “intolerant” movement patterns will emerge.
For example, consider the classic “flexion-intolerant” athletic oak-wooded spined geezer - he experiences pain whilst tying laces, brushing teeth, sweeping creatine granules off the floor, when his butt “winks”, tying his Mrs’s laces and kissing his sensei’s feet.
This indeed will be most of you reading this article. “flexion-intolerance” - which presents itself through pain when folding forwards or when sitting for sustained periods. The pain is worse in the mornings and commonly presents itself in the lower portion of the Lumbar spine (L4/L5 region most frequently). Let’s probe further.
Provocative Testing
After establishing the movement patterns that piss your back off - we then need to pin down exactly what and where the issue is.
This is done through “provocative testing” - which is a fancy term that Physios use for “prodding the injury until we work out the root cause.”
Capisce? Ok, let me be clearer. In order for you or preferably, a health professional (book in now) to pinpoint the causes of your pain they need to induce it through movements noted above that your spine does not tolerate.
Take for example a “compression-intolerant” individual. He hits the squat rack and within minutes senses a dull pervasive ache that can’t be pinned down. In such case, it’s hard to confirm whether it is compression or flexion that is the root cause.
In order to confirm the distinction (if there is one) - the athlete should undertake the following provocative test. The following is an extract from back mechanic by Stuart Mcgill:
“Sit on a stool and, with your arms at your side, grab the underside of the seat pan. Sit-up tall so that your spine is in its neutral position (position 1) . Pull up with your hands to compress the spine. Is this painful? Record your findings.
Now repeat the pulling motion with the same intensity, but this time instead of sitting with a tall posture, allow yourself to slouch (position 2). Record your results in regards to pain.
Finally, repeat the test one more time with the spine in an extended (or “arched back”) position (position 3). Document your results.”
Before commenting on the above and plagiarising any more of Doctor Mcgill’s work, it must be said that the above extract is for educational purposes.
Now, let’s dissect these provocative tests. If you experience pain in position one - compression is your pain trigger.
If you experience pain in position two but not position one - flexion is your pain trigger.
And finally, if you experience pain in position three - spinal extension is your pain trigger.
For those of you with flexion intolerance - which applies most pertinently to this readership - conduct the following test to confirm your suspicions.
This test can only be described as. a “reverse provocative test” - as it is pain relieving.
Lie down on your stomach - stack your two fists on top of each other, then place them under your chin. This will create a slight arch in your spine.
Relax into the pose for 3-5 minutes and document the results. If you experienced blissful relaxation during and following the pose (and tested positive for test 2) - you are most certainly flexion intolerant.
*An exhaustive battery of provocative tests is provided in back mechanic (Mcgill), I would highly recommend anyone with back issues reading this book - as it’s not only highly informative but very digestible for the lay person.
Connecting the Dots
Ok… Let’s wrap things up in a paragraph then. If you experience pain whilst bending forwards, sitting for prolonged periods and you have tested positive for the provocative tests detailed - you are most certainly FLEXION INTOLERANT. For 90% of cases, when coupled with neural symptoms (see part one) this will mean you have posterior disc issues. Frankly, however, that’s irrelevant. If you are flexion intolerant - the definitions don’t matter. First things first - you need to remove the offending movements and build a rehab programme based on enhancing spinal stability. STAY WITH ME…