Prevent Back Surgery
Monday, August 13, 2007
Jolie Bookspan, M.Ed, PhD, FAWM
In the surgery, the facet joint is cut off and replaced by "lumbar position preservation hardware" rigidly attached so that the area can no longer bend or arch backward. At right is an X-ray of the lower spine with surgically implanted hardware. The person is standing sideways facing to the right. Surgical facet rigid fixation surgery is considered innovative because it replaces the more drastic spine fusion. It also replaces repeated injections into the painful area. The seminar would teach me the surgery with a cocktail reception following.Why does the surgery want to prevent arching the lower spine? The facets are in the back of the vertebrae. Chronically letting your spine arch (too much inward curve) squashes the facets in back. According to work I've done over years in the lab, the overarching, called hyperlordosis (or slouching backward), is a chief factor in damage and pain to the facets and surrounding soft tissue. That means that you can stop this yourself without the surgery.
Notice if you allow overarching when carrying things in back (left) and in front (right). It is not the normal curve of the spine. It is too much:
The left photo above is from the post Healthier Backpack Carrying to Get Better Exercise and Stop Back Pain. You do not need to allow the pack to pull your upper body backward. Right photo is from Healthier Carrying - Get Free Ab Exercise and Stop Pain. You do not need to lean back to offset weight carried. In both examples, the hip tilts forward in front, instead of holding vertically.
Two examples above show allowing the spine to arch too much when reaching overhead. Left photo is from Change Daily Reaching to Get Ab Exercise and Stop Back and Shoulder Pain. The drawing at right is from Back Pain in Pregnancy - and Why Men Can Get It. Imagine lifting your baby overhead (or any weight) and allowing your spine to pinch backward on the facet joints instead of standing upright and holding neutral spine.
Two examples above are from Aren't You Supposed To Stick Your Behind Out to Sit Down or Do Squats? (left) and Overlooked Ab Muscles in Overhead Lifts (right).You can stop overarching, thereby preventing crushing force on the facets, and distribute the weight through the core muscles instead. It is a simple positional adjustment that takes seconds (shown below). An alternative is to have surgery.
Following rigid fixation surgery, you will no longer be able to stretch your lower spine as far backward, even when you want to stretch for range of motion and better disc health. You will still be able to slouch your body weight backward - onto the implants. They may eventually wear, along with adjacent bone, from the chronic crushing. Because the surgically fixed area can no longer overarch, increased forces occur on the joints above and below which have to bend more. If you thought the spine in the x-ray above still looked overly arched, not neutral, you are right. The areas above and below the implanted devices are over-arching backward, and the backside is tilting out in back (hip axis is tilted anteriorly). After years, those facets may be next to break down. It is no surprise "when the pain comes back." The cause of the pain was never removed.
Instead of allowing your spine to be pulled into damaging position, use your muscles to hold neutral spine. Here is one easy way to learn to feel it:- Stand with your back against a wall. Touch heels, backside, shoulders, and head. Do you feel a large arch in the lower back making a large space?
- Put your hands on your hips. Thumbs in back. Fingers in front.
- Roll your hip so that thumbs roll down in back.
The muscles used to maintain neutral spine are your abdominal and core muscles. It is not strengthening ab muscles that stops pain or teaches you neutral spine. It is using them to prevent damaging spine position. You get free, built-in core muscle exercise just by avoiding back surgery.
Xray by ryortho.
Photo credits for three arching composites appear in the original posts
Drawing of hyperlordosis when lifting overhead and last photo of tilting to neutral spine copyright by Jolie from the book The Ab Revolution
Photo credits for three arching composites appear in the original posts
Drawing of hyperlordosis when lifting overhead and last photo of tilting to neutral spine copyright by Jolie from the book The Ab Revolution
Labels: abdominal muscles, facet joints, fix pain, injury, lordosis, lower back, neutral spine, surgery, upper back
6 Comments:
At Friday, August 17, 2007 6:27:00 AM,
Anonymous said…
Are you suggesting we hold a pelvic tilt all the time? That seems very unnatural and a big distration.
At Friday, August 17, 2007 10:01:00 AM,
Jolie Bookspan, M.Ed, PhD said…
Anonymous, Hold neutral spine.
If you have to tuck (pelvic tilt) to get to neutral spine, then tilt and hold neutral spine. If you don't, you will be slouching your spine in painful ways.
Don't tuck so much that you round or are not in neutral spine. Neutral spine prevents several injurious forces on the lower back. Easy.
Distraction? It is the same as not slouching your shoulders - healthy, prevents pain, and free exercise. Make being healthy natural.
At Thursday, August 07, 2008 6:11:00 AM,
Anonymous said…
Hey Jolie..
My name is Juraj. I was trying to register a couple of times but there was always some error.
I think I have a a hyperlordosis. Tommorow I going to see a doctor, but do you have any tips what exercise to do and is there a way how to fix it ?
What can I do and what I can't ? Can I work as normal healty person or avin a heavy lifting and etc ? I I was trying to hold pelvic tilt but walk like this or do this all the time is very hard if not immposible..
I was also thinking if there are any back or abdom corsett to wear some during the day... I just wan to know as much I can about hyperlordosis and know things how to life with it and etc... IS enought to do excercise for abdom muscle ?
Really dont want to go on surgery table.
Thank you very much for quick help...
My e-mail; YZEERAK@GOOGLEMAIL.COM or ICQ: 220293979
At Thursday, August 07, 2008 9:34:00 AM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
Juraj, hyperlordosis is just a bad posture, the same as any other bad habit.
- Surgery is not needed any more than you need surgery to hold your mouth closed when you walk down the street. You just hold it closed.
- Corsets make the muscles weaker, since the corset holds instead of muscles.
- Try what the article says to do to relieve the too large inward lower spine curve: learn to stand with normal arch. Read the article where it says "Here is one easy way to learn to feel it…" and try #1, 2, and 3.
- Contrary to popular myth, strengthening the abdominal muscles is usually not needed. The missing link is to just use the ones you have to change the shape of your lower spine posture, just like moving any other body part.
- If the front of your hip is too tight to allow neutral spine, stretch it. Here are two to start with: Fast Fitness - Quick Relaxing Hip Stretch and Hip Stretch While You Strengthen Legs.
If you want more, click the label under the post "facets" and "lordosis." It will give you many more posts showing the problem and things to try. If you still want more, I have written books on this. See my books page, www.DrBookspan.com/books. Don't worry. Good luck.
At Tuesday, August 26, 2008 8:51:00 AM,
Anonymous said…
So you suggesting we hold a pelvic tilt in neutral position all the time even we walk ? Because now is this position very unnatural. Is hard to walk this way. Even if I just standing I have to keep all my buttock muscles stretch all the time. I have your book and reading just now...
But I still missing some answers.
Is not just to keep neutral spine and do exercise but I think as well to live healthy now.
what about mattress ? Foam/memory ?
hard soft ?
what about sitting chair ? kneeling chair is OK or some healthy office ?
shoes ? any suggestions ?
thx
G.
At Thursday, August 28, 2008 1:23:00 PM,
Jolie Bookspan, M.Ed, PhD, FAWM said…
Hello "G" you ask if I suggest neutral spine even during life activity? When else? Think of bad spine slouching like smoking or abusing someone, and neutral spine like not smoking and not hurting someone. When would you like to not hurt? All the time is a good idea.
To stop smoking or stop hurting someone 10 minutes a day as an exercise, then go right back to it, is not healthy lifestyle or common sense. Look at all the examples in this post and see that people are not getting the idea of exercise for health. Look at the first comment from a reader to this post and the answer that it is the same as not slouching your shoulders - healthy, prevents pain, and free exercise.
Mattress - Nothing more than a $5 foam block on the floor is needed and is more than many people in the world have. No fancy memory foam or over-engineered and expensive products are needed. The key is if you are too tight to stand up straight during the day, you will be too tight to sleep comfortably. I don't change how people sleep - the key is getting them healthy during daily life first, then they can straighten a lot of sleeping trouble that is artificially induced by tightness habits.
Chair - kneeling chairs do not make you sit any better than any other chair. You can sit well or badly on any chair. It is silly to spend large sums on special chairs when it is you who determine how you sit, and the money can go to starving people without floors in their homes. See Does an Exercise Ball Make You Sit Straight? and click the labels sitting for all the other posts on sitting.
For shoes, click this post for a list of helpful shoe and foot posts - New Fitness Fixer Index.
Let me know which book you have and I can direct you better to understanding simple natural movement. Hang in there and relax and enjoy.
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