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Basic Mechanical Considerations

Remarks | Terminology | Anatomy | Physiology | Balance + Distortion

Remarks

To delve into the study of any subject requires a basic knowledge of terminology. In this instance, anatomy and physiology are indispensable.
Since this writing is for therapists, nurses, coaches, industrialists and educators as well as physicians, definitions and a brief explanation of the anatomy, physiology and body mechanics is pertinent. Of course, the ever present dangers of oversimplification must be acknowledged. However, the purpose of this book must not be tangential so as to provide a simple, but not misleading background to an uncomplicated method of preventing and treating the low back syndrome.

Terminology

1. Abduction—Movement away from the body.
   
   
2. Adduction—Movement toward the body.
   
   
3. Artery—Muscular tube which conveys oxygenated blood to the cells of the body (except Pulmonary Artery).
   
   
4. Blood—The red fluid which circulates to all cells of the body carrying oxygen and reconstructive materials and carrying away waste products of cellular metabolism. It serves many other purposes, such as fighting infection.
   
   
5. Burs a—A small sac containing fluid and found in area where pressure is maintained or where a tendon plays over a bone.
   
   
6. Cartilage—A connective tissue substance which contains certain fibrillated basement substance.
   
   
7. Cell—The unit of structure of any plant or animal.
   
   
8. Cervical—Pertaining to the neck.
   
   
9. Collagenous—Having albuminoid substance present in connective tissue, bone and cartilage.
   
   
10. Connective tissue—The supporting or framework tissue of the animal which binds cells and organs together; it is contractile and elastic.
    
    
11. Extension—Act of extending or straightening as against bending or flexion.
    
    
12. Fascia—A sheet of fibrous connective tissue which envelopes the body under the skin and encloses muscle groups and layers.
    
    
13. Fibrous—-Having elongated and tenuous cell or filamentous element making up connective tissue.
    
    
14. Flexion—Bending of a joint toward approximating its parts, as against extension.
    
    
15. Hyper—Over, too much, greater than.
    
    
16. Intervertebral disc—Flat circular cartilagenous cushion between the bodies and facets of the vertebrae.
    
    
17. It is—Inflamation of the structure named as the base word, i.e., tonsillitis, appendicitis.
    
    
18. Joint—The point of union of two bones.
    
    
19. Lesion—A wound, injury or result of disease process.
    
    
20. Ligament—A fibrous sheet or band which holds together two or more bones (joint), cartilages, or serves as support for fascia or muscles.
    
    
21. Metabolism—Chemical changes whereby the cell carries on its life process.
    
    
22. Muscle—Contractile tissue by which movement is effected. It may attach to bone directly or by means of a tendon. It is ensheathed by fascia and cemented by collagenous tissue.
    
    
23. Nerve—A whitish cord which extends from the brain;
    
    (a) cause muscles to move,
    (b) pick up sensations.
    
    
24. Organ—Any part of the body which performs a specific function, it may be made up of many kinds of tissues.
    
    
25. Pelvis—Area of hips, genital and lower urinary organs around cup shaped ring of bones.
    
    
26. Skin—Cutaneous tissue acting as a protective covering of the body.
    
    
27. Tendon—A fibrous cord which connects a muscle to a bone.
    
    
28. Thorax—Chest.
    
    
29. Tissue—A collection of similar cells which form a definite structure.
    
    
30. Vein—Thin muscular tube which conveys blood-carrying waste products from the cells back to the heart carrying waste products.
    
    

Fig. 4. Major arteries of the human body in relationship to supporting skeleton. Indicates pressure point for control of bleeding. Indicates point for applying tourniquet. (After War Dept. TM 8-220-Medical Dept. Soldiers Handbook.)

Anatomy

Bony—Illustration No. 2 gives the skeletal anatomy of the human body.

Muscular—Illustration No. 3 exemplifies certain more important muscles.

Vascular—Illustration No. 4 shows the major arteries; as a rule, veins accompany the arteries and are similarly named.

Nerves—Illustration No. 5 labels the major nerve trunks.

Cutaneous nerve distribution—Illustration No. 6 gives the skin areas innervated by numbered nerves as they exit from the spinal column.

Vertebrae—One of the bony segments of the spinal column. Illustration No. 2 shows there are seven cervical, twelve thoracic, five lumbar, five fused sacral and four fused coccygeal (tail bone) vertebrae. Illustration No. 7 exemplifies the complexity of a lumbar vertebrae.

Intervertebral disc—The anatomy of this fluid-containing cartilagenous pad is demonstrated in Illustration No. 8.

Referred pain—Pain originating in an area other than that which the brain interprets the placement. Illustration No. 10 gives some areas and their referral point more commonly encountered.
Trigger points—A circumscribed area, the initiation of which will give rise to referred pain or malfunction elsewhere. See Illustration No. 10.


Fig. 5. Major nerves to muscles and primary parts of human brain


Fig. 6. Distribution of spinal sensory nerves over the skin surface.

Fig. 7. A lumbar vertebra—Side view and as seen from above. (After Morris, Human Anatomy.)
 
This is the function process of the body in parts, or as a whole. To understand the rationale behind the elongation program, it is essential to establish a few physiological facts. Muscle is contractile to perform its function. It is ensheathed in fascia and bound, cell by cell, by collagenous fibers. Nerves and blood vessels course their path peripherally through muscles, fascia and collagenous tissue.
It is now established that ligaments, fascia and collagenous fibers have the two protoplasmic qualities that other tissues exemplify, i.e., contractility and elasticity. As shown in Illustration No. 9, skin, fascia and other ligaments are highly endowed with pain nerve endings. Healing of local injury similar to other wound healing, increases production of fibrous tissues which then contracts. These tissues have a tendency to shorten after injury or after a period of activity following a period of inactivity. Thus, dancers and football players "loosen up" before embarking on another round of activity.

Another cause of connective tissue shortening is the inelasticity induced by old age; hence the elderly are not as supple with their joints. Effects of improper posture will be made evident.


Fig. 9. Pain receptors in the tissue layers. Note that fascia has many more pain nerve fibers than muscle; fascia corresponds to skin in that respect.
(After Williamson's Office Procedures.)
 
Furthermore, these structures arc not discretely localized or areaized entities, but are continuous along the entire length of the body. Hence, one affected area may impede general mobility.

Contracted structures can compress and irritate adjacent peripheral nerves to cause both local and referred pain. Thus reflex muscle spasm and decreased mobility results which, in turn, causes more muscle spasm, thus increasing the pain and a vicious cycle is established.

It becomes readily apparent that the earlier elongation procedures are applied, the more readily the condition will respond and the vicious cycle is avoided. Elongation will return the contracted tissues, both muscle and fibrous, to their normal state. This is the reasoning of the elongation program.

Fig. 10. Diagrammatic representations of some of the more common referred pain and musculofacial trigger areas. "X" represents site of trigger area. Black shaded areas represent 'essential' reference points of pain while strippled regions show the 'spillover' zones of reference. Note: In 10a, the Biceps Femoris is illustrated herewith as the most commonly involved muscle in this area. However, any of the muscles which end in the lateral or medial hamstring tendons may be the offenders. In 10b, the Vastus Medialis muscle is conjoined with the Biceps Femoris, Vastus Lateralis and Vastus Intermedialis to form a quadriceps tendon. The former, however, is the most frequent culprit. In lOo, the Ilicostalis is the lateral segment of the Sacro-Spinalis muscle, one of the group collectively terrmed 'erector spinii.' (After J. Travell, S. Rinzla, and A. Sola.)

   

Fig. 11 A. Major antagonistic muscle groups which maintain erect posture. These muscles and their investing fascia and collagenous connective tissues are commonly involved in low back pain. This is due to overwork of one group or another in compensating for postural changes to decrease pain. (After E. W. Immermann.)

Balance And Distortion

The body framework is a series of bones placed one upon the other. They are bound together by ligaments, but balance is a feat accomplished by constant and synchronized muscular movements. Even the military cadet standing at attention is in constant muscular action to maintain the erect position and must make slight shifts to remain in such attitude. It should be remembered that all muscle groups have antagonistic groups and coordination entails contraction of one synchronized with relaxation of the opponents, Illustration No. 11 A. The normal ratio of muscle mass in back as compared to abdominal muscles is three to one; spinal curvature makes balance possible.

Man has elected to assume the upright position. Unfortunately, this places the weight of the entire trunk, upper extremities and head on the joint where the movable lumbar spine meets the immovable sacral spines. Thus, the weakest link in the chain is created by posture. Illustration No. 11B.

The ligamentous bindings will cause no pain until they are sprained or injured, then shortening occurs. Improper posture will create a chronic strain on the bindings and injury is made likely. Muscles and fascia try to assist the ligaments in their work with all-out effort even to the point that they themselves become strained; then the abused tissues protest with pain. The pain may be two-fold: pain intrinsic to the strained or contracted tissue and pain from compression of adjacent nerve fibers.

{Fig. 11B. Posture and spinal curvatures.

Note: (1) Vertebral bodies contribute % total length of colum whereas discs contribute %. In each region the discs contribute to the curvature of the spinal column.

(2) Intervertebral discs are thickest where movement of local body part is greatest—in cervical and lumbar regions.

(3) Development of curvature; the thoracic and sacral curvatures are primary, allowing for greater capacity of internal organ contents; the cervical and lumbar are secondary or compensatory to maintaining erect
posture. (After J. C. B. Grant's A Method of Aanatomy, using Todd's data.)
 
Illustration No. 12 represents proper and improper standing, sitting and lying positions. Proper standing posture encompasses a straight line from the ears, shoulders, hips and ankles.

Illustration No. 13 shows proper lifting techniques.
In summary, distortions from compensating for painfully contracted or injured muscle, connective tissue or ligaments is the physiological basis for upward of 85% of all back pains. It is rare that surgery on a disc or bone is necessary treatment.

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