1、1How to Have a Healthy BackByVert Mooney, MDBackHealth 2000 and Vert Mooney, M.D., 2006Doctor Vert Mooney received his Orthopaedic Surgery training at the University of Pittsburgh between 1960 and 1964. He earned his medical degree in 1957 from Columbia University College of Physicians and Surgeons.
2、 Doctor Mooney was Board Certified by the American Board of Orthopaedic Surgery in 1967 and is a Fellow of the Royal Society of Medicine. He was named one of the 20 Most Distinguished Orthopaedic Surgeons in America in the 1989 Annual Survey conducted by Town and Country Magazine. He was also honore
3、d with an appointment by the Governor to the California Industrial Medical Council.Doctor Mooney is currently the Medical Director of U. S. Spine and Sport in La Jolla, California. He has had over 30 years of experience in general Orthopaedics and spine care. From 1977 to 1988, Doctor Mooney was Chi
4、ef of Orthopaedic Surgery at Parkland Hospital in Dallas. He was also Director of their Orthopaedic Training Program.Doctor Mooney is a nationally recognized medical researcher who has conducted studies in many areas related to orthopaedics. He has written close to 200 journal articles and abstracts
5、, over 30 chapters for medical texts, and in the last six years has been invited to speak at over 125 medical conferences throughout the world. In addition to spine surgery, Doctor Mooney is actively involved in Orthopaedic Rehabilitation using innovative, specialized equipment.Doctor Mooney has bee
6、n actively involved in and past president of many Orthopaedic, surgical and spine-related medical associations, including the Orthopaedic Chairmans Association. He is current Vice President of the American Orthopaedic Association and is the president-elect of the International Intradiscal Treatment
7、Society. Doctor Mooney currently holds staff positions at UCSD Medical Center and UCSD Thornton Hospital. He is a Professor of Orthopaedic Surgery at the UCSD School of Medicine.Doctor Mooney and his wife, Ruth, reside in Del Mar, California. He has three children and six grandchildren.2INTRODUCTION
8、Low-back pain is the most common musculoskeletal disorder in the industrialized world. In fact, after heart disease and cancer, low-back pain follows as the most costly medical problem facing society today. While nobody dies of low-back pain, it should come as no surprise that the productive lives o
9、f hundreds of people are lost each day to spinal dysfunction; you too, unless you become knowledgeable about the subject, could be facing a life of back pain.What may come as a surprise is that the overwhelming majority of spinal pain is entirely avoidable and, once contracted, absolutely correctabl
10、e. Why then do people with back problems seem to have them forever? And why, in a day of unsurpassed technology, does this particular group of sufferers increase while those with most other medical issues shrink? The principle problem related to diagnoses and treatment of low-back pain is that the h
11、ealthcare professionals who deal in back pain come from widely divergent medical backgrounds; their approaches to a particular back problem often have little if anything in common. These professionals range from physical therapists and chiropractors to spine surgeons and pain doctors. It is no shock
12、 then that treatment choices for a sufferer are radically different and confusing. So are the results.While there is no unifying force or element in back-pain analysis and treatment, most in the business share two things: 1) Most non-surgical treatments focus on how to make you simply feel better, n
13、ot necessarily get better. And the surgical approach, while it may relieve a terribly painful situation, fails post-operatively to restore the back to a fully functional state, a state which, had it been restored prior to surgery, may have avoided such a drastic and irreversible course in the first
14、place. 2) The size of the back-pain pie is huge; estimates as large as $20 billion are probably conservative. Those who purchase back-pain treatment purchase just that, treatment. No one sells a cure. You cant buy one. But, you can buy an unlimited chain of treatments. This explains why insurance co
15、mpanies, with the exception of workers compensation insurance, arent seeking a cure. Approximately 25% of their profits come directly from additional fees tacked onto premiums and dedicated to back pain treatments. Eliminate treatments, eliminate margins. Eliminate margins, reduce profits. Its no co
16、nspiracy. Its American healthcare economics; Yankee free enterprise superimposed on medicine. This is the economic reason. Whats the medical reason? What is lacking in all of this is identification of a core issue in back assessment. This discussion identifies that core issue, tells you how the core
17、 issue relates to you, how you came to suffer in the first place, how to really get better not just feel better, and how to avoid back-pain recurrences. Here I offer sufficient information to give you control over the destiny of your own health. Armed with this knowledge, you can at once regain an a
18、ctive, pain-free life.3BASIC ANATOMYTHE DISC The most significant structure in your back is considered to be the intervertebral disc. And, since the disc heads the list of topics people talk about relating to the back, lets start here. The disc must be considered a joint in that it connects each bon
19、e segment of the spinethe vertebra to the one next to it. This connection is very strong, but allows a small amount of motion between two vertebrae in multiple directions simultaneously. For example, when we bend down to touch our toes, we can also bend sideways, or twist our chest in relation to ou
20、r pelvis, all at the same time. The intervertebral disc should be considered as a universal joint because it allows some bending and rotation in all ranges of motion. This type of joint is found nowhere else in the body other than in the spine. Another function of the disc is that of a shock absorbe
21、r. Because of the discs shock-absorbent nature, our backs tolerate nicely sudden shock waves of force such as when we jump off the swing or run down stairs. In such activity, the disc acts like a shock absorber in a car as the car bounces over a speed bump; it spreads out the sharp peak of a sudden
22、load, protecting the cars suspension and allowing it to return to the same posture it had before encountering the bump.The final function of the disc is that of a spacer or filler maintaining a precise distance between vertebrae. For it is within this space between vertebrae that nerves energizing a
23、ll parts of our body, except our head, enter and exit the spine. When this space is not adequately maintained, vertebrae compress one upon another, pinching these nerves in between. Back pain results coupled with possible malfunction of the body parts that those pinched nerves control.DISC CONSTRUCT
24、IONIn its construction, the disc has a soft, shock absorbent center known as the nucleus and a stronger, stiffer outer binding known as the annulus. Neither of these tissues have direct blood supply and thus, all cells living inside the disc must gain nutrition by some other means. That other means
25、is by diffusion of water. This water comes from the bloodstream, contains all the necessary salts, sugars, and proteins to nourish disc cells, and surrounds the disc at all times. Productive disc cells make the strong connective fibers (collagen) for the binding portion of the disc and the cushy sub
26、stance that gives resilience to the central portion (proteoglycons). Because the disc is truly living tissue, besides maintaining resilient and binding qualities, existing disc cells must constantly generate new cells to replace exhausted and worn out old ones. The water dispersing mechanism by whic
27、h discs supply themselves with elements needed for normal maintenance and repair is somewhat peculiar. A clear knowledge of this process is key to understanding how to cure low-back pain.DISC HYDRATION In the disc there are fewer cells compared to a similar amount of tissue anywhere else in the body
28、, and it is very easy for these relatively few cells to be cut off from essential nutrients. The disc functions much like a sponge that soaks up water as it expands which can then be squeezed out by making the sponge smaller. In similar 4fashion, nutrition for each disc cell can only be achieved by
29、the disc swelling up with water water loaded with rich nutrients from the bloodstream. When this moisture is later squeezed out, it carries with it waste products and break-down products. The amount of change in size for a disc is much less than for the typical household sponge, but it really happen
30、s. This is evidenced by the fact that we all grow slightly taller during the night as we lay sleeping. The force of gravity is diminished within our spine and the discs can swell. Thus we see that physical activity provides the pumping action for the exchange of fluid within the disc. In the vascula
31、r system, of course, the heart does this, but within the disc, there has to be movements of compression and expansion. Compression and expansion activate the hydration cycle.MECHANICAL COMPONENTS OF DISC FAILUREDISC DEGENERATION When the compression aspect of the hydration cycle is not balanced by t
32、he expansion aspecttoo much sitting and inactivity and not enough appropriate exercisea weak spot may develop in the outer ring of the disc. In that weak spot, a portion of the disc may protrude out into the spinal canal where the nerves are. I have somewhat over-simplified here because there are ot
33、her degenerative situations resulting from inactivity that add to the problem. But, restricting this portion of the discussion to the disc, let me say that the portion of degenerative problems solved by exact exercise is great. In fact, the very process of disc and spinal degeneration in general hav
34、e no other remedy than to reactivate the spine through a series of special exercises. Returning to the earlier discussion, when disc material abnormally compresses between the vertebrae, the vertebrae come closer together. Nerves, then, become pinched between either the vertebrae or between the bulg
35、ing disc and the nerve canal within vertebra. Pain begins as soon as the nerve is contacted and will continue until the nerve is relieved. The only way to relieve the nerve is to restore the free space it once enjoyed. This space can be re-established therapeutically or new space can be created surg
36、ically by cutting away part of the disc or shaving bone from the vertebra, or all of the above. Certainly, disc therapy is the method of choice. Sadly, some cases are allowed to deteriorate sufficiently, leaving no option except surgery. However, following surgery to remove only the portion of the d
37、isc pressing directly upon the nerve, the disc material left between the vertebrae must be therapeutically treated with exact exercise on precise equipment, and this precise equipment and its extreme value has only recently come to light. Prior to the appearance of this equipment, floor exercise was
38、 the norm, but floor exercise is only marginally beneficial. Proper equipment facilitates disc hydration and the bodys lift dynamics return to normal within weeks. Without attention to disc healtha direct reversal in the cycle that originated this problem and a re-teaching of proper body lift dynami
39、cs, chances are overwhelming that pain will return and surgery will reoccur.CHEMICAL COMPONENTS OF DISC FAILUREWhile a degenerating and collapsing disc is a mechanical process, not involving any pathogen, disc injury includes an accompanying chemical process worth mentioning: When a protruding disc
40、touches a nerve persistently, the irritation causes inflammation. 5Swelling tissues aggravate the nerves even more. Adding to this, injury changes the chemical nature of the fluid within the disc from usual alkaline to more irritating acid. This chemical change compounds the sensitivity of the nerve
41、s, greatly increasing the sensation of pain. The chemical change can occur even without disc protrusion, called disc disruption syndrome. As with swelling, this acidity can only be removed by a significant amount of fluid exchange. The quicker disc fluid is cycled, the sooner pain will moderate. Thu
42、s the goal of treatment in acutely painful situations is to reduce swelling and wash away the pain-enhancing acid. Fluid exchange can only be increased through expanded motion of the disc, particularly increasing the pumping action well beyond what daily activity might normally provide. Obvious in a
43、cute situations, such disc therapy must be exactly done, causing little or no discomfort. Hence, the equipment and the provider cannot be haphazard.SOFT TISSUESIn addition to the disc and vertebra, other tissues also support the spine. These are called soft tissues and can be divided into two catego
44、ries: The first is muscle that I will talk about later. The second is connective tissue, tissue that attaches from one structure to another. Fascia, ligaments, and tendons are the names of these soft connective tissues. These tissues have a higher density of fibers than the disc. They are flexible a
45、nd slightly elastic aiding the likely disc to absorb and disperse stress. These tissues have to be extremely strong for their size so there is little room for blood vessels. The few blood vessels present in connective tissue are like tiny, thin, plastic hoses. They have no strength on their own, dep
46、ending entirely upon the tissue housing them for their strength, and similarly for their function. Thus, here again, as with the disc, these tissues face the problem of nutrition flow; how to get nutrition to peculiarly located cells. Swelling and inactivity jeopardizes these cells lives. Knowing th
47、at the disc degenerates with inactivity, we now become aware that the situation is compounded throughout the back by similar circumstances in soft, connective tissue. At no time is the need of these cells to stay alive and function to full capacity more imperative than during injury and throughout h
48、ealing. They must remain constantly capable of replacing injured tissue by continuing to create resilient proteoglycons. For this reason, a delay in exercise beyond a few days after the onset of pain lengthens indefinitely the term of the injury. Worse yet, when motion to connective tissue diminishe
49、s, fibers within soon begin to glue themselves together with little electronic bonds known as cross-links. Within days, the result is stiffer, less resilient tissue, tissue no longer flexible that can even tear when suddenly overloaded. Here again, to maintain the health of connective tissue, motion in the form of stretching movements emphasizing flexibility and elasticity speeds healing.MUSCLESMuscles are far more resilient than either the disc or connective
