22 Jan 2020

A very interesting review about the interactions between the fascial system and pain/dysfunction

See Italian version

This article is one of the latest which brings to light the importance of fascial treatment, the soft tissues long-lasting changes and its own relationship with the nervous system. The osteopathic intervention includes a local and global approach. It has been demostrated that an Osteopathic treatment can deeply modify the organization and Hydration of the connective tissue. By reducing the collagen adhesions, the osteopathic treatment can increase the hydration and thicken the fascial layers. A soft tissue stretching by the manual treatment can improve the communication among cells and their own interaction with the external enviroment. Fibroblasts (extracellular matrix) also get the ability to modify its own matrix as a result of the mechanical stimolus. Regarding to the connection to the nervous system, we have plenty of neuroreceptors under the skin, tendons and muscles which reacts quickly in accordance with brain responce and body balance adaptations in order to monitor the muscle tone and function.

Another important aspect is the intervention of adrenalin fybres involved into vasodilatation within the fascia, and the related reflexed release of connective tissue cells. During an acute pain this mechanism helps to release the pressure into the cells on the extracellular matrix (dynamic fluid) with more flow in and out the affected spot accordingly. In conclusion, the manual therapy can decrease inflammatory markers and being the starter for homonal changes during the days after the treatment applied.

Acute Back Pain Acute back pain is common, and usually not serious. Acute back pain usually involves muscle spasm, inflammation along the facet joints, and can be related to disc problems. So what exactly happens? Well there are a few processes going on that need to be discussed. Firstly, acute back pain can occur when either bending forwards, or bending backwards, or coming up from a forward bend. For example, imagine you are picking up a pen from the floor, you bend forwards, and then something “goes” in your back. Your back is in spasm and you are feeling very sharp pain. This is an acute back pain. The pain is typically so severe you cannot sit comfortably, or stand for long periods, and typically the only comfortable place is the bed. But why does it occur? This is often a combination of weak core muscles, stiff or hyper-flexible (hypermobile) spine, or poor posture.

Lower Back Anatomy Facet joints are nestled in the back on either side of your spinal column between the vertebral bodies and the discs. Each vertebra has a bony prominence on either side forming a facet joint between the vertebra above and below. Facet joints are surrounded within a joint capsule and it has been shown that within the lower back a meniscoid structure can lie, similar to that of a mini version of the knee joints’ meniscus. The main role of the facet joint is to minimize excessive movement and provide the spine with stability. In-between the vertebrae sit discs – these help the vertebrae to absorb force and to allow movement. Surrounding the vertebrae are muscles, ligaments and nerves. All of which can become injured and thus increasing the severity of the acute back pain.

How to Treat Acute Back Pain

  1. Anti-Inflammatory Medication In severe cases, a non-steroidal anti-inflammatory can help for a short period of time. Inflammation and pain will be reduced, which will allow you to move freely and not have to worry about being in a tremendous amount of pain. Get advice from your doctor on when/how to take this.
  2. Physical Therapy, Osteopathy, Chiropractic See your therapist as soon as possible. Typically the problem can be treated very quickly. Expect to need treatment every 2-3 days and depending on the severity of the joint lock, back pain can be significantly improved in just a few days compared to rest at home. If the problem has lasted longer than a week and you have limited movement, a therapist might be able to manipulate the joints using a controlled thrust. This will work to open up the joint and break down any scar tissue in the early stages, which can limit your range of movement. Thrusts are not always required, and gentler mobilizations can be very effective. Heat treatment and massage usually precede the treatment to help relax any spasms. Ultrasound or other forms of electrotherapy such as TENS or interferential can also help reduce inflammation.
  3. Exercises Your Rehab My Patient therapist will discuss exercises that you can do to improve mobility to your spine, which will reduce inflammation and muscle spasm.

Tips: • To help prevent the condition from occurring in the first place, work to maintain proper posture throughout the day. • Prolonged bending or sitting where the spine is flexed should be kept to a minimum as they can increase the amount of pressure on your discs, which leads to shrinking and degeneration. Remember that people with a sedentary lifestyle are prone to facet joint problems. • When your discs shrink, they will contact one another and begin bearing weight, which isn’t what they are meant to do. • Do everything you can to take care of your back posture at all times. • Practice exercises to help strengthen the spine and stabilize the surrounding muscles. • Use of a seat support can help improve your posture when in a sitting position.