October 2017 Edition. Volume XVII

The human spine was never designed as being optimal in its design for biped ambulation on a high gravity planet such as earth.  Its structure clearly documents  that it was more favorably suited for use by a four-legged creature.  It was probably about 3 million years ago that one of our ancestors first decided to try walking on two legs.  For those born with genetically “good equipment” Who have worked to preserve this gift ambulation has generally worked out well for the usel.

For those who have chosen their parents less carefully and thus have become endowed with less-than-optimal spine structures and  who have abused this asset by making poor healthcare decisions such as being cigarette smokers pain-free function has typically turned out to be a great deal more difficult particularly with advancing age.

Unfortunately, for those who have come into the world with poor anthropomorphic spinal equipment the world (so far) has provided little in the way of understanding, sympathy, or reasonably effective assistance.  Things, in this regard just haven’t changed very much so far.  The typical back sufferer still receives little in the way of common sense assistance and the early identification and prevention of spinal genomic disease are still  words not well understood in the health care community despite the great amount of time and money expended in attempting to effectively treat back problems.

A deeply entrenched misconception regarding low back pain has to do with the concept that physical stresses in the modern workplace play an important role in causing low back pain. Modern research, however has documented that work itself, as well as regular exercise, is a key component of maintaining good spine health and work absence and long-term disability can be significant liabilities. In occupations such as trucking where research has documented some exceptions to the rule where frequent compressional loading and exposure to vibration can be injurious to normal spines this occurs much less frequently in structurally normal spines and individuals who are non-cigarette smokers

Astronaut200GIFFollowing the space adventure of Russian cosmonaut Yury Gagarin on April 12, 1961, and American astronaut Alan Shepard on May 5, 1961  flight surgeons were surprised to discover that a common problem among space explorers was the production of low back pain which was acquired while they were weightless.  Scientific studies performed at that time  by the United States Space Agency and their Soviet counterparts documented that the elimination of the force of gravity  was producing a painful over-distention of their intervertebral discs.

Due to ambient weightlessness many of the early space explorers increased their body height as much as 2½ inches during the first 72 hours of weightless flight due to the increase in disc volume. Height tended to return to normal within 24 hours following a safe landing on earth.  After almost 50 years of space exploration astronaut low back pain continues to be a problem.

More recent research focused on astronauts spending six months on the International Space Station where artificial gravity exists have documented that despite this the astronauts Have continued to experience temporary increases in height and MRI monitoring has documented high levels of degeneration and atrophying of the low back musculature. These studies have made clear that because the astronauts are not actively using their low back muscles by bending over or using their backs under stress on a regular basis they tend to experience as much as a 19% decrease in the volume of the low back musculature. When considering the exploration of Mars which has 38% of the surface gravity of the Earth concern is being expressed regarding the risk of muscle atrophy, deconditioning, and low back pain becoming significant liabilities. When this information is extrapolated to the normal workplace it becomes evident that regular work is an important key component of maintaining good low back health.

Important lessons which are being drawn from the experience of space exploration is that continuous decreases in intradiscal pressure and decreases in routine stress on the spine can be liabilities. On earth, however, avoiding overloading of this and maintaining good muscle strength, tone, and flexibility are clearly important assets.

Few among us give much attention to the subject of spinal loading or the amount of stress and insult being directed to our spines on a daily basis.  As it turns out discal loading varies considerably during a normal day depending on body position.

Nachemson300GIFThe  illustration at left has been redrawn from the classic work of Alf Nachemson (Nachemson A: The Load on Lumbar Disks in Different Positions of the Body, Clin. Orthop., 45:107-122, 1966).   In shows loading (in kilograms) recorded from intradiscal pressure transducers inserted into the L3 disc space of volunteers. Not many realize that there is more loading in the sitting, rather than the standing position. Even when recumbent there remains some loading on the spine.

 

 

Floating200GIFThe great advantage of floating in water is that there is no associated body loading.  For this reason swimming, and particularly aquatic aerobic exercise are spine friendly as a means of occasionally unloading the spine.  A number of different devices including aquatic treadmills (to be placed in swimming pools) have been produced and self-contained aquatic exercise tanks have also been developed to assist aquatic aerobic exercise.

 

 

Accordian200JPGThe Logic of Intermittent Spine Unloading/ Distraction (Traction)

Unloading simply means that the amount of loading is decreased.  Traction (or distraction) relates to an influence beyond zero loading.  This has been a difficult concept for most individuals to understand.  The simile is that of the accordion player who does not simply continue to compress the instrument but compresses, and then expands.  The human spine is compressed throughout the day by standing, sitting, or walking.

At night spine loading is minimal but still present.  To intermittently expand (distract) the spine allows for better trans-endplate diffusion and convection of nutrients, reverses the degenerative process and also begins to reverse disc protrusion as well as providing a reversal of the process of lateral foraminal stenosis and progressive scoliosis.  In fact spinal traction has been an important therapy in health care for thousands of years.

Intermittent spinal distraction, through exercise or devices, experienced on a regular and long-term basis is very important, not only for spinal health maintenance, but for spine disease prevention.

Once the adversities of poor parent selection (genomics) and the acquired insults of loading of the spine in daily life becomes better appreciated it then becomes possible to begin to explore more logical and scientifically established means of safely improving spine health.  The key to good spine health maintenance is to decrease the daily insults to it as well as enhance spine nutrition and health by the induction of safe and intermittent negative discal pressures designed to enhance nutrition and healing by reversing the effect of gravity.  We know that when intervertebral discs degenerate they loose their normal strength and become subject to tears, from rotational stress, and herniation from compressional forces.  By the regular introduction of safe anti-gravitational distractive influences it is possible for an individual to actively promote good disc health.  The term “safe” refers to distractive forces not exceeding the compliance of normal disc or ligamentous tissue.  The science of increasing the life expectancy of the disc normal beyond “normal” is part of the concept of “eugonomics.”

GLRrussia200GIFThis image shows clients at a health spa in Kiev, Russia being suspended from harnesses in natural warm springs.  This spa has been actively treating clients in this manner for centuries. The treatment being provided is basically sound.

The problem with such insightful technologies is similar to the Gaiffe TENS device produced in Paris in the 1880s. While the basic concept is logical the designed application is inadequate to achieve intended results (as were many of the devices designed by Leonardo da Vinci). This support shown has only minimal effect on the discs themselves.  From the standpoint of treating associated pain and spasm by applying “heat therapy” the activity benefits the patient by addressing the symptoms of the problem rather than the problem itself.

AquaticAer200GIFAquatic Spine Unloading/ Distraction A more modern, and much more effective Kiev Spa therapy is shown at the left.  Here the individual’s body weight is being supported by a inflated inner tube and scuba diver weights are being worn around the waist to allow for spinal distraction. The method is inherently safe because the force exerted is self-limited and the compliance of normal tissue is never exceeded.

This activity can be performed in shallow water.  For those with access to a warm pool the most optimal application would be 2-3x/ day, on a daily basis.  Unloading/ distraction is most meaningfully utilized in the afternoon and evening when rotational and continued compressional forces have begun to exert their most deleterious effects. The modern technology of spine unloading/ distraction has come a long way since the Kiev spa but there is little knowledge of this in the community or in the health professions at this time.  With the advent of genomic screening techniques public awareness will most certainly raise the awareness of the health care community in the future.

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