Leading Spine Care by TEACHING MDs how to RECOGNIZE, APPRECIATE and REFER patients for biomechanical spine assessment and diagnosis.
Accepted Laboratory Science
DOES NOT EQUAL
Accepted Clinical Pathways
When it comes to bringing accepted laboratory biomechanics into daily clinical pathways, it seems that our healthcare system is not doing very well. This paper was reviewed and I am using them to introduce you to do some updated concepts. There will be more information introduced but it is important that you start to get the basics of the conversation.
Presented here is the conceptual basis for the assertion that the spinal stabilizing system consists of three subsystems. These should all sound familiar to you but start thinking about the words being used, this is what we are piggybanking on to educate the medical community, this is straight out of the clinical biomechanical laboratory.
The vertebrae, discs, and ligaments constitute the passive subsystem.
All muscles and tendons surrounding the spinal column that can apply forces to the spinal column constitute the active subsystem.
The nerves and central nervous system comprise the neural subsystem, which determines the requirements for spinal stability by monitoring the various transducer signals. and directs the active subsystem to provide the needed stability.
A dysfunction of a component of any one of the subsystems may lead to one or more of the following three possibilities:
(a) an immediate response from other subsystems to successfully compensate
(b) a long-term adaptation response of one or more subsystems
(c) an injury to one or more components of any subsystem.
It is conceptualized that the first response results in normal function, the second results in normal function but with an altered spinal stabilizing system, and the third leads to overall system dysfunction, producing, for example, low back pain. So PAIN is the last to show and the first to leave, sound familiar?
In situations where additional loads or complex postures are anticipated, the neural control unit may alter the muscle recruitment strategy, with the temporary goal of enhancing the spine stability beyond the normal requirements.
Panjabi, M. M. (1992). The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. Journal of spinal disorders & techniques, 5(4), 383-389.