The many functional conditions of the spine and nervous system can mimic each other and overlap in signs and symptoms. As each should be treated individually, its vital to obtain an accurate diagnosis from orthopedic, neurological and functional movement pattern testing combined with relevant imaging. Whether disk injury, sciatica, or muscle strain every person responds differently to treatment, its important to have a wide range of therapeutic tools and find a combination that suits the individual. Paramount in treating any musculoskeletal injury is addressing the underlying causes and aberrant responses to that injury.
Some injuries are the result of significant trauma like whiplash, but most are the result of a culmination of undetectable micro injuries and aberrant patterns of movement that over a period of time add up to a significant lesion. Its common for patients to report an injury just creeping in or sustaining a significant injury doing something innocuous, like bending to pick something up. This process happens via a breakdown in unconscious, moment to moment, spinal control rather than a loss of strength per se. A vital part of treatment for most injuries is the rehabilitation of spinal control, by waking up the circuits responsible for sensing movement in the spine, processing the information and generating spinal stability.
Common to most back and neck injuries is an overlay of pain and dysfunction in the muscles. The brains response to pain, injury or even movement outside the range of what the brain deems safe, is to initiate a guarding muscle spasm to splint and protect the spine. This will eventually become pathologically tight and painful itself, what is commonly called a pain-spasm-pain cycle. This painful wind-up of the muscles is often perpetuated long after the resolution of an injury and breaking this cycle is a vital part of therapy.
The brain is not hard-wired; it undergoes plastic changes or re-wiring in response to pain or decreased activation. Functionally this can be seen as the brain changes movement patterns to avoid pain or displays aberrant movement as a response to inadequate input to the brain on how you are moving. It doesn’t take long for these aberrant patterns and weakened responses to become the norm and is the basis for re-injury and chronic conditions. Thankfully this process of plasticity can move in a positive direction, spinal adjusting and brain based rehabilitation exercises improve movement representation in the brain and re-establish healthy brain activation and output.
Treatment for most back and neck injuries involves an intensive series of manual therapy visits to address the specific injury, followed up with further therapy and exercises to restore adequate spinal control, movement patterns, conditioning and posture and return muscular tone of the spine to normal levels.
