We would not keep our cars for 30 or 40 years without some major work put into them, but we have difficulty thinking about our bodies in this way. Although modern medicine has made wonderful advances that have dramatically increased our life span, there have not been many discoveries about how to preserve and maintain the musculo-skeletal system. We do know that body structures break down with use, but the back seems to need more care than other parts of the body.

Most chronic low back pain is caused by the formation of adhesive scar tissue in the ligaments of the low back and sacral area. Most people think that muscle spasms cause their pain. What most do not know is that muscle spasms are a secondary phenomenon caused by injuries to ligaments or other structures that have difficulty healing. When muscles are injured they heal very quickly for they have a very rich blood supply. When ligaments are injured the form multiple adhesive scars that cause a great deal of pain when stretched. They do not heal quickly because they have a very limited blood supply.

Lower-Back Structure
The lower back is only about six inches long in an average-sized adult. It is bordered by the lower edges of the rib cage, the top of the hip bones and the upper portion of the triangular shaped bone at the base of your spine called the sacrum. There are five vertebrae in the lower back or lumbar spine. These are abbreviated L1, L2, L3, L4, and L5 as an easy shorthand. The lumbar vertebrae are held together by the supraspinous (X), interspinous (Y) and intertransverse (Z) ligaments. The iliolumbar ligament (D) connects the fourth and fifth lumbar vertebrae to the back of the pelvis (illium) via the bones that protrude at the sides of each vertebrae (A) called the transverse processes.

Functionally speaking the lower back actually has two segments that work together side by side; the five lumbar vertebrae and the sacrum. Here we will focus on the lower back; and discuss the sacrum in its own section.

Natural Alignment and Structural Abnormalities Together the five lumbar vertebrae form a forward curve, so that when you lie flat on your back on the floor with your legs straight you can easily slide your hand under your lower back. This natural shock-absorbing curve is necessary for the health of your lower back. A lower back without a forward or lordotic curve is out of balance and has less stability. A reverse curve, where the vertebrae are straight or curved to the back and actually hit the floor, impairs the shock absorbing function of the spine. This structural abnormality can make a person prone to back pain by interfering with the natural alignment of the spine.

Another structural alignment problem is spondylolysthesis (pronounced spondi-lolis-thesis). This is a congenital condition in which one vertebra is significantly out of line in a forward or back direction. (Illustration.) It is either forward or back, either toward or away from the abdomen, instead of sitting squarely stacked on its neighbor. The vertebra may be one-quarter to one-half inch out of alignment, and although this distance may not sound so substantial, it can create a lot of difficulty. People with this condition are more vulnerable to injuries to the ligaments and discs. Spondylolysthesis occurs more frequently in the lower back region than in other parts of the spine.

Scoliosis, an exaggerated sideways S curve of the spine, is an overrated cause of back pain. Extreme scoliosis will cause severe pain problems and will often require surgery but the common variety, which many people have, rarely causes problems in the low back. Low back pain is as common for individuals without scoliosis as those individuals with it.

© copyright Ben Benjamin 2001