As a musculoskeletal specialist I have been treating patients with lower
back pain for almost a decade. It is imperative to realise that optimising the
body for the tasks that the patient wants to achieve is vital for the success
of any treatment program. Over the last decade our world has changed
tremendously with respect to the typical requirements that patients need. We
sit on our travels to work, we sit at work, we sit on our travels back home and
then we sit again when we are at home. This is coupled with bouts of exercise
by some people, anything from regular to random. So how the spine adapts to
these new requirements could be argued as a significant cause of lower back and
neck pain. From a biomechanical perspective the lumbar sacral junction (L/S
junction) is the foundation of the entire spinal mechanics and most adaptations
are based on this foundation. We know that when the spine is hyper flexed for
long periods, especially when loaded as when lifting an object the discs will
over time begin to degenerate. This degeneration could lead to many different
· Reduced disc height leading to approximation of the facet joints.
· Annular tears, disc bulges, disc prolapsed, leading to a change in the
chemistry of the disc thereby affecting disc function.
There are many more knock on effects that disc degeneration has on the
biomechanics of the spine however there is an important contribution from the
L/S junction. If the L/S junction is flexed during most functions like sitting
and exercising the L5/S1 disc is placed in a compromised position predisposing
it to degeneration. Due to the shape of the L5/S1 discs it is another reason
that this is clinically the most common disc to degenerate however there are
other reasons for this like its position at the base of the spine thereby
taking more weight.
We also know from a biomechanical perspective that if there is an area that is
flexed in the spine there will be an area that is extended. Clinically patients
that present with an area of the spine that is hyper extended typically have
pain from the facet joints that have been approximated.
Since it is very common to find patients sitting with a flexed L/S junction
it should become more common to see patients presenting with lower lumbar disc
degeneration and middle/upper lumbar and lower thoracic spine degenerative
joint disease. This is probably due to the compensation that the spine makes to
maintain us upright. The cervical spine also has a difficult time compromising
from a flexed L/S junction. When the entire lumbar spine is flexed the cervical
spine will hyper extend creating faced approximation, patients typically
present with anything from hypertonic muscles to neurological symptoms in the
For long term success of treatment, the L/S junction needs to be in its
neutrally extended position when sitting, this will allow for a smooth neutral extension
of the lumbar spine as well as a neutral thoracic kyphosis and neutral cervical
extension. This will allow the scapula to sit on the ribcage in a neutral
position thereby reducing neck pain.
Should you have any questions or would like to know how to get the L/S
junction into neutral extension when sitting please feel free to contact us.
The information contained in this Newsletter was prepared
from medical and scientific sources which are referenced and are believed to be
accurate and reliable. The information herein should not be used to treat or to
prevent any medical condition unless it is used with the full knowledge,
compliance and agreement of your personal physician or other licensed health
care professional. Readers are strongly advised to seek the advice of their
personal health care professional(s) before proceeding with any changes in any
health care program.