Chapter 1 Introduction

Back pain is usually a symptom of dysfunction in the musculoskeletal system.

Janda¹ suggests that pain, however undesirable, serves an important biological function acting as a warning signal that all is not well in the movement system. It may be functioning in a harmful way and rather like the warning light on your dashboard reminding you the car needs a service, pain heralds the ‘tipping point’ in a continuum of dysfunction. Addressing the dysfunction will generally ameliorate the pain. However, classical Western medicine has by and large tended to view pain within a ‘disease model’, hunting for ‘the pathological’ structure in order to arrive at diagnosis and ‘fix it’. As we all know, the results have been less than promising and there is now a shift towards the possibility that disturbed function may be more important than structural damage as the physical basis of back pain.¹ When the dysfunction and pain continue unabated, secondary factors such as disability and psychosocial factors begin to create a complex picture of interlocking dysfunctions. The ‘biopsychosocial model of dysfunction’² acknowledges the multifactorial nature of the ‘problem of back pain’ and contemporary treatment approaches generally embrace addressing each aspect as indicated.

Back pain is fundamentally a physical problem and the focus of this book is to primarily address the ‘bio’ aspect – the physical perspective of back pain.

Gracovetsky³ has said ‘restoring the function of the injured patient implies knowing what the normal function is, something which is still the subject of speculation’. In similar vein, Van Dieën⁴ states ‘the relationship between low-back pain and motor behavior is poorly understood. Consequently the (para) medical disciplines involved lack a theoretical basis for treatment and outcome evaluation’. Moseley⁵ asks ‘what is it about pain that changes the way people move?’ Conversely, one could ask: ‘what is it about the way people move that causes pain?’

The aim in this work is an attempt to assist the understanding of normal movement function and the nature of movement dysfunction seen in spinal pain patients. Understanding how and why movement is altered goes a long way towards effectively redressing it.

Related posts:

Changed control of posture and movement: the dysfunctional state Classification of muscles The analysis of movement Clinical posturomovement impairment syndromes Common features of posturomovement dysfunction Therapeutic approach

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