Question
I woke up one morning, my back felt stiff, not in pain. So I usually stand in one place with my feet facing forward and turn my upper torso to the left and then to the right as far as I can. Didnt sound like a normal crack though...in all honesty it sounded like a machine gun!

I ignored it and got on the excercising bike and then lifted weights that day. Well later that night if I sat still on a chair, and leaned my neck forward it would hurt really bad! But if I'm up and walking it's fine, it just feels like when im sitting down it all builds up with this amount of pain.Now this is the second day...my upper and middle back still hurt..and everytime my neck leans foward it shoots a pain down my back, specially when im sitting down....

What could it be, disc split, pulled muscle, poor posture...and also I sleep with a lot of pillows and my boyfriend gets on me about that? Could that be the case....I need advise! Thanks for the time on helping me, I appreciate it

Answer
Dear Rachel,

This does not sound like a disk problem per se, with pain going down the center of the back, it is more likely to be a pulled muscle either in the fibers of the trapezius, the rhomboids, or the erector musculature. However, you could have easily disrupted the outer fibers of the disk (annulus fibrosus) which will result in appreciable pain patterns that are diffuse and hard to pinpoint.

Concerning the effect of poor posture, this is a likely scenario especially with the report of sleeping with a lot of pillows.  Your boyfriend is correct...you need to stop doing this.  You should only be sleeping on one pillow maximum, and that pillow should be a cervical pillow that provides support to the curve in the neck while NOT pushing the head forward.  You probably have a reduced neck curve with forward head movement on the neck in relation to the chest, and this is problematic.  It increases the gravitational stress on the posterior neck and back musculature, and predisposes the tissue to injury.

揊or every inch of forward head posture, it can increase the weight of the head on the spine by an additional 10 pounds.?Kapandji, Physiology of Joints, Vol 3.

揕oss of the cervical curve stretches the spinal cord 5-7 cm and causes Disease.? Dr. Alf Breig, Neurosurgeon (Nobel Prize Recipient)

揊orward head posture leads to long term muscle strain, disc herniations, arthritis and pinched nerves.? The Mayo Clinic, Nov. 3rd, 2000

?0% of the stimulation and nutrition to the brain is generated by the movement of the spine?Dr. Roger Sperry, (Nobel Prize Recipient for Brain Research)

Additionally, Dr. Sperry demonstrated that 90% of the energy output of the brain is used in relating the physical body to gravity.  Only 10% has to do with thinking, metabolism, and healing, so when you have forward head posture your brain will rob energy from your thinking, metabolism, and immune function to deal with abnormal gravity/posture relationships and processing.

Now, concerning the twisting and cracking of the back in the morning...you should not be doing this.  This is considered a long lever torque movement, and it does not address fixated vertebral segments in a correct manner.  What you are doing is creating instability in the adjacent vertebral levels of the spine above and below the fixated segments.  Over time this leads to dysfunctional ligamentous stabilization of the spine and degeneration of the facet joints and the disk fibers...NOT GOOD!

Rachel, my advise to you is to have the area looked at by a chiropractic physician, and get these issues addressed by a professional.  Additionally, I am going to include information on training exercises you can perform throughout the day to minimize stress on the spine, and to address ergonomic issues when in seated positions, and at the computer.  See below:

Training for Stability of the Neck and Back匩ot What You Think!

A brief look around any boardroom, construction site, grocery store etc?will provide any observer an insight into poor posture and de-conditioning syndrome. A deconditioned individual has only one option for lasting pain relief which is increasing their functional capacity. The average teenager and adult have pronounced spinal displacements due to chronic poor ergonomics of basic living, poor posture, and constrained working environments.  Back or neck pain is the number one reason for a visit to the chiropractic physician and medical doctor!  Shouldn抰 you work to prevent injury and strain?  The obvious answer is yes!

The most common reasons for back and neck pains are poor lifting techniques, abnormal posture, and repetitive micro-strain coupled with the lack of stability within the muscular system, and trauma.  It is sometimes difficult to avoid trauma, but if you eliminate poor technique, improve the ergonomics of your work station, and train your spine for stability, you significantly reduce your risk of injury.  Remember that we live in a gravity controlled environment and all muscular actions are in direct opposition to gravity.  We stabilize bridges and buildings so they won抰 buckle or break, you need to do the same for your spine.  

That being said, conventional strength training with free weights and isolation machines will give general overall gains in muscular strength if utilized properly, but won抰 necessarily target stability of the core or the spine.  Muscles to target are the multifidus, rotatores, intertransversales, transverse abdominis, and the pelvic floor.  Moreover, it is important to train for balance and symmetry thereby reducing abnormal weight bearing on all joints of the body.  

Lifting technique is important for optimal health and the reduction of injury.  To execute a lift properly, the back should be fairly straight while maintaining the normal lordosis (forward arch of the low back).  This position will activate the musculature properly for stability while not recruiting the ligaments for support.  Squatting is optimal, due to its neutral spinal position and the ability to use the muscles of the legs to accomplish the lift.   Stooping should be avoided, especially with repetitive movements.  Stooping creates an unstable configuration for the disk with increased tensile pressure on the posterior portion of the disk due to increased compression on the anterior portion of the disk.  This can easily result in a rupture of the disk.  In addition, objects should not be lifted if they are placed awkwardly which may require twisting and or bending, weights should be held close to the body, and jerky movements are only appropriate for highly trained individuals such as advanced athletes under the supervision of a trainer.  The last key is to create contraction of the abdominal musculature before the lift. This provides greater stabilization the spine, and your entire core.  You can easily accomplish this by sucking the belly button in toward the spine.  This activates the transverse abdominus muscle which is key for all movements.

One of the most deleterious activities people engage in is sitting. Sitting increases disk pressure more than standing and encourages abnormal flexion (forward bending) of the neck and upper back in addition to slumping in the chair.  These postures chronically load the disks, ligaments and musculature of the spine creating micro-injury and dysfunctional movement patterns.  

Many of us spend the majority of our days at a desk, computer or workstation.  We need to consider and modify our workspace carefully.  Adding a support for the lumbar spine reduces disk pressures.  A seatback angle of 5-15 degrees from vertical will reduce low back muscle activity and disk pressure.  Proper desk height is approximately 30 centimeters from the seat of the chair.  Arm rests are important in limiting strain on the upper muscular complex of the back and neck to include the trapezius, rhomboids, and levator scapulae.  The shoulders should be able to relax with the elbows bent at 90 degrees while the hands rest on the desk surface.  

Forward movement of the head on the neck is extremely problematic. For every inch forward the head moves in relation to the neck and shoulders, the compressive forces on the lower neck increase by the entire weight of the head, 10-16 lbs. Think about the difference in holding a bowling ball close to the body, or away from the body. This illustrates the differences in muscular work needed to support the weight and the ligamentous strain.  Computer monitors should be elevated so that the center of the screen is at eye level while looking straight ahead.  This will reduce eye strain; further reduce muscular tension of the neck while limiting the forward flexion of the head, therefore reducing the abnormal loading of the ligamentous complex.  This will also help reduce those 搘ork headaches?  Placing the monitor higher to induce a slight extension of the head is permissible.

Now that you have proper technique, and your workstation is optimal, structural and functional training of the musculature on the back of your body and your core is the key.  You must have a balanced and relaxed spinal cord for optimal function.  That being said, specific training is the way to achieve spinal balance and stability, and you don抰 have to go to the gym to achieve it.  If you can appreciate that we spend most of our days in a flexed position, the way to relieve that cumulative stress is to train the small stability muscles in an extended position.  

Most people are flexed forward at the hips/pelvis, have rounded shoulders, and a forward head and neck, this is called Global Flexion.  Extending the head backwards, opening up the chest by turning the palms of your hands outward and stretching your arms backwards relieves this global flexion.  The last step is to stand up and bend backwards at the waist approximately 20 degrees. You have just accomplished the task of Global Extension.  If you flex or tighten up all you muscles while in this position it further accentuates the value of the exercise and also promotes increased blood flow and oxygen delivery to the body.  This is a relief position that everyone should use frequently throughout the day to abate cumulative postural stresses.

Moving on, posture is the next consideration.  Your posture should not be a conscious task, but with the level of deconditioning in the population, conscious postural improvements are necessary.  This is mostly common sense, and your mother has telling you to do this since you were a child.  Exercise your postural muscles while walking.  Stand up straight, hold your head up high and walk with confidence looking ahead of yourself, not at the ground.  Pull your shoulders back, breathe deeply, and take confident long strides.  This alone will bring more oxygen to your body by fully opening up the lungs, increasing blood flow, and reducing abnormal stress on spinal structures.  You can also practice this position on a physio-ball or thera-ball to improve your seated posture and balance.  Complex postural issues and stability issues need to be addressed by a professional.

Remember that weight training, aerobic activity, and general fitness types of activities are only good for you if done with proper form, balance, control and stability.  If you don抰 have good posture and spinal symmetry, a traditional workout program will only make those problems worse.  It is essential to incorporate stability into your spine and your life before starting any exercise program.  You should see a medical or chiropractic physician before starting a fitness regime to make sure you are in good health and able to handle the rigors of increased physical activity.  If you have any cardiovascular issues, a stress test should be performed.  Many subsequent doctor visits are caused by improper fitness activities; it is better to see you doctor before rather than after.

All chiropractic physicians will be able to teach you about postural imbalances and how to improve your own posture, but many chiropractors have additional post-doctoral training in advanced postural biomechanics and structural correction to help you attain improved spinal dynamics.  Ask your chiropractic physician to tell you about their training, and provide written documentation about their qualifications.  To learn more about postural correction check out www.idealspine.com. In addition, a Certified Pilates instructor, www.nypilates.info, www.pilates-trainning.com or Certified Personal Trainer www.nsca-lift.org, www.ncsf.org  can have great benefit.  Remember to check their qualifications as well.

Respectfully,
J. Shawn Leatherman, BA, BS, DC, CCST, CCSP?br> Director of Clinical Rehabilitation
Suncoast Healthcare Professionals
www.suncoasthealthcare.net