Physiotherapists in High Peak treat many different conditions including the issues profiled below.

Good and Bad Lumbar Posture

Good and bad lumbar posture has often been decided on grounds that are not sufficiently scientific and future recommendations need to be based on solid research. Early research on the effects of different spinal postures indicated that maintaining a lumbar lordosis reduced the pressures inside the disc nucleus. This seemed fine until it was realised that these pressures were being transferred to the rear disc walls and the facet joints. As the facet joints are known to be frequent causes of low back pain and the nucleus of the disc is not a source of pain the idea that a lordosis is desirable in all circumstances does not stand up to examination.

Overall having some flexion in the spine is better in static positions whilst a slight lordotic posture is better when walking. Too much flexion interferes with the ability of the muscles of the back to protect the spine, so a moderate position should be taken between too much flexion and too much extension. The benefits of slight flexion are mirrored in the typical habits of people in postures, such as crossing the legs or putting a leg up on something at a bar, both actions which increase the flexion of the lumbar spine.

Back Pain and Pathology

It is difficult to connect back pain symptoms to causative factors but some pathological findings are easier to link. Disc herniation can be objectively observed on MRI scanning and is reliably connected with sciatica but MRI scans on normal subjects show disc herniations in people who do not have symptoms. Lumbar disc degeneration seems very common in people of middle age but it is difficult to clearly define so that it can be measured in a way relevant to clinical practice. Disc degeneration starts sooner and is more developed in the L4/5 and the L5/S1 disc levels than in higher lumbar levels.

Even 15 year old school children have been found to have a significant incidence of these disc changes, with the incidence rising to close to 100 percent in people who have reached 50 years of age. MRI findings are not well correlated with requirements for medical care for back pain or for the levels of disability which can result. Narrowing of disc spaces, bony outgrowths and increases in bone density are connected to a degree with levels of back pain. Eastern societies which depend a lot more on the squatting posture are reported to have lower levels of degeneration than western societies.