The causes of limitation of motion are numerically legion. Statistically, mechanical factors account for approximately 90% primarily and is an accompanying secondary factor in many of the remaining cases. The physiology of ligamentous contracture is briefed in the preceding chapter. Sufficeth to say, strains and sprains may rent fascial tissues, but contrary to popular belief, this is seldom due to heavy lifting. Usually the patient does not know exactly when the injury occurred; it gradually became apparent over a period of time and frequently after a period of rest.

Pain supercedes movement; immobility causes more shortening and more spasm, thence more pain and a vicious cycle is initiated.

Differential Diagnosis

Remarks -- It is not within the scope of this passage to detail each possible entity which could cause back pain. For the sake of brevity, general categories will be outlined and specific diseases will be listed without discussion.

Glandular deficiencies -- hypoadrenalism and hypothyroidism (these cause change in muscular consistency); hypoestrinism and hypoadrenalism (results in tightening of ligaments); hypo-pituitarism; hyperparathyroidism and osteoporosis.

Systemic and infectious diseases -- Arthridities, gout, malaria, syphilis, poliomyelitis, meningitis, encephalitis, tetanus, herpes-zoster, upper respiratory infection, influenza, anemias, chronic alcoholism, multiple sclerosis, diabetes, arteriosclerosis.

Emotional disorders -- Deep seated vexations causing nervous or emotional maladjustments, conversion hysteria, compensationi-tis.

New growth -- Tumors of spinal cord, meninges, vertebrae, metastatic implants, tumors of pelvic area, fat nodules, cancer of prostate, and visceral carcinomata (cancer of abdominal organs).

Visceral referred -- The nephridities, cystitis, ureteritis, prostatis, pelvic inflammatory disease, broad and round ligamentous stretching, ovarian dyscrasias, pancreatitis, anal disease and infrequently referred from remainder of gastro-intestinal tract and abdominal aortic aneurysm.

Mechanical (90%) -- Congenital defects as, spina bifida, spondylolisthesis, spondylosis, facet or apophyseal joint abnormalities, lumbarization, sacralization or blocked (fused) vertebrae. Sciatic neuritis, bursitis, tendonitis, myofasciitis, fibrositis, coc-cydynia, traumatic sprain and strain with fascial tears and muscle spasm, osteomyelitis, pyriformis, muscle syndrome, knee pathology, foot pathology and herniated, or slipped interverte-bral disc. It is interesting to note the discrepancies of statistics in herniated disc diagnosis. Howbeit, 90% of proven disc cases respond to conservative treatment. Sacro-iliac strain as a cause of back pain is highly exaggerated; simple anatomy will discount any suggestion to the contrary.

Temperature change and moisture -- Contraction of ligamentous structures results from sudden temperature changes, particularly chilling, or after sudden air drying of wet skin.

Postural defects -- Instructions toward proper posture and postural habits should begin in the home and school; adolescence is particularly and important time for vigilance against poor posture habits. The body has a proper initial alignment, but also must shift to maintain erect position. If one area cannot relax normally or tighten coordinately, then its opposite acting muscle will have to guard balance movements constantly. This brings on undue fatigue of muscles and strain of connective and supportive ligaments. A few faulty posture conditions which contribute to low back pains are: over-curvature of lumbar spine (sway back), obesity with sagging abdomen, flat chest with protruding chin (stoop posture), shortened Achilles tendon and proated feet.

Therapist In This Field

Orthopedists and other M.D.s are not the only practitioners interested in low back and fascio-myositic cases. Osteopaths manipulate the spine and muscles to some good effect; furthermore, their educational background teaches them to realize their limitations. Chiropractors practice on the theory of vertebral displacement causing pain on the nerve root as it exits from the intervertebral spaces; their inherent basic medical backgrounds assures a certain amount of danger due to sins of omission and it is hard to conceive of their cure to a backache of anymore than primary muscle spasm or of psycho-genie origin.

Masseurs, naturopaths and various other cults thrive on the inadequacies of treatments by organized medicine. However, organized medicine is beginning to realize the value of physical medicine; physical therapists and even physiatrists are accepted members of medical societies and ancillary professional associations.