Low-Back Pain? You May Have a Joint Workspace Problem

People don’t know if they have a joint workspace problem because they don’t know of an assessment that provides this information exists. Therefore, individuals will continue to exercise and do activities using or accommodating a dysfunctional joint or joint system. This creates a positive feedback loop whereby a person will reinforce joint dysfunction by never intervening at the joint level and continuing to do external work, neglecting the very thing that needs work.

Low-back pain (LBP) is probably the most common complaint I see in a clinical setting. LBP is also among the most complained-about issues doctors encounter with their patients. However, many doctors and patients are unaware that they can assess the spine and its joints, as well as other joints, to determine the actual cause of their back pain. Unfortunately, this lack of awareness can lead patients down a challenging path of treatment “care.”

Trying physical therapy, chiropractic, Pilates, yoga, foam rolling, kinesiology tape, percussion guns, and funky-shaped tools to “release” their psoas, along with breathing exercises and blowing up balloons, bird-dog exercises, inhibiting this and facilitating that—I could go on and on with the things myself and clients have done in an attempt to relieve back pain.

A client has never come to me after seeing their doctor, PT, chiropractor, or other professional and told me that they were diagnosed with a joint workspace problem, except for an MRI report, which results they cling to. Rather, they’re just given a list of exercises to do for a number of weeks and temporary relief tools.

Unfortunately, there isn’t a simple solution to the shortcomings of our medical system problem. On the other hand, I hope to provide reassurance that there are practitioners out there who assess and manage the care and true nature of such cases of LBP. 

It is my job as a manual therapist and practitioner to enlighten clients about themselves and their current physical capacities to unravel the problem of their current physical state, ie, low-back pain. 

Using a logical and appropriate assessment method is needed to gather information about a person’s current physical state and joint function. Understanding the physical capacities of a joint will allow us to intervene at the appropriate joint level and begin to create a negative feedback loop by doing joint-specific training work.

What is a joint?

Briefly, let’s discuss what I mean by a joint.

A joint is the connection of two or more bones and the ability for motion to occur relative to one another. The space between these bones is joint workspace, and the connective tissue that encapsulates those bones is known as the joint capsule and is our capsular workspace. Joints are often made up of several other elements of connective tissue which include ligaments, tendons, and cartilage. 

Joints are plastic to training, and joint-specific training will elicit positive multifaceted effects to change the physical state of the joint in ways that increase function, fitness, and health. 

 

Case Example

Recently, a client came to me who was experiencing low-back pain. We did three different spine assessments, each of which focused on the fundamental joint range of motion of the spine, flexion, and extension. Majority of cases that I see, the client lacks one or both of the fundamental ranges of motion in the area complained about.

The goal of each test was to see how much joint workspace had access to and could control.

First, we assessed his entire spine. This test showed that he has a point in his mid-back that moves the most, while other areas of the spine move in large chunks versus segmentally or joint by joint — we call these hinge points. Next, I had them do a test that focused on the thoracic spine, again only in flexion and extension. This was his better “stuff”; he was able to move it some each way on his own, and after some verbal cueing and tactile feedback, he was able to improve and explore the current joint workspace of his entire thoracic spine. Last, we assessed his lumbar spine or lower back, where his main complaint was. This lumbar-specific test revealed he essentially had NO useable joint workspace. His lumbar spine not only hardly moved and sought compensation in the hinge point but moved in one large chunk rather than in five segments. 

This last assessment revealed a few things; one, from an information perspective, his nervous system has no clue that it has five individual joints to organize with and use, basically just a rod. Because of this, he has no idea how to control and move that stuff. Further, none of these segments are able to move actively, so there will be atrophy in the deeper tissues whose job it is to move the individual segments of the lumbar spine—the multifidus muscles. Based on all of this information, we know exactly where we can start to intervene from a treatment and training perspective. 

Our job is to begin by learning how to contract the deep tissues of the lower spine, essentially putting a spotlight on the joints and deep muscles and telling the nervous system, “Hey, look at this stuff!” 

It may not seem like a lot, but for a nervous system that has not had any type of experience with that tissue in decades, it’s a big deal. 

This is where we are going to live, treat, and train for a while, learning to fire that stuff and learn to move those five joints in their fundamental ranges of motion. Over time, we will improve the nervous system’s action map, having more access to more “stuff,” and teach it how to use that stuff to move individual joints through space, thus providing more information. 

This is low-hanging fruit. A simple place in the system to intervene and create massive changes—cumulative multifaceted effects. Being that it has been years upon years of receiving little to no information from the lumbar spine, any new and relevant information we do provide, the CNS will gobble it up like a little fat kid. 

It is important to realize that LBP can be a complex problem that can be managed with simple solutions if there is a logical means to assess the root causes and a logical and appropriate means to intervene.

The problem is navigating the medical system to find such an assessment and practitioner. I recommend self-advocating and doing the research and networking to find trusted health practitioners. 

Don’t let the system define your care. Create your own care. You can create your own choices from people you trust and build your own network of care choices.