Acute functional blockage of the spine

Acute functional blockade of the spine occurs when one of the facet joints is displaced.

What is acute functional spinal block?

When you make a careless movement, a sharp pain pierces your back like an electric discharge. This is an acute functional block of the spine. The pain, like a lightning strike, strikes a person at the very beginning of the movement, leaving him bent double, motionless and unable to straighten up.

The slightest movement causes you extreme pain. You can neither bend, nor straighten, nor move your leg. This is a truly critical situation. Often your knees simply give way, and you sink to the floor, and in order to move you from the spot, you may need an injection of pethidine (a narcotic analgesic, similar in action to lidol or promedol). This is a very frightening experience, difficult to forget for many years.

Such an attack can occur at any time: when you turn over in bed, get out of a car, move a chair, bend over to pick up a toothbrush, pick up a bundle of laundry, etc. In one patient, it happened when she was zipping up her dress. The characteristic feature of all these cases is the complete unexpectedness of the attack: after all, it would seem that you have done nothing special. Moreover, the lack of tension and the ordinariness of what you were about to do seem to play a key role here.

For me as a therapist, acute functional spinal block is one of the most discouraging conditions. During the crisis, patients are in an emergency situation; the very thought of movement is unbearable for them, and they are hysterically afraid of anything that might provoke a second attack. Long after the first attack, they are afraid of its recurrence, and some even feel that their lives will never be the same again.

Over the years, there have been many speculations about what might be causing this phenomenon. Although an acute spinal block feels like something has popped out, it is clear that it is not a disc. However, there is no objective evidence to explain exactly what has happened. There are no abnormalities on X-rays or any other type of scan, and neurological evaluation does not indicate disease. But here we have a suffering person, immobilized and helpless on the floor, as if in a frozen frame of a film, literally numb with pain.

The most popular explanation was that the meniscoid (a tiny wedge of cartilage at the edge of the facet joint) was pinched between the two articular surfaces, causing an immediate protective spasm of the back muscles. A similar, and more likely, explanation pointed to pinching of the sensitive tissue of the synovial membrane between the two articular surfaces.

I believe that the main reason for the "locking" of the facet joint is a short-term loss of coordination in the movements of the spine, due to which the facet joint is slightly displaced. The spine is caught off guard by the movement that has begun, and one of the facet joints protrudes slightly from the general line.

The shift is almost imperceptible, so it is simply impossible to discern the displacement of the joint. But the problem is not the shift at all. The problem is the reaction: the immediate and powerful defensive response of the muscles that lock the spine, which literally takes your breath away.

There is no such protective response when any other joint is dislocated. (Many of us have experienced what it is like to have a dodgy knee, when the kneecap temporarily comes out of the joint.) But the spine has a serious responsibility for supporting the entire musculoskeletal system and protecting the delicate web of nerve endings inside the spinal column, so it reacts very sharply to any threat to its integrity.

When the facet joints of the neck are blocked, it is quite easy to return them to their normal position. The cervical vertebrae are easily accessible, so manipulations with them are much easier than with the lumbar ones, where a strong protective spasm makes it difficult to affect the segments. If you are lucky and quickly get to an osteopath, chiropractor or physiotherapist, a sharp pressure with the hand, which will cause a characteristic click, can unlock the joint and return the vertebrae to their original position.

Here are the miracle cures we hear about so often. This method instantly opens the joint so that the articular surfaces can then join together correctly. If all goes well, the joint immediately begins to move freely, and you can safely go home, completely free of pain. Any residual muscle spasm will disappear the next day.

However, much more often you only see a doctor when the muscles have already contracted so much that the joint cannot be opened by physical force. Any manipulation at this stage will only worsen the situation, further increasing the protective muscle spasm.

What causes acute functional spinal block?

• Natural weak spot early in the tilt.
• Limitation of mobility of the vertebral segment predisposes to blocking of the facet joint.
• Muscle weakness contributes to blocking of the facet joint.

Natural weak spot early in the tilt

The spine is extremely vulnerable to bending if it is not properly braced. It seems to me that the facet joint locks up when the spine is not prepared to bend as it passes through the weak spot at the very beginning of the bend.

The muscles of the back and abdomen contract simultaneously, creating a kind of belt around the body that protects the spine. They are an indispensable spring mechanism that supports the motion segments until the powerful system of muscles and ligaments running along the spine starts working. This mechanism gradually “lets go” of the spinal column, tilting it forward like a mechanical crane. However, neither the powerful long muscles of the back nor the posterior ligamentous apparatus come into action until the back is properly bent; and only then do they create sufficient tension to protect the movements of the spine.

Up to this point, the spine passes through an "unsprung" section of tilt, where it feels unsure and where it has to round slightly and rely on the abdominal muscles. The slight tension and rounding play a subtle but extremely important role, as they prepare the multifidus and transverse abdominal muscles, which control the tilt of the segments, for action.

But a minimal delay in one of the "partners" in joint contraction can cause a failure in movement. If the spine begins to move before both systems are fully alert, it is caught off guard, and one of the facet joints shifts slightly. The threat to the spine causes a powerful defensive reaction by the muscles, clamping the slipped joint so that it does not move further. It is this reaction that literally brings you to your knees.

This often happens during recovery from a viral infection. It seems to be caused by general weakness, when all reflexes are dulled and the abdominal muscles are unable to respond quickly and support the spine.

Blocking of the facet joints can also occur a day or two after serious physical exertion, such as repairs or digging a garden. Most likely, in this case, it is the excessive activity of the long muscles of the back and their residual increased tone that disrupt the natural harmony of these imperceptibly working muscle groups.

The story is always the same: your back has been stiff for a day or two, and it's been harder than usual to keep your stomach in. Then, when you least expect it, some trivial incident - too insignificant to be taken seriously - happens that can lead you to disaster.

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Limited mobility of the vertebral segment predisposes to blocking of the facet joint

Limitation of mobility of the spinal segment, in which the disc has already lost its properties, predisposes to spinal block.

One of the specific functions of the multifidus muscle (and its assistant on the other side of the facet joint - the yellow ligament) is to prepare the intervertebral discs at the lumbar level. When the spine begins to move, the disc should already be as tight and voluminous as possible so that the vertebrae do not move from side to side. If the disc has lost fluid and the pressure inside it has dropped, it is much more difficult for the muscles around the facet joint to prepare it for work. Therefore, facet joint blocking is more likely in a spine in which symptoms of limited mobility of the vertebral segment are gradually developing.

When the thickness of the disc has decreased and the ligaments holding the segment in place have weakened, the segment becomes more vulnerable. The facet joint, which provides stability at the initial stage, is unable to prevent minor movements of the vertebra, and unless there is support from consciously contracted abdominal muscles to compensate for the lack of joint function, the facet joint may slip slightly obliquely. When the abdomen is relaxed, any accident can lead to disaster.

Muscle weakness contributes to facet joint locking

Chronically limiting the mobility of a spinal segment weakens the muscles. When a segment cannot move, the small muscles that move it atrophy. This is especially true for the multifidus muscles, which are located directly on top of the facet joints and serve as their special protection.

When a segment slips, the multifidus muscle that controls the joint may not be able to do its job. This is especially important if you have a pre-existing problem in your back. For example, there is evidence to suggest that when the facet joint is mildly inflamed, the multifidus muscle "deliberately" under-works to keep the inflamed joint from becoming too compressed. While this may relieve the discomfort of the inflamed joint in the short term, in the long term the facet joint is left without muscle control to compensate for its inefficiency. The problem joint is ready to lock up.

Not only automatic suppression of muscle activity, but also their simple weakness can also cause blocking of the facet joint. Due to banal laziness and unwillingness to keep your body in shape, the fine coordination of the abdominal and back muscles is disrupted, so that they are unable to interact synchronously, creating support for the spine. At some point, they begin to act inconsistently, which makes it more difficult for the deep muscles to engage in work at the right moment. If they fail to slightly round the back at the early stage of the tilt, and two important groups of deep muscles do not create an optimal line of traction, the main element in the center of the moving segment - the disc - will not be properly prepared and the segment can slip. First of all, weak muscles are to blame here - during this movement, the multifidus muscle on the left side of the abdominal press is activated, and, unfortunately, many of us suffer from this. Due to muscle weakness, the "hydraulic bag" that should spring the spine becomes completely flabby. When there is almost no support for the spine from the abdominal cavity, the structures connecting the segments weaken, and the vertebrae hit each other when bending. Women in the last months of pregnancy and after childbirth suffer from this especially. When the abdominal muscles and ligaments are stretched and weakened, the entire muscular system is poorly prepared for the work of the spine. This can happen to any of us with exhaustion, poor physical condition, or recently acquired obesity. Joint blocking also often occurs during the recovery period after an illness, possibly due to general weakness. Food poisoning and flu are also commonly mentioned as risk factors.

The relatively weak ability of the multifidus to prevent rotation of the vertebra around its axis also contributes to the locking of the facet joint. Almost all of our bends involve rotation (we are not robots that move only up and down or left and right), and the multifidus, trying to limit the torque, looks like David in front of Goliath compared to the massive body. The rotation of the segment is only possible a few degrees, and only the multifidus (working on one side) has direct control over its vertebra. It limits rotation at the very beginning of the turn, holding it by the process and not allowing it to move either forward or to the side. (Another deep back muscle, the iliocostalis, also limits rotation of the vertebra, but only as you bend deeper.) All the other muscles that prevent rotation of the spine are located on the surface of the torso and do not attach directly to the spine.

What's going on with your back?

Acute phase

The electric shock of pain hits you early in the movement – almost before it even begins. A split second before, there’s an ominous feeling that your back is about to do something unnatural. The action itself is seemingly insignificant: you reach for your coffee cup, and suddenly the whole world stops. It’s not just that it all happened so suddenly, it’s just impossible to believe that such a simple movement could completely knock you out.

The pain shoots through you and leaves you completely helpless. You grab onto furniture for support, then your arms drop and you slide helplessly to the floor. At least there's no pain here, but you're like a beached whale - no one can move you. If this happens when you're home alone, it may be hours before you can get to the phone and call for help.

During this period, the unpleasant sensation of cramping alternates with excruciating attacks of pain with any movement. If you need to move your leg, you will have to move it centimeter by centimeter. When you try to lift your leg or move in any direction, the pain will surge again, and you will literally catch your breath.

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What causes back pain?

The acute phase pain comes from the muscles that have squeezed the entire spine to hold one joint. They react instantly as soon as they sense that the joint is trying to move. Oddly enough, it is your body's protective reaction that causes the pain. The muscle spasm prevents the joint from moving further, and also prevents it from separating and then coming back together in the right position. The muscles are stubborn, and they are the root cause of the problem.

Squeezing a joint that is still out of order will raise the same alarm bells as an injury. The back will not let go as easily as, say, a sprained ankle, perhaps because of its complexity and the disproportion between the tiny joint and the powerful muscles that protect it. Until these muscles feel they can relax, they will continue to guard the joint, preventing it from moving.

Special mechanoreceptors in the joint capsule tell the brain that the joint is tightly compressed. They do this when the joint is immobilized. and repeat the signal every time the muscles contract even slightly. A few hours later, new pain appears - this time from stimulation of the chemoreceptors of the joint capsule. They register the accumulation of toxins in the tissues, both from the initial damage to the capsule and from the slowdown of metabolic processes in it. As the concentration of toxins increases, the protective spasm intensifies, and because of this, the pressure on the joint increases, and therefore the pain becomes stronger.

Muscle spasm itself can also cause constant pain of the same nature. When blood pushes through the contracted fibers, metabolic products are not removed. Their concentration increases, they irritate the free nerve endings in the joint tissues, which is interpreted by the body as pain. In addition, convulsively tense muscles cannot pass through themselves a sufficient amount of oxygen, which causes a characteristic aching pain, with attacks of tingling after a long period of motionlessness.

Pain causes spasm, and spasm causes pain. If you do not start moving and activate the joint, this cycle will repeat itself with renewed vigor. Accordingly, when treating, it is important to quickly relieve muscle spasm and start moving. However, immediately after an attack, any movement seems completely impossible. At this time, your body seems like a continuous source of pain, and your back is hard as a rock.

At this point, it is best to give you intramuscular injections of petits (a strong painkiller) and a muscle relaxant. The first thing to do is to move you from the floor to the bed; the sooner you call the doctor, the better. For the sake of subsequent rehabilitation, it is best to go through this stage as quickly as possible.

If you or your doctor made a mistake during your first attack, you may never recover (either physically or emotionally). Many people with chronic problems believe that it all started with such an incident from which they never truly recovered. Twenty or thirty years later, they remember every detail and claim that their back never returned to normal.

Subacute phase

The acute crisis period should pass in a few days. Rest in bed and properly selected medications relieve muscle spasms, and it becomes easier to move. Your own position plays an important role here. Fear and internal tension only slow down the healing process. Stay calm and consciously force your back to move - this is the only way to heal and develop the joint.

As the muscles relax, you can get out of bed more easily, although turning over is still painful. The protective reaction gradually loses its strength, and the "armor" gradually weakens. If you move slowly and smoothly, there will be no sharp attacks of pain. You can now sit up, unless, of course, you make sudden movements, cough or sneeze; but doing something more complex, such as getting out of bed, is still very difficult.

The extensive pain gradually localizes to a small sensitive area, and it is easier to determine its source. At this stage, your back, although weak, is ready to start moving.

Chronic phase

When the disease enters the chronic phase, your sensations are almost the same as with facet joint arthropathy. After a protective muscle spasm, the joint often becomes incapacitated. It is necessary to restore its mobility as soon as possible, otherwise the problem will become chronic and will accompany you throughout your life.

As the injured facet joint begins to move gradually, the muscle spasm around it remains and your condition worsens. The joint capsule is compressed by scar tissue, but paradoxically, it remains weakened. Microscopic scars cover the entire joint and pull it tight, causing it to remain tight; but at the same time, the initial tear in the joint capsule and the weakness of the local muscles weaken it and make it more vulnerable to re-injury.

In extreme cases, the facet joint can become unstable. This condition is one of the most confusing puzzles for physical therapists. How to strengthen a compacted joint capsule when perhaps only its rigidity is holding the joint together?

This problem occurs with instability of any synovial joint, and it is very difficult to deal with. Therefore, it is better to tackle it early - after the first case of facet joint blocking - so that you do not have to deal with this difficult stage later.

Our goal is to get the joint moving quickly to avoid scarring. Even if the problem is long-standing, the joint still needs to be worked on. This can be achieved with deep back exercises, such as lifting the body from the edge of a table or, in a lighter version, bending over and touching the toes.

If the deep muscles of the segment are not restored, the back will be damaged with every rotational movement. You bend over to help an old lady carry her bag, and you feel a familiar pinch - you have overstrained the weak facet joint. The next day you are twisted and the familiar transverse curve with the hip pushed forward has appeared. The back is more tense on one side, you constantly knead it with your fingers to get relief.
Usually, this is the moment when people go to the doctor, because the weak joint is pinched more and more often, and it is becoming more and more difficult to restore it. If before it was enough to spend a couple of days in bed, now it takes ten; just one attack has passed, and now there is a new one. It feels like they replace each other.

What can you do for self-treatment in case of acute functional blockade of the spine?

In treating acute spinal block, you first need to overcome your fear so that you can at least move and turn over in bed. After the crisis has passed, it is important to work on the joint and then tighten the problem joint with a muscle band to secure it.

The best way to relieve muscle spasms is with muscle relaxants and painkillers, usually given by injection. Once the medications have taken effect, the back should begin to move to loosen the muscles and free the joint. As soon as possible (and as often as possible), you should begin to exercise - lifting your legs and pulling your knees to your chest. Usually in less than 24 hours you will be able to move your legs freely in bed and sit up.

The shorter this phase, the faster the healing process will begin. Relaxation of muscle spasm and restoration of normal mobility of the injured joint can be achieved by bending forward from a lying position. By making the abdominal muscles work properly, you thereby relieve the spasm of the long muscles of the back and promote normal sliding and rotation of the blocked vertebra. As soon as the joint begins to move, excess fluid is removed from it, and the pain immediately subsides. Treatment at this stage is in many ways similar to treatment in the chronic phase of facet joint arthropathy, although here the emphasis is on restoring muscle control over the injured joint.

The last stage of treatment is devoted almost exclusively to strengthening the various muscles that act on the diseased joint and improving their coordination. The strength of the deep muscles compensates for the stretching of the capsule and will ensure that the joint is not subjected to new tests. At the same time, stretching the long muscles of the back, especially with deep bends, suppresses their tendency to overactivity, due to which the deep muscles automatically weaken. Bending (in particular, touching the toes) helps to relax the back.

Typical treatment for acute functional spinal block

Goal: to relieve muscle spasm, relieve pressure from the pinched facet joint.

• Knee to Chest Pulls (60 seconds)
• Relaxation (with knees bent) (30 seconds)
• Knee to chest pull-ups
• Relaxation
• Knee to chest pull-ups
• Relaxation
• Knee to chest pull-ups
• Relaxation
• Raise your knees to your chin (5 times)
• Relaxation
• Raise your knees to your chin
• Relaxation

Take medications: intramuscular pethidine, muscle relaxants and non-steroidal anti-inflammatory drugs prescribed by your doctor. Stay in bed. Repeat the exercises every half hour, or less often if the medication makes you sleepy. Pull one knee to your chest, then the other. By lifting both legs, you risk disturbing your back and causing another attack of pain.

Duration: If you start treatment immediately, you can move on to the subacute regimen the following morning.

Typical treatment in the subacute phase of functional spinal block

Objective: to relieve muscle spasm, strengthen abdominal muscles, and begin to develop the clamped facet joint.

• Knee to Chest Pulls (60 seconds)
• Forward bends from a lying position)
• Relaxation (30 seconds)
• Knee to chest pull-ups
• Forward bends from a lying position
• Relaxation
• Swing your raised knees towards your chest
• Forward bends from a lying position
• Relaxation
• Forward bends from a lying position (10 times)
• Relaxation
• Forward bends from a lying position
• Relaxation

After completing the set of exercises, rest on the floor with your feet on pillows. Repeat the set three times a day, but do not rush. Remember that the first forward bends from a lying position will be more painful; make sure that your shoulders are straight during the exercise. If you rise with a straight back, you can only aggravate the situation. The pain may subside after the first bends from a lying position. If you find them too painful, you should move on to the exercises for the acute phase. Stick to the programs for the subacute phase until the bends become painless and you do not have attacks of pain with careless movements. This is usually achieved in 2-3 days.

Typical treatment for chronic spinal block

Objective: to relax the back, restore mobility of the facet joint, strengthen the multifidus muscle and abdominal muscles.

• Knee to Chest Pulls (60 seconds)
• Rolls on the spine (15 seconds)
• Cobra pose (10 seconds)
• Child's pose (10 seconds)
• Back Block Exercise (60 seconds)
• Knee to Chest Pulls (60 seconds)
• Forward bends from a lying position (15 times)
• Cobra pose
• Child's pose
• Block Exercise for the Back
• Knee to chest pull-ups
• Forward bends from a lying position
• Squatting (30 seconds)
• Bends with toe touch (3 times)
• Diagonal bends with touching toes (4 times on the sore side, 1 time on the healthy side)
• Squatting
• Toe Touch Bends
• Diagonal bends with toe touches

At this stage, your back still hurts when you make careless movements, but overall, you are feeling much better. You will experience discomfort from staying in one position for a long time or a nagging pain if you have spent a lot of time on your feet. In this case, you should lie down and swing your knees towards your chest until the pain subsides. You can move on to the next mode when your back almost does not hurt.

Typical treatment for near chronic spinal block

Objective: to restore mobility of the problematic facet joint, strengthen periarticular muscles, improve coordination of the back muscles.

• Tennis Ball Exercise (15 seconds)
• Cobra Pose (10 seconds)
• Child's pose (10 seconds)
• Back Block Exercise (60 seconds)
• Knee to Chest Pulls (30 seconds)
• Forward bends from a lying position (15 times)
• Cobra pose
• Child's pose
• Block Exercise for the Back
• Knee to chest pull-ups
• Forward bends from a lying position
• Lying Diagonal Twist
• Diagonal bends with touching toes (4 times to the sore side, 1 time to the healthy side)
• Squatting
• Diagonal bends with toe touches
• Squatting
• Body tilts from the edge of the table (12-15 times)
• Knee to chest rolls (15-30 seconds)
• Forward bends from a lying position (2 times to the sore side, 1 time to the healthy side)
• Squatting (30 seconds)

You don't have to do the entire exercise routine all the time. Once the pain has subsided, continue doing the tennis ball, back block, and diagonal toe-touch bends twice a week. However, you should squat more often during the day (especially when your back gets tired). The tenderness and weakness of the injured joint will remain for a long time, so you simply must continue doing exercises that support it. Remember that when bending toe-touch bends, movement on the sore side will always be more limited than on the healthy side.

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