Function of the spine
The spine is designed to permit movement, absorb shock and protect the delicate spinal cord.
The spine consists of 26 bones: 7 cervical (neck), 12 thoracic (middle back), 5 lumbar (lower back) vertebrae and the sacrum and coccyx. Intervertebral discs lie between each vertebrae acting as shock absorbers. At the back of the vertebrae are facet joints, which permit spinal motion. Spinal nerves enter from the holes in the sides of the vertebrae, known as the vertebral foramen. Arguably, the most common nerve within this region is the sciatic nerve, which exits the lower lumbar vertebrae and is often compressed by disc injury and/or spinal degeneration.
The muscles that support the spine are often known as the anterior and posterior muscles. The anterior muscles consist of the abdominal muscles (commonly known as the ‘core stability muscles’), Transversus Abdominus, and the hip flexor and posterior muscles (including the lumbar erector spinae and multifidus).
There are four curves in the spine: the cervical and lumbar spine, which tend to be forward curves (collectively known as lordosis), and the thoracic and sacral curves, which are backward curves (collectively known as kyphosis).
Alignment and posture
The perfect spine and curves portrayed in many scientific books is seldom seen in a clinical setting; most people, from our experience, have slight deviations (often called postural scoliosis) that may actually be normal for them. Alternatively, these deviations may be accentuated by poor posture and exaggerated movements and/or simply due to the ageing process, which may never cause symptoms. Other observable asymmetries, such as a pelvic side shift, scoliosis or torticollis (twisted neck) may occur temporarily during acute spells of pain, and will often recover quickly.
To our knowledge, there are few scientific studies that have evaluated whether poor posture results in pain; however, we feel it is logical to assume that poor posture leads to increased demand on the bony structures and soft tissues—muscles, tendons, ligaments and discs—which may progressively cause tissue breakdown, possibly resulting in pain and dysfunction. Therefore, we will assess and offer appropriate treatment without obsessing over every single asymmetry.
More serious spinal deviations may need to be assessed medically.