PHYSIOLOGICAL ANALYSIS OF POSTURE: DEEP LAYER OF SPINAL MUSCLEThe deep muscles of the spine, often known as intrinsic or para-vertebral muscles, interconnect and stabilise the vertebrae. They are relatively short muscles (up to 60 of them) that are either attached to adjacent vertebrae or cross one vertebra and are attached to the one following it (see Figure on page 72). In various combinations, their shrinkage produces slight extension or rotation of the spinal column. Their main function is to stabilise adjacent vertebrae and to make delicate adjustments to the position of individual vertebrae. Thus if the spinal column has rotated and then returned to its normal position, the chances are that some vertebrae may not have returned to their perfect aligned position. Since the vertebrae have to be in perfect alignment in order to maintain the body’s erect posture, the smaller but deep muscles of the spine play an important role in returning them to their final destination.These muscles are thus vital in fine-tuning the spinal alignment. Injury to these delicate muscles, through injury or bad posture, can hinder natural alignment of the vertebrae. As we will see later, this disalignment of vertebra(e) can cause abnormal pressure on the disc(s) and cause it/them to bulge or even herniate. This can cause compression of nerves, producing pain and other neurological symptoms like tingling, numbness etc. Moreover, from my experience, it is these delicate muscles that, when injured, produce more complications of the spine than the injury of strong superficial muscles. Posture adjustment is a fine matter and tough muscles can play only a small role. The delicate deep muscles of the spine play a more important role in the genesis of backache and its cure. Their weakness may cause backache and their strengthening may improve or prevent the condition.*77\330\8*

Education Patients are introduced to a ‘model of pain’ demonstrating its multiple factors. They can thus closely identify with this typical model so they can analyse their problem to get it into proper perspective.

Also, education lectures are incorporated into daily group sessions. The group sessions are designed not only to supply education regarding pain management, they also effectively give psychological support and a forum for direct psychological management of the patient’s psychological problems.

An Individual behaviourial programme This is aimed at increasing the quantity, and quality, of the patient’s daily activities. Another objective is to decrease any behaviour not helpful to the patient. Sometimes this behaviour has developed over a very long time, perhaps years.

The programme is then extended to the home, and work, environments during weekend leave and following discharge.

Marital and family therapy This is delivered through individual therapy sessions as well as for couples. The aim is to minimise the damaging effects of chronic pain on marital and family relationships.

Individual psychotherapy

Relaxation techniques All patients are trained in these techniques, involving hypnosis, self-hypnosis and progressive muscular relaxation where appropriate.

Individual relaxation tapes can be made. Biofeedback augmented relaxation techniques are also available if these are found to be more suitable. These include EMG or muscle feedback and temperature feedback where the skin temperature of the pain-affected part of the body can be modified as well.

Both of these are particularly useful for pain problejns related to blood vessel abnormalities such as migraine.

Occupational therapy This involves an assessment of the patient’s ability to function in his, or her, normal day-to-day activities and abilities. The patient is then educated in how to maintain as normal a lifestyle as possible, despite the pain.

Particular emphasis is given to leisure activity, self-care and creative activities which can be performed despite any apparent disabilities.

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For example, Jenny, a 50-year-old nurse, visualised a flock of black birds pecking away at a ‘bunch of black grapes’ which were a bunch of cancer cells. When this wasn’t working as well as she thought, she imagined an even bigger, hungry blackbird helped by poison sprays.

Positive imagery can decrease the fear which comes mostly from feeling out of control. In the case of cancer, feeling your body is deteriorating makes many people feel powerless. Relaxation and mental imagery help to positively participate in regaining your health. You begin to sense your own control.

The process can bring about major changes in attitudes and strengthen the ‘will to live’ and the imagery process can serve as a method of evaluating current beliefs and altering those beliefs.

The process can be a tool for communicating with the unconscious and relaxation through imagery can be a tool for generally reducing tension and stress.

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Magnetic field therapy is also used extensively in Europe for treatment of skiing injuries and in the rehabilitation of patients suffering from many medical conditions such as osteoporosis (brittle bones) and varicose ulcers.

In Australia, magnetic field therapy has been successfully used in the treatment of early repetitive strain injury, soft tissue injuries in general, osteoporosis (the lack of the calcium in post-menopausal women) and in the treatment of blood vessel insufficiencies causing ulcers.

Magnetic field therapy has been extremely successful in the treatment of injuries to racehorses in Australia and has achieved much publicity in racing circles.

There are few situations in which magnetic field therapy should not be used. Patients with unstable diabetes or undiagnosed bleeding from the bowel should not be given such treatment.

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