We all know that our spines move, and typically, people suffering back pain are all too aware of how their pain changes their ability to move their spine.

Even without the presence of an overt injury, the most common change to our spines is a loss of flexibility through the muscles or the creeping development of stiffness in our joints.

Stiffness can cause back pain, but it can also be a response to back pain.

Muscles regularly go into a spasm when your back is in pain to reduce your movement and guard your back against further irritation. This is perfectly natural and represents a great short-term strategy. However, it becomes less useful and even detrimental in the long term.

People with back pain often note that one or more of their movements causes the most discomfort. This information can help us decipher what might be the matter, at least at some basic mechanical level. 

A point of interest is whether a painful movement remains forever reduced after an injury?
Or was it perhaps deficient before the injury?

How many movements are there in our spines?

At its simplest, you might say there are two positions of the spine. Either straight (let’s call it our natural shape) or bent. This is too simplistic...

Better, we can recognise four movements:

• Flexion – bending forwards
• Extension – bending backwards
• Side bending
• Rotation

This is a definite improvement and draws attention to the shape of your vertebrae; the pieces that make up your spine.

Vertebrae are symmetric from right to left, but not front to back.

This means that the mechanical movement required to bend the spine forward is different to that required to bend it backwards.

In contrast, side-bending and rotation are achieved in the same manner, but with a matching pair of movements for left and right.

Understanding that there are four movements available from our spine might be enough academically, but in the real world of back pain, it's not enough to help us really analyse a patient and see how they’re coping.

Really, we need to consider:

• Flexion
• Extension
• Side bending right
• Side bending left
• Rotation right
• Rotation left

Now, we have our six key movements.

What are we looking for?

We are looking for availability and symmetry.

First of all, we need to see a spine that can move in all six directions. The biggest problem of ageing is that movements start to get lost. Have a look at our circle of life blog that examines the changes to flexion and extension as we develop and then move into old age.

A lot of people talk about needing strength in our bodies to keep them healthy, and we’d never disagree with this, but strength can only be put to use creating a movement that is already available or in order to stabilise an excessive movement that is causing concern.

Control is also important – most commonly in terms of balance. But again, you can only control a movement you have access to.

Once we can see the availability of movements, we should then look for a sense of symmetry:

• Symmetry of rotation is easy to imagine – the ability to twist around equally to the left and the right.
• The same goes for side-bending
• Symmetry in the sagittal plane (flexion forwards and extension backwards) is less obvious but think of it simply as being able to bend forwards and backwards yet return to a comfortable upright position where your head is above your feet. Sadly, this system invariably fails, preventing us from being able to pull back upright so our head is balanced on top of our feet. Again, have a read of the circle of life blog.

The importance of this?

While some will argue that spinal mechanics have little effect on back pain, it should be obvious that a spine that remains free to move in all six directions is free to succeed.

In contrast, a spine that is deficient in one or more movements is more likely to demand compensations elsewhere, and these will make our movements harder to perform.

If you spend all day bending your spine in only one direction and rarely experience any other movements, there’s a chance that the "missing" movements will become stiff from lack of use, or that you will simply forget how they’re done making them effectively unavailable. Believe me, we see this in clinic every day.

But hang on, we are NOT saying that this in itself causes injury.

However, imagine a person who has not moved in a certain way for a long time who now has to perform that “missing” movement suddenly in order to solve a problem (falling, lifting awkwardly, catching a precious object). Their lack of movement availability or skill can contribute to injury.

Our Advice?

The take-home message from this is to look at what you do with your spine. Look for a complete set of the six movements we have outlined through the course of your week, even better, your day.

• If you lift things for a living, find something other than lifting weights in a gym to do in your spare time. You're probably doing plenty of flexion and extension, perhaps less side bending or rotation.
• If you spend your day sitting, find a way of adding extension, side bending and rotation to your movement diet.
• If you’re on your feet all day (this can become an extension activity as our backs fatigue and the low back curve increases), make sure you add some flexion to even yourself up.

As ever in life, it’s about balance.

Everything in its place.