In biology class, the spine went unnoticed by most. Much has been told to us about the heart and the brain. We know what they do and more or less how they do it. Disdain for the spinal column is not new and the poor thing has been accompanying the thymus, mesentery and parathyroids in the dock for years.
Think that most organs or tissues have their own name, but the spine does not. We will all agree that naming it that way, just because it involves several vertebrae arranged in a kind of column, is, at best, reductionist. It’s as if we called the stomach an “acid bag” or the heart a “blood pump.” Among doctors we usually call it rachis, from Latin. In the world of science, Latin improves everything. But the leaves of ferns and the shafts of the feathers are also called rachis, among botanists and zoologists. So even in Latin there is no proper and exclusive noun for thorn.
On the other hand, the stomach is the stomach in the dictionary you consult; here and in China. This favoritism for certain body parts is embedded in our language and culture. Consequently, managing spinal ailments is rarely intuitive. Despite being systematic, spinal problems feel distant, unless we suffer from them. Our disorientation is evident in some questions that I frequently hear: Does my back or kidneys hurt? Is low back pain for the general practitioner or the rehabilitator? Should I go to a physiotherapist or osteopath? Should one have surgery with an orthopedist or a neurosurgeon?
The objective of this delivery is to make visible the neglected spine and the changes it undergoes throughout life. Maybe by offering two new perspectives on it, we will understand it better. I hope it awakens interest in its operation and encourages its care.
Broadly speaking, there are two ways of understanding the spine: a mechanical perspective, where the spine is a set of tissues that keep us upright and participate in body movements. The other perspective is neurological: here the mechanical column becomes the articulated armor of bone and muscle that protects the spinal cord.
The latter is a powerful nervous structure housed inside the vertebrae that communicates the brain with the rest of the body. Both perspectives on the column are true and complementary in functions. Furthermore, harmonious aging of the spine depends on a fine balance between both elements throughout life (let’s call it spinal anti-aging if you like).
From a mechanical perspective, the spine is the axis of our body. Think of it as a complex biological machinery made up of bones, muscles, cartilage and ligaments. It has a structural function (hence the first half of the name), and also facilitates movement by providing flexibility and twisting capacity to the trunk. Biomechanically, the spine and pelvis distribute the body’s weight symmetrically to the hips, knees, and feet. When any of these elements fail, the abnormal distribution of loads can impact the spine, producing overload and consequently pain.
Sometimes, having knee osteoarthritis can be the cause of lower back pain. On one occasion, I referred someone with flat feet to a podiatrist and corrective insoles were the panacea for stubborn cervical contractures. And more than one outwitted the operating room by acquiring better postural hygiene or greeting the sun daily. I usually call these problems in my practice: the fifth floor syndrome, since if the foundation of the building is not optimal, sooner or later problems will appear higher up.
From a neurological perspective, the anterior locomotive is also the bone and cartilage armor that protects the spinal cord. The latter is evolutionarily the oldest portion of the central nervous system. It is a complex bundle of neurons that runs from top to bottom connecting the brain with the rest of the nerves in the body. Through it, all types of information from the body ascend to the brain: sensitive, thermal, positional, vibratory and painful.
It is in the brain where we compute and decision making occurs. Then, through the spinal cord, all kinds of orders descend from the command bridge to the body. These instructions make us move voluntarily, but there are also other automated orders, over which we have no control and which manage important aspects of our life such as sweating, digestion, heart rate and the functioning of pelvic organs.
The spinal cord and the nerves that come from it travel throughout the body and its successive branches reach every square millimeter of the ball of our fingers. The medulla is the interface that informs our mind of the realities of the natural world. Thanks to this network of neurons, the spinal cord self-perceives the body, even though we close our eyes. Thanks to the spinal cord we explore our environment and execute our desires on it. What would the brain be without marrow? It is almost analogous to asking what would be of the mind without a body?
Both spines – the orthopedic and the neurological – have evolved to be naturally symbiotic and their components are usually in balance. However, during the aging process of the spine, wear processes can destabilize the balance between the two. For example, it is common for the mechanical portion to wear out and weaken, like gears in an old machine. The vertebrae deform like a melting candle. The spaces meant for the spinal cord and nerves narrow, trapping them in their once protective armor. These phenomena, popularly known as pinching, can progressively compress the nerves and spinal cord, sometimes producing symptoms in the neurological spine: paresthesias, tingling and radiating pain.
In contrast, the spinal cord, which thanks to its nervous network knows everything, perceives the melting and degenerative changes in the bones, discs and joints of the spine. Their pressure sensors notice that the vertebrae no longer articulate as before. Your muscle receptors inform you of greater muscle tension around less stable joints than years ago. The spinal cord knows when the locomotor machinery begins to rust and passes the report to the brain, which ultimately decodes the information as symptoms in the orthopedic spine: stiffness and localized mechanical pain. As you will see, the two columns are symbiotic in the positive, but they can also be symbiotic in the negative.
When the spine ages and becomes unbalanced, it will sometimes do so at the expense of orthopedics. Other times neurological. But more usually, a little of both, in random proportions. Just like icebergs, no two columns are the same, and that is why there is no strategy that works equally for everyone. Philosophically, there are three solutions for a sore spine. There is a corrective approach, which aims to restore the original biomechanics of the spine. There is a palliative approach, which seeks to alleviate the pain we perceive in the spine without modifying its structure. And finally there is a preventive approach, which tries to promote harmonious aging between both components of the spine. The science behind these three options is solid, but designing a plan tailored to each person is also an art.
Keeping the two columns in balance is not guaranteed. The preventive approach is based on the following big ideas: avoid a sedentary lifestyle, maintain adequate control of weight and the percentage of muscle mass, avoid harmful habits such as alcohol and tobacco, and develop a minimum of body awareness. Each of these ideas deserves to be explored in detail. But it is worth clarifying that more than a metallic set of instructions with immediate effect, these are organic lifestyles that reward perseverance rather than vehemence.
There are few certainties in life, but I will end up venturing with two. The first: time rusts us. In general, the modern struggle is not to live longer, but to live better. The second: it is easier to avoid a problem than to find a solution; In health matters, prevention is the most profitable strategy.
