Paul Manley Back Pain and RSI Clinic
Paul Manley, D.O. (ESO 1980), M.A.O.(Manip), Registered Osteomyologist
For muscle and joint problems
Location Map (click):
The London Trauma Specialists’ Clinic,
2nd Floor, 22 Bloomsbury Street, London,WC1B 3QJ
Opening hours: Monday 9am to 5pm, Thursdays 9am to 5pm and Saturdays 9am to 6pm.
Please Call or Text Paul 24/7 on
07925 616 753
Glossary of back pain terminology.
Below is an illustrated glossary of commonly used back pain, spinal and pain terminology which has been compiled by me from the phrases and wording commonly used by patients to describe their symptoms and disease names.
Many of the terms used are non-medical or pseudo-medical. Many of the terms used are inter-changeable with others. It is the purpose of this glossary to inform those in need of help how to understand some of the terminology in common use. My definitions and explanations are drawn from the experience of addressing issues and confusion over pain terminology for many years.
is the response by the body to damage. It is
the beginning phase of the repair mechanisms.
It feels hot to the touch, sometimes there
is some swelling around the area of repair
due to the build of repair fliuds and damage
collecting white blood cells, platelts
and other cellular substances. Sometimes
and are of swelling will become so taut
that it pressurises the perimeter of the
swollen area and blocks the passage of
repair fluids away from the area of repair.
In this indurated state the repair will
slow down and will be more likely to form
scar tissue in the long-term. thus, we
will tend to rub the area better. If it
is too delicate we tend to cool the area
with cold applications. Some of us take
anti-inflammatory drugs to varying degrees
of good to 'no-help at all' types of responses.
Aspirin is very effective as an anti-inflammatory
but much under-rated due to the over promotion
of other less efficacious remedies, most
notably paracetamol. Some of the supposed
pain killers available without prescription
are too dangerous to be let loose on the
public. The common perception of the dangers
of over the counter drugs is that because
they are available without prescription
they must be safe.
of the joints,
muscles and tendons are more possible when
the body is 'building up' to an infection.
During the first few days of an infection,
most commonly, flu and colds, the body switches
on its inflammatory response system. During
this period any area of the body which is on
the verge of inflammation will respond by getting
more inflammed. The whole body is in repair
mode and anything which needs it gets repaired.
The trouble is that it often gets 'out of hand'
whilst the metabolism switches into a 'collapse,
rest and repair' mode such additional pain
and discomfort is most unwelcome. The patient
will often present as an acute pain in the
spine and then 3 days later they have come
down with an infection of some sort. The additional
effect of the swelling of the bone marrow in
order to produce more white and red blood cells,
stretches the membranes covering the bones,
producing that awful acheing across the whole
body, nerves are more sensitive, pain more
acute, we crave peace and rest. Any loud noise
or excessive commotion can profoundly disturb
the ill person, so we quite naturally tiptoe
around them. This has the added dimension of
allowing them to feel your caring and your
love and respect. We are complex beasts y'know.
Often the feelings of the carers can become
inflammed at these times. Stress, frustration
and fear all take their toll on both the patient
ache for various reasons
Muscles are fuelled just like any engine,
and just like any fuel, it can run
out. The muscle needs rest whilst
the body restores its fuel supply
to the muscle. During this state
the lactic acid and other metabolites
which accumulate as the 'spent fuel'
will easily induce a cramp, spasm
or acheing in the muscle. The lacitic
acid is drained away by the circulation
of blood back to the heart and lungs
which occurs in all tissues. If the
area concerned is already tight and
thererby, constricted in its blood
supply, the the crampy state will
persist for longer. At times this
can be a continuous state where we
'must be careful not to strain a
certain parts of our structure'.
We are usually aware of these areas
which need some protection, but not
always. Areas of tension will build
up come what may. Such muscle adaptations
to functional requirements is what
makes us such rapid learners of new
mental skills as well as of manual
skills. Thereby being a blessing
in disguise, an instrument for change.
Muscles can be in a continual state of
activity, even when supposedly 'at
rest'. The resting tone of any muscle
of the skeleton will change according
to its typology i.e. phasic or postural
but, primarily according to the amount
of regular work we ask the muscle
to do. If the type of work is of
a static or stabilising, supportive
role, then the muscle resting tone
will increase and the fibo-elastic
make-up of the muscle will adapt
to become thickened and shorter.
In this state they will be much more
prone to acheing, muscle pulls, tears,
strains and inflammations due to
the poor blood supply to the now
dried up, leathery tissue which used
to be a part of fully functioning
muscle. I say 'part of' because it
is more usual that the deep fibres
of the muscle will undergo this type
of change most readily. The more
superficial fibres become redundant
in the functioning of the muscle,
and will shrink to add mechanical
advantage to the deeper fibres.
a short term repair response to the stretching
of the membrane surrounding the muscles
( sarcomyalgia ). This results in the
acheing experienced following unusually
strenuous or new exercises. The pain
is a direct result of the rapid expansion
and ulitimate growth of the muscles which
produced the exercise.
in brain stem respiration control
can lead to inappropriate breathing patterns
which will make our body either too acidic
or too alkaline. In either extreme, the
body becomes more prone to muscle acheing.
It is wise to be aware of the balance
of our own pH. The most common state,
by far, is one of acidity. Use water
to alkalise if dehydrated, Andrews liver
salts or a very alkaline spring water,
are ideal buffers for your blood. A buffer
will absorb the acid in your blood and
digestive tract. Panic attacks whilst
in pain can only serve to make the situation
- The feeling
of tiredness, overwhelming lack of motivational
ability, depression and an uncaring attitude
to the neccessities of life. Can be due to
geberal metablolic mal function or the need
to recharge our batteries. Adrenalin exhaustion
is a common cause amongst workaholics and
worry-aholics. Convalesence is often the
answer. A period of two to three months of
careful attention to rest and sleep as well
as establishing a more regular daily schedule
will often be sufficient to rejuvenate us.
Anemia, low blood sugar, shock and long term
emotional trauma can lead to lethargy.
- We are
often told that our pains are due to stress.
Whilst this label is often used as an excuse
for poor physical diagnosis, there is interplay
between the state of the nervous system and
pain perception. When adrenaline is high
due to stress, any pain will be amplified.
The fact is that in the brain stem there is
a nerve centre which governs our perception
of pain. Theoretically, if this centre were
set to maximum we would be in agony all over
our body, if switched off, we would be numb.
Morphine can achieve this latter effect.
The nervous system and its' pain perception
settings fluctuate according to various factors.
We all have areas of repair or ache which will
remain subliminal ( below the level of conscious
perception ) until other factors raise the
overall activity in the nervous system. An
example of this is when, for instance, you
have sprained your ankle and have just achieved
a comfortable position of rest for the ankle.
Someone then comes into your vicinity who is
screaming and shouting about something concerning
them. The immediate result is that your ankle
suddenly becomes intensely painful and you
must beg them to be quiet. The sound input
and angst behind their indelicate assault on
your senses raises the overall excitation of
your nervous system and you are instantly in
agony. Hence when people are in pain, they
need peace and quiet in order to recover. Thus
the appearance of a person in pain can be one
of attention seeking and manipulation of those
around us. However, the term is immensely overused
due to the total inability of some doctors
to diagnose sources of physical pain.
Then you have the added complication of inadequate
treatment for the common causes of pain. When
a course of treatment fails to bring relief
the patient then questions the diagnosis, treatment
and their own mental state. I have found that
all too often the source of pain is obvious
and its' treatment simple to provide. However
there are many people who end up labeled as
neurotic, due simply to the ineptitude of the
professionals involved in their case. This
adds to their stress, amplifies their fears
and multiplies the uncertainty about a successful
cure being possible.
is more than rest. It actively repairs our
body, restores the nervous system to a quieter
state. It enables our conscious-unconcious
state to stand back and observe our stresses
It is normally considered that sleep prepares
us for our awake life and is often relegated
to being an unwelcome interference with that precious
awake life. I could posit the opposite: that
we wake in order to sleep. During sleep, our
dreams are often more vivid and intense than
most daily events. We can die in our sleep
from nightmares, we can make love to the girl
of our dreams, we can sun ourselves on Bondai
beach or be chased by demons. If the whole
purpose of our existence is to experience
life, then surely sleep provides an adequate
alternative to the humdrum of our daytime lives.
Have you ever asked yourself a question as
you are passing into sleep. I
usually ask myself a question about solutions
for practical, technical problems which have
been bothering me for lack of a solution. Usually
a computer or clinic related matter. Almost
without fail I will come up with the correct
answer or at least another angle on the puzzle
view of sleep upgrades the value
of sleep not only as reparative
on the physical and emotional
levels but also a valued state,
to be cherished as equally as
If sleep is denied, the whole
body becomes more painful due to
the effect on the brain stem.
How many times have we been
in pain all day, aching and
tired, we have a ten minute
'catnap' and most of our pain
disappears? When the sleep
cycles i.e. circadian rhythms,
are out of cycle due to jet lag
or late nights it affects all
of our metabolic cycles negatively.
The Pineal gland governs the
overall timing of these intricately
interdependent metabolic cycles.
Each organ repairs itself in
its' own time slot. The liver
and kidneys repair late at
night whilst we sleep. If we
deny our organs this repair
time or disrupt their repair
sequences we may be putting
out the garbage in empty sacks
whilst the garbage builds up
in our kitchen. Sleep is the
best thing that we can do for
ourselves on all levels of
our existence. Perhaps the waking life
simply fuels us with food,
experiences and the money to
buy a roof over our head and
a bed beneath our bones.
of the three main body types are readily observable
in real life and are therefore a useful reference system.
We are all manufactured in accordance with these descriptors.
We all have a different combinations of these factors.
- The muscles
are thick and heavy, skin taut, tend to be
stocky, joints tight and have less range
- The muscles
lack tone, skin spongy, tend to be round
in shape, joints very flexible with extreme
range of movement.
- The muscles
are high tone and compact, skin smooth and
elastic, tend to be slim and graceful, joints
flexible with good range of movement
- The excitability
of the nervous system varies from person to person.
You can be high, medium or low in terminology of reflex
response. This is best evaluated by using a reflex
hammer, testing the femoral, ankle, triceps, biceps
and brachioradialis jerk responses. Thus the typologies
mentioned above can exist along with such reflex
settings as their long term state. The higher the
reflex tone the easier it is for a person to put
on muscle. A high reflex tone also means that a
small pain can become huge, spreading along the
nerves and exciting any older, subliminally irritated
or repairing injury, long forgotten. By the same
means the high tone person generally repairs more
quickly. The reflex setting of the individual if
too low can delay repair and pain dulling responses.
The low tone muscles adapt less rapidly. There
are dramatically different response times for musculo-skeletal
repair in the two extremes.
Disc related terminology
of the terminology commonly used to describe the condition
include herniated disc, prolapsed disc, ruptured
disc, and the misleading expression "slipped disc." Other
terminology that are closely related include disc protrusion,
bulging disc, pinched nerve, sciatica, disc disease,
disc degeneration, degenerative disc disease, and
- The popular term "slipped disc" is quite misleading. An intervertebral disc, being tightly sandwiched between two vertebrae, cannot actually "slip," "slide," or even get "out of place." The disc grows together with the adjacent vertebrae. A disc can be squeezed, stretched, and twisted, all in small degrees. It can also be torn, ripped, herniated, and degenerated, but it cannot "slip."
- Most disc herniations occur when a person is in their thirties or forties when the nucleus pulposus is still a gelatin-like substance. With age the nucleus pulposus changes ("dries out") and the risk of herniation is greatly reduced. At the same time osteoarthritic degeneration, especially in the facet joints, makes its inroads.
- Cervical disc herniations occur in the neck, most often between the sixth and seventh cervical vertebral bodies. Symptoms can affect the back of the skull, the neck, shoulder girdle, and shoulder blade. But are most likely to cause severe pain in the shoulder, arm and hand.
- Lumbar disc herniations ( lower back ), occur most often between the fourth and fifth lumbar vertebral bodies or between the fifth and the sacrum. Symptoms can affect the lower back, buttock, back thigh, and may radiate into the lower calf and foot. Usually pins and needles on the outside of the foot accompanied by aching in the low back and buttock is a good indicator of some degree of disc compression.
- Great care must be taken to assess the role of secondary spasm. The muscle reactions to a non-disc related primary irritant and their resultant spasm in the buttock can put direct pressure on the sciatic nerve. Even a small amount of pressure in this area will mimic a disc protrusion. In such cases it is best to calm the secondary ares and then to decompress the disc area. The reflex hammer will reveal much about the source of irritation to the sciatic nerve. The femoral nerve which runs down the front thigh is more usually affected by deep muscle tension over L1 - L3.
following a local microtear of
muscle or ligament
will commonly cause irritation to the
I find that most pains which have been diagnosed as disc herniations respond very well to my techniques. Normally I see the patient within a few days of the pain having occurred and calm the whole thing down. I then proceed over a few sessions to lengthen the compressed areas of the spine specifically over the area involved and generally along the whole spine and legs, front and back. This usually does the trick within a couple of weeks. On the other hand, I have seen many who have been suffering for many months and who have had all sorts of help, drugs, exercises, manipulation, physio with little or no response. It is wonderful to be able to help these cases so dramatically. Conventional medical diagnostics has not and should not attempt to place inadequate labels onto conditions which can consist of multiples of variables, as complex and individual as your face.
MRI of spine:
This degree of disc bulging of L4 and L5 (rare) will definitely cause symptoms but often the majority of the symptoms are from the secondary spread of muscle spasm and thus is more amenable to manual hands-on relief techniques.
A list of commonly used disc related terminology: Most of which are used interchangeably by people to describe their back pain.
- slipped disc
- ruptured disc
- bulging disc
- herniated disc
- crumbling disc
- disc compression
- displaced disc
- twisted disc
- pinched disc
5. Joint related terminology
- Facet joint
The joints which act as guide rails and leverage points for movements of the spine.
The long term result of compression and, or inflammation is the outgrowth of bone (spondylosis) around the perimeter of the facet joints.
Inflammation of a facet joint normally from adjacent micro-trauma to the muscles and, or ligaments.
The forward slipping of a vertebra on anther. Usually due to a congenital defect known as a 'pars imperfecta'. The bridge of bone from the facet joint to the body of the vertebra (the pedicle) is born weak. The bridge remaining normally as tough fibrocartilage instead of becoming hard bone.
- Arthrosis and Osteo-arthrosis
The long term degenerative changes which occur in chronically irritated and compressed facet joints
- Osteo-arthritis of the spine
similar to spondylitis but chronic (long term)
- Facet joint sprain and strain
A facet joint can be irritated by stretching it too far too suddenly. They can also be irritated by sudden compression and extreme rotation.
- Facet joint displacement
When a joint has been injured, it will be held out of its natural position by the muscle spasm around it and by the adhesion which rapidly forms in the joints thus 'gluing' one or more facet joints together. this limits the range of motion and further, more widespread muscle tension develops in order to maintain some kind of balance of the spine.
- Facet joint adhesion
The surfaces of the facet joints are lubricated by synovial fluid. This fluid is continuously secreted by the cartilage lining the joint. The fluid is maintained within a certain pressure range and can change density. When inflammation or repair is in progress the fluid becomes extra-sticky and can 'stick' the joint surfaces to each other.
- Pinched facet joint
When a facet joint is placed into hyperextension i.e. bent back a facet joint can 'pinch' the capsular ligaments which surround the joint. This commonly produces nerve pain, pins and needles and numbness down the arm or leg.
- Out of place joint
See facet joint adhesion above.
See facet joint adhesion above. Also a term used mainly by Chiropractors and Osteopaths to describe the character of partial dislocation which occurs due to injury and, or postural distortion of the spine.
Except in very extreme trauma this does not happen
- If a postural
muscle is irritated it will generally tighten
in response. Sometimes the contraction response
is so strong and goes on for so long that
the muscle goes into a cramp. This is due
to the muscle having run out of oxygen due
to the contraction limiting the blood supply
- Torn muscle
- A muscle
can suffer complete rupture, but this is
very rare. Usually a small percentage of
the fibres which make up the muscle will
'come apart'. After some rest and appropriate
treatment the fibres can heal like new.
- Sprained muscle
- A muscle
sprain is a lesser form of tear. It can occur
because of sudden stretching whilst over-contracting
the muscle or from lifting too heavy a weight,
- Hypertonic muscle
- A muscle
in a hyper-tense state. The muscle(s) have
been either habitually worked too hard, kept
in a tense, stabilising function, or chronically
irritated by an underlying joint condition
- Tense muscle
- Flaccid muscle
floppy, weak muscle, usually one of the skeletal
muscles. These muscles weaken and lose reflex
tone rapidly in response to irritation. Sometimes
a flaccid muscle is produced by paralysis.
- Weak muscle
which through under-use has become too weak
for proper functionality.
- Inflammed muscle
which has sustained enough damage to have
become inflamed (repairing). The muscle can
swell, become hot and too painful to operate.
Best to rest and cool it with a cold, wet
fibrous/muscle/pain. This is a loose term
and implies hardness, leatheriness accompanied
by aching and pain
- Muscle pain
register pain from various sources associated
with the muscle. It can come from the chemical
pain receptors which pick up signals from
cramp and hypertonic states. There are other
signals which emanate from the membrane which
surrounds all muscles, the perimysium, when
the muscle enlarges through exercise. The
stretch on this tough membrane feels like
stiffness. Muscle pain can come from damage
and the stimulation of the repair process
using both chemical and nerve pathways.
- Muscle ache
- Muscle stiffness
- Tendonitis and
- An inflamed
tendon, usually due to repetitive over-use
or due to trauma such as a direct blow or
having suddenly overstretched (pulled)the
tendon. The inflammation rapidly spreads
along the tendon and its muscle and then
onto the joints which lay beneath it. Occasionally
the tendon can form a fibrous lump of scar
tissue at some point along its length. These
occur in specific areas of the body, such
as the palm and calf tendon. This can develop
into a trigger finger'.
Prolonged irritation and contracture of the
tendon can lead to a condition known as Volkmanns'
ischemic contracture and Duy-Putrens' contracture,
although the latter condition is usually congenital
- Inflamed tendon
- Pulled tendon
- Strained tendon
- Torn tendon
a tendon can be torn. As in the case of torn
muscles, there are degrees of tear that occur
in a tendon, from the micro-tear to the complete
'snap'. A torn tendon, given the right care
can heal very rapidly. Special attention
must be made to keep the circulation stimulated
with light massage.
- Atrophied tendon
- The tendon
and its associated muscle are short, taut
and virtually non-contractable. Normally
due to extreme under-use of a muscle. In
some genetic disorders and central nervous
system disorders atrophy will occur despite
attempts at normal usage. This state is rare.
- Tendon contracture
- Tendon ischemia
when the demands on blood supply exceed the
available blood supply. Results in aching
pain and cramp in the associated muscle and
- Trigger finger
- Carpal tunnel
- Most often
mistaken for a disc problem in the neck and
vice-versa. The 'tunnel' passes beneath the
intercarpal ligament of the palm of the hand.
This ligament blends with the thenar muscles
of the thumb and so are influenced greatly
by the amount of tension resident in the
thumb muscles. Pressure from displaced carpal
bones, direct trauma to the palm and excessive
tension in the long flexor muscles and their
tendons as they pass beneath their bindings
in the palm can all give rise to this condition.
The result is usually pins and needles and,
or numbness in the thumb, index, middle and
half of the ring finger. Sometimes the thenar
muscles become so congested that a throbbing
pain can occur due to the blood supply away
from the palm being impeded by the tension
and swelling in and around the carpal tunnel.
8. Nerve related terminology
- Pain emanating
from a nerve due to direct irritation of that
of a nerve. For example optic neuritis and
- A group
of nervous system disorders ranging from tertiary
syphilis to diabetic neuropathy and lead poisoning.
- A nerve
can be 'pinched' at various points along its
route, each nerve having its own characteristic
'weak points'. The most common areas of pinching
is at the exit of the nerves from the spine
( the foramina). They are pinched, compressed
and pulled at these points.
- A nerve
can be traumatised to the degree that it can
no longer send signals to the muscles that
it controls. This can be transient, as in 'dead
leg' or permanent in severe trauma to the nerve.
Poisons can also cause paralysis as well as
central nervous system disorders. In the latter
case the nerve signals cause contracture of
- Pins and
- The sensation
of little needles pricking the skin and numbness
occur principally due to often slight amounts
of pressure on the nerve roots in the spine,
or a greater amount of pressure somewhere along
the route of the nerve. Such aberrant sensations
are grouped under the descriptor 'parasthesiae'.
The timing, intensity, permanence and variance
from pins and needles to numbness and back
again, all serve well to judge the severity
of the case.
- Pulled nerve
- This is
rare but can happen if a limb is stretched
passively for example hanging by the arms form
a tree branch can bring on parasthesia and
even temporary paralysis.
- Can also
result from a direct blow or intense squeezing
as in industrial accidents, this condition
is rare. If caught in the beginning there is
hope of help. Nerves grow back and remake their
connections but it can take many months, sometimes
years to finally right itself. In cases of
back pain, severe nerve pains from a gradually
increasing 'squeezing of the nerve roots or
at certain prone points along the route of
the nerve e.g. sciatica, femoral neuralgia
and radial neuralgia are most common.
hope that you have found this glossary of back pain
and commonly used terminology useful.
Location Map (click):
The London Trauma Specialists’ Clinic, 2nd Floor, 22 Bloomsbury Street, London,WC1B 3QJ
Opening hours: Monday 9am to 5pm, Thursdays 9am to 5pm and Saturdays 9am to 6pm.