Muscle strengthening, stretching and maintenance programmes based on exercise are helpful. In the advancing years, these should be moderate in degree but daily and vigorous; generally one half hour plus in duration (i.e. stretching, swimming, walking, Pilates, Yoga, etc.). This will keep the muscles strong and the tissues flexible. For optimum health this measure should be complemented with a balanced diet, vitamin and mineral supplements and the avoidance of inappropriate stress both physical and mental.

If the above methodologies are instituted in a disciplined, systematic fashion, most pathological conditions are minimized, delayed or avoided completely. Once symptoms have become established and cannot be controlled by conventional measures (i.e. analgesics, anti-inflammatories (NSAIDS), muscle relaxants and cortisone) a serious problem develops. The aforementioned measures simply mask or modulate symptoms but have no healing effect on the cells which compose the various tissue structures.

In due course, surgery may be necessary (i.e. joint replacements, laminectomy, discectomies, fusions, etc.). In essence these therapies have limited curative benefit with regard to cellular health and indeed in most cases produce a long term deleterious effect that may be more harmful than the original disease.

All conventional therapies currently in use modulate symptoms but do not cure the pathology. Surgery attempts to repair the problem and is sometimes successful, but more frequently than not it falls short of its objectives and may make the condition worse and irreversible.

Over the millennia as man evolved from homo sapiens into homo erectus, he has been increasingly plagued by the all-inclusive term known as "back ache". Transformed over the centuries from an active hunter/farmer with a powerful musculature, based on the axiom of "survival of the fittest", the human race has become largely sedentary and in the age of technology, relatively immobile.

The result - muscle atrophy, diminished bulk, tone and flexibility; good posture is relegated to the past, and the spinal column literally collapses. This deterioration creates numerous biomechanical imbalances. The result of these developments places increasing stress on the vertebrae, discs and ligaments that form and maintain the basic infrastructure of the body.

The spine, which is the pillar of the architecture, is no longer supported by a vibrant musculature. This is comparable to the bricks and mortar around a steel skyscraper and when this breaks down it results in numerous pathological conditions which can be extremely painful and physically restrictive.

The inherent problems are compounded by weekend or periodic strenuous activities on the part of the individual whose tissues are dormant during the week and are then subjected to physical stress for which they are not prepared. The recommended "minutes" of stretching prior to activity is really of minimal help. This is one of the major mobility problems facing bipeds in the age of technology. As people live longer, tissues are also subjected to the "wear and tear" of the aging process, characterized as "degenerative osteoarthritis". The combination of disuse due to the sedentary factor and degeneration of the tissues as a result of aging, produces multiple problems of the joints, cartilage and soft tissues of the spine, for reasons which are readily apparent. The spine supports the weight of the upper body and the functional stress imposed by the lower body and by virtue of its perpendicular state the complexity of the discs, vertebrae, facets, etc. make it the largest and certainly the most vulnerable structure in the entire body.

As degeneration progresses there is increasing osteophyte formation, chronic and acute inflammation of the surrounding tissues, scar tissue formation, joint contracture, etc. Other more ominous complications accompany these events (i.e. stenosis, a narrowing of the spinal canal with compression of the cord and the foramina through which nerve roots exit from the spinal canal).

In high level athletes the process is dramatically accelerated. Excessive exposure to high levels of activity speeds up the wear and tear phenomenon. It is not unusual in our practice to see fifteen year old gymnasts with spinal X-rays and symptoms that resemble someone in the 6th or 7th decade of life; a rather elementary conclusion one might add. Whether secondary to activity, trauma or degeneration, back-ache has become one of the major healthcare problems in our society and the economic impact is astronomical.

Few individuals go through life without back problems and the burden on the healthcare system increases exponentially as people live longer and increasingly develop arthritis. The elderly whose problems all too frequently are neglected, often end up in a wheelchair; the younger and healthier members of society following traumatic episodes lapse into a lifetime of inactivity. Both add to the socio-economic burden.

Back problems are seldom simple and often complex. Even a routine disc herniation occurring in a teenager while sneezing during a moment of relaxation of the musculature, results in nerve root compression and scar tissue formation. Chemicals released from the disintegration of the nucleosus pulposus may cause acute/chronic irritation of nerve roots much as osteophytes, disc fragments and scar tissue result in nerve root compression, often with loss of sensation or even motor paralysis.

The process is invariably accelerated in professional athletes and those who have performed many years of intense manual labour.

CLASSIFICATION of THERAPIES:

Symptom Modulation: Definitive Therapies:

- Analgesics & NSAIDs - Surgery

- Muscle relaxants - Laser

- Cortisone

- Interferential Current

- Ultrasound

- Diathermy/ Ice

- Manipulation

- Massage (shiatsu, swedish, etc.)

FACTORS CONTRIBUTING to BACK PROBLEMS

1) Lack of exercise accompanied by loss of muscle mass, tone and flexibility

2) Dietary imbalances, depriving tissues of the proteins necessary to maintain muscle bulk

3) Depletion of hormone production (i.e. H.G.F. Estrogen, Testosterone)

- concomitant with aging, systemic diseases, etc.

4) Obesity which further increases the stress factor of the spinal column

5) High level sports accelerating the wear and tear process

6) Vehicular accidents resulting in STI, fractures, whiplash type injuries, etc.

PATHOLOGICAL CONDITIONS

1) Myofascitis (inflammation of overlying muscles and fascia, adhesions, scar tissue)

2) Herniated/bulging discs (Figure)

3) Degenerative disc disease (D.D.D.) (Figure)

4) Scar tissue contractures

5) Osteophyte formation (Figure)

6) Stenosis - foramina, spinal canal (Figure)

7) SI joint dysfunction

8) Facet joint syndrome (Figure)

CONCLUSIONS

Probably the greatest beneficiaries of our technology are individuals that suffer from back pain and arthritis. This includes athletes suffering from myofascitis, facet joint syndrome, sacroiliac joint dysfunction and disc herniations with nerve root compression. More significantly, dramatic effects are obtained by sufferers of chronic degenerative osteoarthritis accompanied by spinal/foraminal stenosis with attendant neurological complications.

Many of the patients who come to us, either through word of mouth or referred by healthcare providers, arrive in wheelchairs or utilize canes; many have been bedridden for years. Usually after five to twenty treatments which are totally noninvasive, painless and easily applied, they become ambulatory and voluntarily lose their drug dependencies along with their mechanical supports. More significantly they experience the elimination of pain and regain mobility and quality of life.

Included are patients who have been taking up to thirty Tylenol tablets per day and over the past years have taken as many as fourteen medications at the same time. The latter in itself often results in addiction problems, sometimes worse than the basic pathology.

The most promising and least known technology

The therapy acts by converting light into biochemical energy, resulting in normal cell morphology and function, which causes symptoms to disappear. Aside from the gradual elimination of inflammation, various degrees of the ablation of scar tissue, and osteophytes at all levels, there appears to be little question that a thin layer of cartilaginous regeneration can occur.

With "back problems" laser therapy should be the universal treatment approach and clearly establish its role as the treatment of choice.