Relief From Posterior Back Syndrome

Update on the Pandemic Disease of the 21st Century

On June 1, 2011, I posted an alert that the pandemic disease of the 21st century was on the rise. That disease—Posterior Alimentary Canal Syndrome (PACS)—continues to gain traction. Frankly, it looks like it’s out of control.

The chief symptom of PACS resists any potential cure. Sufferers embrace the philosophy of solipsism, in which they are only aware of themselves and appear not to know that others exist.

I noted that PACS was rampant on social networks, which give the afflicted platforms with endless opportunities to self-brand, celebrate themselves, and glorify the trivia of their lives.

Some alarming incidents of PACS infestations have prompted medical experts to initiate more intensive tracking of PACS and to issue a global plea to medical research institutions to step up the race to find a cure. Sadly though, no public health initiatives have even begun to stem the rising tide of PACS.

When a woman was recently ejected from the “quiet car” of an Amtrak train in Oregon after sixteen hours of nonstop cell phone chatter, experts expressed despair at the record-breaking symptom flare-up. Epidemiologists worldwide wondered if this incident signaled “a new more lethal strain of PACS.” Indeed, they have good reason for concern, as more and more reports of PACS infestations pour in to PACS Central.

Author and psychotherapist Dr. Marcella Bakur Weiner recently reported witnessing a disturbing PACS incident that suggests PACS may be reaching a new level: group infestation. While Dr. Weiner was trying to enjoy a quiet dinner with her husband in a fashionable Manhattan restaurant, two couples at an adjacent table engaged in a high-volume, intensely graphic discussion about certain intimate experiences. Dr. Weiner stood up, faced them, and expressed a restrained objection to their choice of conversation in a public place, and the invasion of her space. To her dismay and disgust, she received a typical PACS response. “What’s your problem?” one of the men barked. The women smirked dismissively. The other “gentleman” sneered openly. To those familiar with PACS symptomatology, this is not surprising: interpersonal disturbances don’t register for PACS sufferers simply because “interpersonal” requires at least two participants in a give and take. For people with PACs there is only one player: ME, and now, possibly, MYgroup.

One promising note comes out of a report from Asia. We may have identified the original source of PACS. Eminent New York City based psychiatrist Dr. Hae Ahm Kim, just back from a two-month visit and lecture tour to Korea and Japan, astutely observed striking similarities between PACS and the well-known addictive disease PC Bang, which has swept Korea and other parts of Asia. While PC Bang is primarily an addiction to PC gaming, the consuming self-absorption of PC Bang—similar to the main symptom of PACS—strongly suggests that PACS may be a more pervasive and lethal mutation of the PC Bang affliction.

Posterior Chain in the Hips, Sports Injury Doctor Mesa, Az ...

. Unfortunately, the posterior chain is all too often a neglected region. Why? Two reasons.

First, most people sit on their glutes all day, leading to quad dominance; in essence, their butt now becomes their feet. The glutes lose their primary role of hip stabilization and extension. Second, none of the primary muscles is a mirror muscle. It’s the out-of-sight, out-of-mind theory. Even people leading an active fitness lifestyle that includes strength training, usually overwork anterior muscles. They end up neglecting the more important posterior ones.

The quadriceps take a back seat to the posterior chain (hip and lumbar extensors) when it comes to performance, strength and power. Compared to the quads, the glutes and hamstrings are more powerful muscles for stabilization. Sedentary lifestyles and lack of proper exercise lead to suboptimal muscular activation patterns within the posterior chain due to  lower crossed syndrome  (LCS).

Patterns of Dysfunction

Dr. Vladimir Janda referred to the systems of the posterior chain as the deep longitudinal subsystem and the posterior oblique subsystem, and demonstrated how critical these muscles are in transferring force from the ground to the upper body. In LCS, the hip flexors are overactive and reciprocally inhibit the gluteus maximus muscles. Without contribution of the gluteus maximus to hip extension, the hamstrings and lumbar erector spinae muscles must work overtime and become synergistic dominant movers. There is marked anterior tilt of the pelvis and an accentuated lordotic curve at the lumbar spine. This is a recipe for acute and chronic lower back pain syndromes.

The “chain of pain” from dysfunctional movement continues, affecting the rectus abdominus, which becomes inhibited by the overactive erector spinae. With the gluteus maximus and rectus abdominus both at a mechanical disadvantage, one cannot optimally posteriorly tilt the pelvis (important to the completion of hip extension), so there is increased lumbar extension to compensate for a lack of complete hip extension. When patients bend over, pick something up or stand from a seated position, they are now at a mechanical disadvantage. Instead of activating muscles in the correct movement pattern (hams-glutes-contralateral erectors-ipsilateral erectors), they compensate and skip right over the glutes. Proper hinging at the hips and pushing the hips forward simultaneously are critical to effective posterior-chain motor control.

The failed back syndrome, etiology and therapy

Clinical anatomy of the lumbar spine and sacrum

Surgical management of pain

JAMA., The Journal of the American Medical Association

Minimally Invasive Surgery in Orthopedics