​Can we at least agree that a muscle spasm creates a shortening of the muscle as it performs its action? When you have a true calf cramp your foot starts to plantar flex (point down). When your hamstring spasms, your knee bends. When your toe flexors cramp, your toes curl. And so on. (There can be many causes of these muscle spasms including musculoskeletal, nutritional, and others.)

So, if your low back muscles were in true spasm, they (primarily extensors which extend - or backward bend - your low back) should pull you into backward bend. Why don’t they? Because while you feel muscular symptoms, it’s rarely (I want to say never) a true muscle spasm. Instead, it’s pain referred from the nearby low back joints. These muscular symptoms can be horrendous, but they are driven by the joint; and once you start to get the joint moving correctly again, the muscular symptoms calm down.

Many patients with low back problems actually lean forward or are stuck forward due to the joint derangement, which further disproves the common theory that muscle spasm is the problem and is what needs to be treated. -- Laura

Inflammation is rarely the main cause of complaints. And before any symptoms are addressed with pharmaceutical anti-inflammatories or injections, a quality clinical exam must be performed. Typically a mechanical problem will be found - which is treated with targeted movement. While inflammation may indeed be present, it almost always resolves once the real mechanical cause is resolved. Inflammation is usually therefore a symptom (not a cause).

If a patient does not respond to mechanical care, chemical (anti-inflammatory) care may be indicated. I have suggested anti-inflammatory measures in just 4-5 patients in the past couple years. So if your knee keeps swelling, for example, the question is why. A joint disturbance (derangement) can easily cause consistent inflammation. So can any number of problems.

​I clearly remember one patient years ago who had years of knee pain with episodes of swelling that got so bad she had it drained many times. An avid runner, she was sidelined. The issue was coming from her low back and after 5 visits of different movements, her knee was good to go. Once her muscles had their electricity restored in the spine they could control to the knee so it didn’t reactively hurt and swell. -- Laura