The rest of this website and my old website are
concerned with my work since 1981 which started with my investigation of the
cause of lumbar back pain. Over the years this took me into office chair manufacture,
car seat design and manufacture, chiropractic, posture and exercise but has so
far failed to get any recognition of the basic point which is contained in the
The lordosis in
the human spine is difficult to explain in engineering terms. In fact it's impossible and all engineering
explanations have been wrong. The real
reason was shown by the anthropologist Owen Lovejoy in "The Obstetric
Pelvis of Lucy". It is simply the
maintenance of an adequate birth canal in the pelvis. (full details of this, and all other,
references are in the paper The obstetric reason for Lordosis etc on this website)
The birth canal defines the
shape and angle of the sacrum and this in turn results in the lowest two discs
of the spine being wedge shaped by about 20 degrees. (Thick edge of disk anterior, thin edge
posterior at L4/5 and L5/S.)
But note that this 20 degrees
is far greater than the mobility of these joints in flexion. (Max nine to fifteen degrees. Piercy, Portek and
Shepherd, Jonk and van Niekerk
etc.) meaning that these discs will always remain wedge shaped in the same
direction, even in full flexion-- as a long as there is nothing that distorts
this evolved situation.
Sadly there is. It is one of the most common items in our
civilised lifestyle. It is the chair or
seat with a backrest.
A backrest will always tend to
flex the lowest joints of the spine in comparison with unsupported sitting
while at the same time extending or hyperextending those higher up. This should be predicted by any engineer and
was clear from the tabulations in
"The Influence -- -- -- Of Lumbar Support -- --" by Anderson,
Nachemson et all.
Well, maybe it won't matter
that these discs, instead of always remaining wedge shaped as they were
evolved, are made to flex and extend like any other discs of the spine. Sadly it does matter. It matters very much, for the following
In the chimpanzee, the
strength of the spine increases with flexion of the lowest joints. This is because the origins of the back
muscles on the pelvis are above the lowest spinal joints. With the changed shape of the human pelvis,
this situation is reversed. The origins of the back muscles are now below the
lowest joints. To any engineer this is obviously an over-centre mechanism and
the strength of the spine will be reduced to almost nothing by flexion. This
would mean that the human spine could be broken like a chicken leg where it
connects to the pelvis.
This problem does not have an
easy mechanical solution. It must have
happened frequently to our earliest bipedal ancestors and some of them would
very quickly have become food for the predators and scavengers of the savannah.
However, before the spine lost
all its strength, there would be a phase when the lowest discs just began to
flex beyond the parallel sided shape to the situation where the posterior edge
of the disk was a bit thicker than the anterior edge. The nucleus would then, for the first time
for that individual, tend to move towards the posterior edge of the disk. The proximity of the nucleus would be a new
and unusual event for the nerves in the posterior annulus of the disk. Nerves that experience an unusual event will
produce pain. In some individuals the
pain would have been marginal or just a feeling and they would have ignored
it. They would go on to break the spine
and be gobbled up.
In other individuals the pain
would have been sufficiently strong to stop them lifting or bending. Even if they suffered further pain they would
survive. The more severe the pain was,
the more that these individuals would stop doing anything that might further
damage the spine.
This Is the ‘Evolution of Low
Back Pain’. It has evolved to be an amazingly severe and persistent pain. It is also a very successful warning
pain. Real damage is relatively rare and
only develops progressively.
We all know that many joints
and structures of the spine become involved and are eventually damaged when a
low back problem has started. This makes
it difficult to analyse the real cause of the problem. Many causes and components have been
Do the known statistics of the
problem support the cause proposed here?
The only clear statistical
association is with driving cars. This
was first shown by Kelsey and Hardy in 1970 and has been confirmed by many
studies since. Would we expect this
mechanically? The answer is definitely
yes. Car seats tip the thighs and
therefore the pelvis further back than almost any other seat. Car seats incorporate far more direct support
for the lumbar spine than any other seats. We sit still in a car seat for far
longer than we ever sit anywhere else. This mechanical situation could not be
better designed to cause the problem outlined above.
If we combine Kelsey and
Hardy's work with the surveys by Mark Porter, Professor of Ergonomics at
Loughborough University UK it appears that a high mileage car driver is about
twelve times as likely to have a serious low back problem as anyone who never
uses a car at all. (This work was
published in the trade magazine Automotive Interiors International )
This combination may not be
good statistics but it's very good common sense. It suggests a far higher correlation between
driving cars and low back pain than between smoking and lung cancer. Comparison of these two surveys also suggests
that the situation is far worse for the high mileage driver in the late
nineties than it was in the late sixties.
Is this compatible with the mechanical argument proposed?
Yes. It is more than compatible. It's predictable. In the eighties and nineties the angle of the
sitting surface of car seats was tilted further backwards in order to counter
the problem of slipping under the seat belt in an accident. At the same time lumbar support was
introduced generally into car seats. The
combination of these two is bound to increase the flexion force in the spine at
the lowest spinal joints. We should
expect the statistical situation to be worse and judging by these published statistics
What can we do about this problem before it
results in serious damage to the spine?
We need to find some way of limiting the flexion of the lowest two discs
to the designed or evolved shape defined above. Our civilised lifestyle causes
the problem so obviously modifications of this are one part of the solution.
This is what Natural Joint Mobility is all about and obviously backrests must
incorporate pelvic support not lumbar support.
But even with this knowledge of what we need to
do, it can be a slow process to correct the distortions caused by a lifetime of
civilised sitting. People want, and deserve, a more instant and complete
One of the medical procedures currently used is
sclerosing injections into the ligaments at this
level to reduce the mobility. In principle this will help but the ligaments are
not suitably oriented. There is no supraspinous ligament at these joints. It stops at L4 (Rissanen). We could however build up a supra-spinous
ligament from the spinous process of L4 to some points on the sacrum. This should be nylon or carbon fibre so that
it does not simply stretch plastically under the flexion forces defined above.
solution is a simple and obvious result of being able to define exactly how far
these discs (L4/5 and L5/S.) should flex.
It might turn out to be a very effective corrective measure in the early
stages of a low back problem. I am
interested in working with an orthopaedic surgeon who wishes first of all to
fully understand this proposal and then to develop his or her own method of
implementing it. (Click here for
is explained in more detail in the booklet;
by John Gorman.
Member of the Institution of
Member of the Institution of Electrical Engineers