------------------------------------------------------------ BASIC ANATOMY PART ONE ------------------------------------------------------------ With over 140 muscles attached to the 24 vertebrae of the spine and supporting structures, the human back is a miracle of engineering. While the human brain may be more complex in design, the human back is more sophisticated in terms of mechanical engineering. Consider the mathematics... If you bend forward at the waist so you are at about a 65 degree angle from vertical, and assuming you weigh about 180 pounds, 450 pounds of muscle force is needed just to keep you from losing your balance and falling over. If you happen to carry a 50 pound weight in this position, the muscle force rises to 750 pounds. At the same time over 850 pounds of direct force will be exerted on the fifth lumbar vertebra. The fact that the spine can be flexible, rigid and twist under varying loads and circumstances is a tribute to evolution and engineering on a biological scale. Despite its impressive performance, the design of our back and spinal column is flawed. During our brief evolution from quadrupeds or four legged walkers into bipeds or two legged walkers nature did not completely finish the job. Quadrupeds such as cats, dogs and horses - and presumably four legged walking primates from which we evolved - use a spinal column which is more evenly supported by four legs which serve as support pillars. This conservative engineering system provides a stronger design much like a suspension bridge with the spine held horizontal and supported by four vertical pillars. When man evolved into a bipedal erect walking creature, this intrinsically sound design was lost and two of the support pillars, our arms, lifted up into the air. To compensate for this weaker design, the stomach, hip and back muscles act as delicate "guy wires" in much the same manner as you might tie a young tree upright with three or four ropes to keep it from toppling over in the wind. The fact that over 90% of disc and muscle related spinal injuries occur in the LOWER spinal area gives testimony to the imperfect design which our accelerated primate evolution delivered to of our spinal and muscular anatomy. In truth, the complicated nature of its design and its slowness to adapt to our relatively recent upright posture makes our backs more susceptible to injury and pain than most other body organs and structures. Your back hurts because its evolution is still catching up with the sudden adoption of an upright posture. Surprisingly, it was BOTH our brains and backs which played the most dramatic role in our evolution since walking erect freed our hands which, along with our developing brains, led to new skills such as tool making, agriculture and writing. Our brains have drawn praise during evolutionary change, but our backs have borne the brunt of a shortened and as yet incomplete evolution. Let's turn to specifics. A brief course on anatomy... The spine has three functions. 1) To support your body, anchor your ribs and connect the pelvis and head. 2) To protect and house the spinal cord whose nerves connect most major body organs to the brain. 3) To provide flexibility, balance and mobility. The spinal column or backbone, is a series of separate bones called vertebrae. Curiously, the vertebrae are not precisely the same size nor are they stacked exactly on top of each other. Rather, to balance with forces of weight and various organs, they are arranged in a precise S curve which is seen when the spine is viewed from the side. Each vertebrae, depending on its shape and the muscles and ligaments which attach to it rests at a slight angle. The spine can be divided into four regions, each of which is quite unique in form and function. 1) The neck region or cervical spine consisting of 7 vertebrae whose function is to support the head. These vertebrae permit the extraordinary range of motion for our heads, eyes and ears. 2) The middle back or thoracic region consisting of 12 vertebrae which are slightly less flexible since they provide attachments for the bones of the ribs. 3) The lumbar spine or lower back consisting of 5 large vertebrae which support the substantial mass of our body weight and which bear the brunt of many opposing forces. These vertebrae are broad and heavy which reflects this task. It is this region of the spine which suffers to most wear and tear from poor posture, sudden trauma and other injuries. It is also this region which displays pain most frequently when people visit the doctor for backaches. 4) The coccyx and sacrum region. The sacrum is a triangular, broad bone attached to the base of the spine which is formed from the fusion of 5 separate bones during early pregnancy and gestation of an infant. Finally, we arrive at the coccyx which is the lowest bone of the spinal column. It is a collection of small bones which are probably all that remains of our primitive vestigial primate tails. If you were to remove one vertebra from the spine you would see that it is a solid cylinder of bone with a hollow canal through the middle for the spinal cord. The hole through each vertebra is called the vertebral foramen. This hole is the primary conduit which houses and protects the spinal cord. Three crucial spurs or projections of bone extend from the back or side of each vertebra. One spur points straight back and is called the spinous process - if you feel your backbone with your fingers you can feel the point of each spinous process along the length of your back. The two other spurs point to the side and are called transverse processes. The single spinous process bends down at an angle and overlaps the vertebra below it. This overlapping tends to provide additional protection for the delicate spinal cord much like shingles on a roof. The two sideways-pointing transverse processes serve to act as anchor points for muscles. Between each vertebra is a tough capsule of ligament which encloses an elastic, jelly-like substance called the nucleus pulposis. To the average lay person this is the "disc" but in fact it is several structures. 1) the outer band of ligament. 2) the flexible gel within. 3) on top and bottom of this whole affair are a pair of tough cartilaginous plates which are the bearing surface upon which the vertebrae rest. Each specific region of the disc is designed for a unique function. A single disc is a composite of several types of tissue, each with a different composition and function. If the spine lacked these "shock absorbing" discs, the vertebra would rub directly against each other and soon destroy the whole structure as well as doing damage to the spinal cord. The clever construction of the discs absorbs shock and distributes spinal pressures evenly in all directions. In early life the disc spaces between vertebrae are wide. As we age, changes begin to take place and the disc gap narrows. The disc loses flexibility, drying out proceeds and scarring from wear and tear can begin. But this can also be a function of use as well as aging. A 70 year old man can have good discs if he has been active and careful while a 30 year old sedentary office worker can have poor discs. The discs expand and contract slightly during the day due to the effects of gravity and work. When you wake up in the morning you are slightly taller than at the end of the day. Astronauts also "gain height" in the weightlessness of space where the discs are freed from the bonds of gravity. The structures of the spine are not the complete bony anatomy of the back. Next we come to the pelvis which is a large bony structure on which all of the lower soft organs rest. This includes the large intestine, uterus, bladder and rectum. At the lower end of the spine the backbone rests on a junction of three bones: the sacrum, a broad triangular bone mentioned earlier, and the right and left and right illium bones. Thin, tough ligaments connect the illium bones to the sacrum. This ligament is known as the symphysis pubis and it is this junction of illium bones and sacrum that gives rise to the famous and sometimes painful "sacroiliac" joint. Moving to the front of the pelvis are the two large sockets or acetabula into which the joints of the upper leg or thigh bones fit. Other than the thin joint between the illium bones and the sacrum, the remainder of the pelvis is rigid and inflexible bone. In the female, the pelvis is wider and broader to allow for the demands of childbirth. The coccyx, our vestigial tail, is the lowest point of the spinal column and is a fused assembly of three or four small bones. The coccyx rarely causes much back pain, unless you have had occasion to slip on icy pavement or sit on a chair which was suddenly pulled out from under you. In a nutshell, this covers the bony structure of the back and spinal column. In the next chapter we move on to the soft tissues of the back: the muscles and ligaments which give this amazing bony foundation its strength, flexibility and tension. This tutorial is merely a starting point! For further information on back care and back pain, be sure to register this software ($25.00) which brings by prompt postal delivery a printed, illustrated guide to back pain written by a physician plus two software disks. From the main menu select "Print Registration Form." Or from the DOS prompt type the command ORDER. Mail to Seattle Scientific Photography (Dept. BRN), PO Box 1506, Mercer Island, WA 98040. If you cannot print the order form, send $25.00 to the above address and a short letter requesting these materials. End of chapter.