What is the pathogenesis of unspecific low back pain and how can a successful causative treatment outcome be achieved?

Introduction
The correlation with stress- and sympathicotonia- induced regulation rigidity has been demonstrated with the relaxation of the dorso-lumbar and lumbopelvic fascia and muscles following the resolution of vegetative hypertension with neural therapy injections into the umbilical fascia or osteopathic abdominal fascia relaxation.
In early 2009, the search for alternatives resulted in the introduction of the umbilical integration technique.

Material/Methods
1989 patients with unspecific back pain underwent standardised examination and treatment between 01/03/2009 and 01/03/2012. At 91.1%, the most common condition was muscle hardening of the quadratus lumborum muscle with sacroiliac joint block and positive Patrick’s sign (restricted abduction of flexed hip). 65% of patients additionally suffered from mutually dominant contracture of the iliopsoas muscle, i.e. pelvic torsion.

Treatment consisted of the following steps:
1. Manual relaxation of the abdominal fascia system by means of “umbilical integration”
2. This procedure resolved the vegetative regulation rigidity in the adrenal cortex and the solar plexus
3. Simultaneous relaxation of the manually contacted lumbopelvic muscles and fascia
4. Resolution of the sacroiliac joint blocks as well as pelvic muscle tensions by means of ”sacral bone integration“
5. Continuous manual treatment, possibly with acupuncture and injections (16.6%)
Steps 1-4 can also be performed by patients or family members.

The correlation between stress and pelvic torsion is also demonstrated by its spontaneous resolution, either through:
1. Jaw relaxation, first with cotton rolls for diagnostic purposes, then manually
2. Refinement of scars and throat by “scar integration” technique
3. Removal of foreign objects such as belly button piercing (!) or ear rings

Results
In view of the pathogenesis of unspecific back pain, the following chain of causes has analogously been determined:
1. Stress-related irritation of the connective tissue associated with impaired information transmission within the basic extracellular system and tension of the fascial system
2. Overload of the hypothalamic-pituitary-adrenal axis with sympathicotonia-induced vegetative regulation rigidity
3. Muscular imbalance in the torso, primarily with contracture of the quadratus lumborum muscle, secondarily of the iliopsoas muscle, typically mutually as pelvic torsion, often associated with a difference in the length of the legs
4. Impaired joint function, primarily of the sacroiliac joint
5. Other functional irritations, including the dorso-lumbar and pelvic region, symphysis, head- and jaw joints, hips, calves, feet
6. Pain-related, psychovegetative, emotional, mental and social stress

Every link of the chain can have a detrimental effect on the remaining links.

Conclusion
1. Pelvic torsion is considered the primary, often low-symptom reaction of the musculoskeletal system to even minor stress which severely reduces the back strength.
2. Pelvic torsion and Patrick’s sign or hip flexion contracture can also be used as stress indicator in back pain.
3. Umbilical and sacral bone integration which can also be performed by the patients represent an effective basic treatment as well as prophylaxis for unspecific low back pain.




Zentrum für Integrale Medizin und Therapie
Drs. Bita und Khalil Kermani


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