What do Joe, Martha and Julie have in common? Joe, a 37-year-old construction worker, came to the clinic for back pain. The therapy helped-exercise, modalities and body mechanics-and Joe was discharged. Three weeks later he was back with the same complaints.
Martha, an 82-year-old retired teacher living in a retirement community, was seen by therapy for balance and ambulation deficits. Some days she could rise from sitting independently and walk using a cane. The next day she was unable to rise from sitting and was unsteady walking in a flexed position with a cane due to balance problems. It was a cyclical problem.
Julie, a 23-year-old mother of a 9-month-old daughter, came to the clinic complaining of back pain. She has been treated for the problem including exercise, manual therapy, body mechanics and an SI belt-but the pain kept returning.
Joe, Martha and Julie all have functional bowel problems including constipation, diarrhea and dyssenergia. Constipation affects more than 27 percent of the population, diarrhea impacts up to 15 percent and dyssenergia can limit function in up to 8 percent of the general population. These dysfunctions can perpetuate and/or lead to reoccurring back pain and balance problems.
Bowel/Colon
The colon/bowel is an indicator of body function especially in the at-risk and aging population. The enteric nervous system of the intestines is the third division of the autonomic nervous system (ANS) and influences every muscle and nerve in the body.
Any bowel dysfunction becomes an ANS-enteric dysfunction. The colon/bowel is directly connected to the sacrospinal column and influences its alignment and function.
Back Pain
Back pain and bowel dysfunction are linked through the fascial connection of the bowel to the sacrum and through the autonomic nervous system reflex arcs and sensory messages between the colon and proprioception sensors in the low back and sacroiliac joints. The lower colon is attached to the sacrum by fascia and ligamentous tissue in the left lower quadrant.
When there is bowel dysfunction, especially constipation, the lower colon and rectum sink lower in the pelvis with the increased weight of fecal material. This can pull the sacrum and sacroiliac joint into altered alignment.
The constipated colon/rectum puts additional pressure on the pelvic muscles that attach to the sacrum leading to sacroiliac alignment changes and increasing pelvic muscle resting tone and muscle dyssenergia. The spine, sacrum and pelvis function as one interdependent unit of joints and tissue.
Dysfunction in any segment leads to abnormal stresses in the other segments. Both sacroiliac alignment and pelvic muscle resting tone changes can lead to back and pelvic pain.
Balance Problems
Balance problems and bowel dysfunction are linked through the pelvic muscles and autonomic nervous system. The constipated colon changes pelvic muscle tone and pelvic rotator cuff function.
Pelvic rotator cuff function helps maintain upright midline stance and adjust to small perturbations. Larger pelvic muscles such as the iliacus are also influenced by ANS changes from the bowel.
When the bowel is in turmoil, the striated muscle system of the pelvic region functions abnormally too, leading to movement pattern disruption-sit-to-stand problems and ambulation balance issues.
Bowel dysfunction changes autonomic nervous system influence on pelvic muscle resting tone and proprioceptive sensors in the low-back and sacroiliac joints.
Twelve to 14 reflex arcs control bowel and bladder function through the visceral and somatic nervous systems. There is a direct connection via the vagus nerve between the bowel and heart and blood vessel function.
Changes in bowel function, constipation and diarrhea, alters heart rate and blood pressure. Rapid variation in heart rate and blood pressure can significantly affect sit to stand and ambulation balance.
Central activation and eventually sensitization of the cingulate cortex bias the limbic system toward perpetuated pain and holding patterns.
Assess Bowel Function
It is important during the initial intake to include bowel and bladder questions as part of past and present health status. Appropriate screening questions can include:
• What is your normal bowel pattern?
• Do you have the awareness of a need to have a bowel movement?
• How often do you have a bowel movement?
• What is the consistency of the bowel movement? (use the Bristol Stool Scale)
• Do you strain or push hard to have a bowel movement?
• Do you experience pain or discomfort before, during or after a bowel movement?
• Do you have any uncontrolled loss of bowel material day or night?
Normal adult bowel function includes:
• Presence of controllable awareness for need to toilet.
• Toileting every day or every other day.
• Bowel movement is of soft but formed consistency.
• Bowel movement is round and long.
• Toileting is completed without straining.
Treat the Bowels, Treat Back Pain
Adding a component to normalize colon/bowel health can significantly improve the outcomes for some back pain and balance dysfunction clients.
The added colon/bowel component integrates well into the usual back and balance treatment protocols. It includes normalizing bowel function, normalizing colon/bowel position in the abdomen and normalizing autonomic nervous system balance.
Normalizing colon/bowel function occurs when the food eaten is broken down and reconstituted into appropriate nutrient chemicals the body needs for health; then travels through the intestines at an appropriate speed for the nutrients and water to be absorbed.
Changing the foods eaten can improve the chemical composition, speed and absorption rates. For example, when there is constipation, adding more water instead of coffee or soda and a spinach salad with fresh pear and extra virgin olive oil may be all that is needed.
Adding physiological quieting once daily helps to rebalance the enteric division of the ANS that runs the intestines.
Normalizing colon/bowel position can occur when the individual spends five minutes two to three times a day with inversion on a Wonder W'edge and by practicing Roll for Control Exercises.
The inversion allows gravity to help return the colon/bowel to a more normal position and roll for control exercises facilitate normal pelvic muscle tone and function. In combination with physiological quieting pelvic muscle dyssenergia and pain significantly decrease.
Normalizing ANS balance occurs using quieting techniques to rebalance the sympathetic-parasympathetic-enteric messaging system to the colon, bowel, pelvic muscles and sacrospinal joints.
Bowel/colon dysfunction is an important consideration in the analysis of back pain and balance problems. It occasionally is the primary problem and many times can be a factor in perpetuating or causing reoccurrence of an acute problem.
A few simple questions during the intake assessment and when indicated integrating treatment techniques that will help normalize bowel function can greatly improve outcomes for back pain and balance problems.
Janet A. Hulme has been a practicing therapist for more than 40 years and trains for half-marathons at 64 years old.