The Treatment of Low Back Pain According to the Mézières Method

Treatment of low back pain according to the Mézières method

Dr. Mauro Lastrico 

Technique framework

The Mézières method aims to research and treat the causes that led to the appearance of the symptom. It is therefore one of the causal-type methods.

Observations

• radiographically, in every low back pain, an alteration of the physiological lumbar and/or lumbosacral lordosis is detectable
• such alterations are not isolated to the lumbar tract but involve the entire vertebral sinusoid and other joints
• muscles acting on the lumbar tract are shortened
• muscles behave as interdependent and interacting forces determining the shortening of the complex muscular system.

It follows that the symptom is caused by an alteration of the physiological articular sequence, itself caused by the muscular shortening both of the muscles acting on the joint and of those acting on the entire skeleton.

Causes of muscle shortening

The muscle fiber is composed of a sequence of contractile parts and non-contractile parts (the latter made of connective tissue). Referring to the physical laws on deformations of elastic and plastic bodies, it turns out that the contractile components of the muscle fiber behave as elastic elements; consequently, after deformation in compression due to contraction, they basically return to their initial conditions. Conversely, the non-contractile components of connective tissue behave like plastic materials, so if a deformation in compression occurs with a force and for a time sufficient to exceed the threshold of the elastic deformation curve entering that of permanent deformations, the connective tissue will retain a permanent shortening deformation.

Complex systems

Physics and mathematics have shown that for any system in which there are multiple acting forces, the same laws apply. These systems are called "complex systems." Each complex system consists of the sum of the individual simple systems that compose it.

The incorrect functioning of a complex system can be caused either by the malfunction of one of its components (alteration of one or more simple systems) or by the incorrect integration of the acting forces (alteration of the complex system).
The fundamental laws on complex systems state that:

• All forces acting in the system are interdependent
• Understanding the functioning of a complex system can only occur through understanding the system as a whole
• Complex systems can generate original solutions that are not given by the simple sum of the acting forces

Differential diagnosis

The symptom, low back pain, can be:

• the expression of a specific pathology not attributable to local or systemic muscle shortening
  In this case, the Mézières method does not apply for treatment but the care will consist of the use of specific medical and physiotherapy techniques
• the expression of a local muscle shortening
  In this case, treatment can take advantage of the Mézières method which will aim to restore the physiological lumbar lordosis, correct lateral and rotational deviations of the vertebral column, through isometric contractions in maximum stretching of the acting muscles preventing compensations upstream and downstream of the treated area
  The use of isometric contractions in maximum stretching is motivated by the fact that, always referring to the laws on elastic deformations of bodies, they produce a permanent elongation deformation of the connective components of the muscle fiber
• the expression of systemic muscle shortening
  In this case, the symptom (low back pain) is the consequence of a postural alteration and the therapeutic objective of the Mézières method will be to act comprehensively on the latter.

Postura

Per postura si intende come il corpo si posiziona nello spazio, questa definizione è però insufficiente nel determinare la correttezza o meno del posizionamento stesso.
La definizione può essere allora modificata come sommatoria di sequenze articolari. Se le articolazioni nel loro complesso rispettano i normali rapporti fisiologici, la postura è corretta indipendentemente dalla posizione assunta dal soggetto, in caso contrario qualunque postura verrà assunta, sarà di base scorretta.
Gli elementi che possono influenzare la postura sono molteplici: il sistema masticatorio, visivo, scheletrico, muscolare, neurologico ecc.
La postura è quindi un sistema complesso ove ogni sistema semplice che lo compone è in grado, utilizzando la muscolatura, di modificarla.
La postura intesa come corretta sequenza articolare è cioè modificata dalla modificazione in accorciamento del sistema muscolare dovuto a cause insite nel sistema stesso (accorciamento muscolare primario) o come reazione ad un’alterazione di un altro apparato (accorciamento muscolare secondario).
Il trattamento del caso 3, quando cioè la lombalgia è conseguenza di un’alterazione posturale, dovrà avvalersi di test diagnostici per accertarsi dell’eventuale presenza dell’alterazione di altri sistemi e, in caso positivo, sarà necessaria per la risoluzione del caso, la collaborazione con altri professionisti.