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Sarah Key Method

Are you wandering in a wilderness with your back, wondering what to do and who to see next? Are you one of eight in ten people suffering (or have suffered) from back pain?

Low back pain has reached pandemic proportions. It is present in every society, every, social group, every occupation - scientists and stevedores, computer operators and carpet salesmen, shearers and chefs - young and old, tall and small, large and thin. Back pain is on the move.

The Sarah Key ‘working hypothesis’ offers an explanation for; non-specific low back pain of unknown aetiology; and the progressive breakdown of a lumbar motion segment.

Sarah Key postulates that the breakdown of a lumbar motion segment and subsequent production of pain occurs in sequence and runs through 5 stages. These are;

  • Stage 1: Stiff spinal segment or External disc dysfunction
  • Stage 2: Facet joint arthropathy
  • Stage 3: Acute locked back
  • Stage 4: Prolapsed Intervertebral disc
  • Stage 5: Unstable spinal segment

As long ago as 1970, Nachemson postulated, "a deficiency of nutrient supply to the disc may be a contributing factor in disc degeneration". Sarah Key says a reduced nutrient supply to the disc results in a stiff spinal segment (stage one of the Sarah Key 5 stages of spinal breakdown).

In the early stages of degeneration the disc is simply dehydrated, which causes it to distribute load poorly and also to resist stretch. As the spinal segment becomes less compliant, it is rendered a sitting target for additional micro-trauma from run-of-the-mill activities of daily life. The sensitive outer ligamentous layers of the disc (the annulus fibrosis) develop scarring and lose extensibility, just like any ligament repeatedly sprained. This segment loses the stretch to 'give' when the spine moves and its unyielding disc wall emits pain; the typical discomfort of most cases of simple back pain.

Degeneration escalates as movement of the stiff segment gets more sluggish. It then cannot generate sufficient changes of pressure within the disc to suck and squirt fluid in and out. Thus it loses one of its main mechanisms for imbibing nutrients and expunging waste products.

As pain and disability spread, the interplay between spinal and abdominal muscles becomes discordant. The large back muscles keep on keeping on (we call it 'muscle spasm') which further compresses the segments and is uncomfortable in its own right. Spasm also exerts an inhibitory effect on both the deep abdominal muscles (transversus abdominus) and the small muscles which hold the individual segments stable (multifidus). This causes bending to become difficult, which further disables the mechanical pump-imbibition method of disc nutrition.

The good news: 'pressure change therapy'

Sarah Key diagram Recent research tells us that stretching discs makes them less prone to degeneration (Lotz et al 2008, ‘Annulus fibrosis tension inhibits degenerative structural changes in the lamellar collagen’) although it is proposed by Sarah Key that discs that have already degenerated can also be helped by intermittent distractive or decompression forces.

As well as making the disc more resilient to compression, Sarah believes that dynamic end-of-range movement (‘pressure change therapy’ or PCT) introduces extremes of pressure through the discs, which shunts extra quantities of fluid through.

In spines with disc degeneration, PCT uses macro spinal movement to compensate for impaired performance at a micro or molecular level within the disc.  Segmental decompression is most simply and effectively achieved by using a BackBlock and also by touching the toes, or squatting through the day.

Declining concentrations of proteoglycans (a water attracting molecule within the disc) weaken the nucleus' attraction to water and is one of the first signs of the disc degeneration. The good news is that synthesis of new proteoglycans is also stimulated by the pressure changes delivered by large-scale spinal movements. Thus 'pressure change therapy' for painful unhealthy discs works by augmenting the role of the mechanical or convection 'nutritional engine' to compensate for degenerative weakening of the other two mechanisms: osmosis and diffusion.

Disc degeneration also involves stiffening and thickening of the disc wall (in some cases up to 80%), making spinal movement stiffer and the wall itself a more obstructive barrier to diffusion of nutrient molecules through to the nucleus. The good news is that bigger tides of fluid passing through the more metabolically-active outer disc wall gives it 'first use' of the nutrients coming in and bolsters the repair processes. Note: since most of the pain of 'simple low back pain' comes from painful scarring of the sensitized outer layers of this posterior disc wall.

Patients using The Sarah Key's 'pressure change therapy' regime do most of the treatment themselves at home, although painful backs must not launch willy nilly into full-scale spinal movement from a standing start. The metabolic rate of discs is very slow and overall disc healing is a process that takes place over many months, if not years. Relief from simple low back pain can be surprisingly rapid however, as the introduced movement restores the compliance of the outer ligamentous layers of the annulus and enriched nutrient tides pulled through the posterior annulus by the pressure changes bring about fast repair of scarring here.
Although hands-on treatment from a therapist is necessary initially to physically mobilise a jammed spinal segment free, no amount of practitioner-based intervention can bring about the quantum exchange of discal fluid required to bring about repair and reduce pain. Self treatment on a daily basis can achieve incomparably more.
The bottom line is that patients are best at fixing their own backs!

We are open from 7:30 am until 6:30 pm Monday to Friday and from 8:00 am until 12:00 pm on Saturday.

We offer same day appointments and no referral is needed for private patients.

We accept all major health funds for patients with private health cover and have HICAPS facilities to make claiming easier. EFTPOS is also available.

With an appropriate referral we also see compensable patients (Work Cover, TAC, Medicare and Veterans Affairs).


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