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32 m a s s a g e & b o d y wo r k n ove m b e r/d e ce m b e r 2 0 2 3 The ABZs of Low-Back Pain TECHNIQUE By Erik Dalton, PhD MYOSKELETAL ALIGNMENT TECHNIQUE KEY POINTS • Researchers found that pain arising from the lumbar Z joints accounts for 10–15 percent of mechanical back pain in young adults and up to 40 percent of cases in older people. • Leveling the head and tail is a biomechanical approach to restoring balance and function to the musculoskeletal system by addressing postural imbalances in the cervical and sacral regions. According to the latest information on the prevalence of low-back pain in the US, the Centers for Disease Control and Prevention (CDC) reports that 60 percent of adults 18 years or older experienced low-back pain within the last three months. 1 Of this group, 20 percent report chronic pain lasting 12 weeks or longer. Low-back pain is the single leading cause of disability worldwide. 2 The symptoms of low-back pain include localized pain and stiffness in the lower back, often on one side. Some people experience localized tenderness over affected vertebrae and pain that increases with specific movements, especially extension or rotation. Spasms are present in surrounding muscles, and sitting causes increased pain. In chronic cases, diffuse pain may spread to the buttocks, groin, or down the leg. Several structures in the lumbar spine might serve as pain generators, making it difficult to determine the etiology of low-back pain. However, researchers increasingly point to the zygapophyseal joints (Image 1), also called Z joints or facet joints, as primary pain generators in low-back conditions. 3 In one study, researchers found that pain arising from the lumbar Z joints accounts for 10–15 percent of mechanical back pain in young adults and up to 40 percent of cases in older people. 4 In a cadaveric study of 647 lumbar spines, researchers discovered evidence of degenerative changes in Z joints in 60 percent of adults by the time they reach age 30. Moreover, the degeneration continues and is pervasive by age 70. 5 In this article, we'll discuss Z joints and their role in low-back pain. We'll identify a holistic approach to working with the spine and practice two myoskeletal alignment techniques (MAT) that help us normalize Z joint movement. Z JOINT ANATOMY The zygapophyseal joints are a crucial component of the human vertebral column, contributing to its stability, f lexibility, and load-bearing capabilities. Z joints are paired synovial joints formed from the superior articular processes of one vertebra and the 32 m a s s a g e & b o d y wo r k n ove m b e r/d e ce m b e r 2 0 2 3 1