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Understanding Spinal Biomechanics & Pain

Proper Posture is essential for overall health. Without proper posture, our body is in a constant state of stress which leads to bone, muscle, joint and nervous system stress.

Better posture = less pain and better long-term health. See below.

Spinal Biomechanics

Proper Spinal posture is critical because it directly governs how efficiently the vascular system, muscular system, cerebral spinal fluid and nervous system perform. The spine is not just a structural support; it’s your bodies fuse box.

When posture is optimal, joints move properly, muscles balance appropriately, and neural/vascular/CSF input/output remains clear and coordinated.

However, poor posture (such as forward head carriage or pelvic imbalance), loss of spinal stability or severe degeneration creates abnormal joint stress and sustained muscle tension, alterations in proprioceptive, CSF flow and blood flow to the brain.

Over time, the brain adapts to these distorted signals as a new “normal,” reinforcing dysfunctional movement patterns with protective muscle guarding, which is called muscle splinting.

This can lead to a cascade of effects, including chronic pain, reduced mobility, impaired coordination, hormonal changes and even changes in autonomic function such as headaches, fatigue, and brain fog.

Blow we will discuss how spinal postural changes affect:

Spinal Discs
Spinal Facet Joints
Spinal Ligaments
Nervous System
Cerebral Spinal Fluid Flow
HPA Axis - Stress Response
Brain Function
Pain Perception

Disc Degeneration

The primary function of the intervertebral disc is to absorb and transmit axial compressive loading through the spinal column and to control loading by distributing stresses within the dense fibrocartilage of its annulus fibrosus. Abnormal cervical spine posture, including loss of normal lordosis or forward head positioning, alters load distribution across the disc, resulting in increased anterior or posterior stress concentrations. This leads to abnormal strain within the annular fibers, accelerated disc degeneration, reduced disc height, and increased risk of annular fissuring and herniation. Over time, these biomechanical alterations compromise the disc’s ability to effectively dissipate forces, contributing to chronic spinal dysfunction, degeneration and pain.

Yoganandan, Narayan; Nahum, Alan M.; Melvin, John W.; The Medical College of Wisconsin Inc. Accidental Injury: Biomechanics and Prevention (p. 551). Springer New York. Kindle Edition.

Research

Changes in Kinematics can accelerate spinal degeneration.
- Miyazaki M, Hymanson HJ, Morishita Y, He W, Zhang H, Wu G, Kong MH, Tsumura H, Wang JC. Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. Spine (Phila Pa 1976). 2008 Nov 1;33(23):E870-6.
- Link: Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine - PubMed
Once degeneration starts, motion at this level reduces and motion at the level below increases. This results in further progressive degeneration over time.
- Hussain M, Natarajan RN, An HS, Andersson GB. Motion changes in adjacent segments due to moderate and severe degeneration in C5-C6 disc: a poroelastic C3-T1 finite element model study. Spine (Phila Pa 1976). 2010 Apr 20;35(9):939-47.
- Link: Motion changes in adjacent segments due to moderate and severe degeneration in C5-C6 disc: a poroelastic C3-T1 finite element model study - PubMed

Facet Joint Degeneration

Facet joints are paired synovial joints located at the back of each spinal segment. Their main functions are:

Guide and control spinal motion
- Prevent excessive rotation, flexion, and extension
Stabilize the spine
- Work with discs to maintain spinal segment integrity
Distribute load
- Share weight-bearing forces with intervertebral discs
Limit shear forces
- Prevent vertebrae from sliding abnormally
Protect the disc
- Reduce excessive stress on the intervertebral disc during movement

Facet joint osteoarthritis (FJ OA) is a degenerative condition affecting the facet (zygapophyseal) joints of the spine. It is strongly associated with degenerative disc disease and is now understood as part of a whole spinal motion-segment failure.

Goode A, Nelson A, Kraus V ...Biomarkers reflect differences in osteoarthritis phenotypes of the lumbar spine: the Johnston County Osteoarthritis Project Osteoarthritis and Cartilage, 2017; 25, 1672-1679

Cervical facet joints have been well established in the literature as a common source of axial neck pain, with an estimated prevalence up to 66%. The diarthrodial joints are formed by bony articulation of the SAP and inferior articular process, surrounded by a fibrous capsule; they contain articular cartilage and menisci and are innervated by the medial branches of the dorsal rami. Pain from the cervical facet joints can originate from traumatic hyperextension injuries such as whiplash or degenerative processes such as osteoarthritis.

Kirpalani D, Mitra R. Cervical Facet Joint Dysfunction: A ReviewArchives of Physical Medicine and Rehabilitation, 89, 770-774

Research

Abnormal Facet Joint Loading: While not producing visible tearing, can produce functional plasticity of dorsal horn neuronal activity. The increase in neuronal firing across a range of stimulus magnitudes observed at day 7 post-injury provides the first direct evidence of neuronal modulation in the spinal cord following facet joint loading, and suggests that facet-mediated chronic pain following whiplash injury is driven, at least in part, by central sensitization.
The significant increase in the number of wide dynamic range neurons classified in the painful group (69% of neurons; p >0.0348) in this study suggests that a phenotypic shift in the re sponse of the neuronal population in the deep laminae of the dorsal horn may play a key role in modulating chronic pain after facet joint injury.
- Quinn, Kyle P.a; Dong, Linga; Golder, Francis J.b; Winkelstein, Beth A.a,c,*. Neuronal hyperexcitability in the dorsal horn after painful facet joint injury. Pain 151(2):p 414-421, November 2010.
- Link: PAIN

Best Conservative Treatment

Chiropractic Diversified and Thompson Drop Techniques

Restores normal joint glide and motion
Reduces facet joint hypomobility and stiffness
Helps break the pain–spasm–pain cycle
Improves mechanoreceptor input → pain modulation

Additional beneficial therapies.

Electro-Acupuncture
Pulsed Radiofrequency
Manual Flexion/Distraction
Cox Flexion Distraction

Spinal Ligament Injury

The cervical vertebrae are stabilized by many ligaments in both the anterior and posterior regions of the spine that normally contribute to maintaining the head position and providing neck proprioception, which is the sensory input that aids in awareness of relative position and movement of the body during spinal motions. The ligaments in the cervical spine include the anterior and posterior longitudinal ligaments that span the entire vertebral column, ligaments that connect pairs of adjacent vertebrae (ligamentum flavum, interspinous, and supraspinous ligaments), and the bilateral facet capsular ligaments that enclose the apposing surfaces of the articular pillars of adjacent vertebrae. The anterior longitudinal, facet capsular, supraspinous, and interspinous ligaments are at particular risk for undergoing excessive strain during injurious loading of the cervical spine, because of their role in bearing tensile loads during spinal motion.

In addition to proprioception and structural support, numerous immunohistochemical studies have reported the longitudinal, supraspinous, interspinous, and facet capsular ligaments to be innervated by nociceptive fibers (pain fibers) and free nerve endings. Histological studies have also identified low and high threshold mechanoreceptors, based on visualization of specialized sensory terminals, in many of these same spinal ligaments, along with nociceptive innervation. The capacity of nerve fibers in spinal ligaments to be activated by a wide range of mechanical loading modalities further suggests their role in initiating and/or signaling painful loading from cervical spine injuries due to excessive loading of those tissues.

Yoganandan, Narayan; Nahum, Alan M.; Melvin, John W.; The Medical College of Wisconsin Inc. Accidental Injury: Biomechanics and Prevention (p. 552). Springer New York. Kindle Edition.

Research

We could show that there is a focal increase in sensory and nociceptive nerve fibers at the level of C4 and C5 for both ALL and PLL.
- Analysis of the mechanical response of damaged human cervical spine ligaments - ScienceDirect
For all whiplash-exposed ligaments, the average failure elongation exceeded the average physiological elongation. The highest average failure force of 204.6 N was observed in the ligamentum flavum, significantly greater than in middle-third disc and interspinous and supraspinous ligaments. The present decreases in neck ligament strength due to whiplash provide support for the ligament-injury hypothesis of whiplash syndrome.
- Tominaga Y, Ndu AB, Coe MP, Valenson AJ, Ivancic PC, Ito S, Rubin W, Panjabi MM. Neck ligament strength is decreased following whiplash trauma. BMC Musculoskelet Disord. 2006 Dec 21;7:103.
- Link: Neck ligament strength is decreased following whiplash trauma - PubMed

Best Conservative Treatment

Spinal ligament injuries are not just “sprains”—they involve:

Mechanical instability (ligaments guide motion)
Proprioceptive loss (ligaments are sensory organs)
Pain sensitization (ligament nociceptors → chronic pain)
Poor healing capacity (low blood supply)

So treatment must focus on: stability + neurology + controlled loading.

Stability
- Microcurrent Therapy - Probes
- Galvanic Therapy - Probes
- Russian Stimulation Supporting Muscles
- Fardiac Stimulatino Supporting Muscles
- Chiropractic Biophysics - Spinal Curve Remodeling
Neurology and Controlled Loading
- Neuro-Kinetic Therapy
- Biofeedback

Myelopathy

Degenerative cervical myelopathy comprises age-related degenerative pathologies of the cervical spinal column that lead to myelopathy from compression of the spinal cord. These include osteoarthritic degeneration (cervical spondylosis) and ligamentous aberrations (ossification of the posterior longitudinal ligament or ligamentum flavum

Witiw CD, Fehlings MG: Degenerative cervical myelopathy. CMAJ | JANUARY 23, 2017 | VOLUME 189 | ISSUE 3
Link: Degenerative cervical myelopathy | CMAJ

Research

Degenerative cervical myelopathy occurs when age-related osteoarthritic changes cause narrowing of the cervical spinal canal, leading to chronic spinal cord compression and resultant neurologic disability. A 2017 study has estimated the prevalence of DCM to be 1120 per 1 million people in Canada, with an incidence of hospitalizations at 4 per 100 000 person-years.7 However, the precise prevalence of DCM is not known owing to nonuniform definition and the lack of large population-based studies, and thus true prevalence is thought to be higher.8 Patient presentation can vary broadly, with symptoms ranging from mild dysfunction, such as numbness or dexterity problems, to severe dysfunction, such as quadraparesis and incontinence, as later findings.5,9–12 It is important to note that paresthesia in the extremities is often the first sign, and because it might be mild, it can be easily overlooked by patients and providers.
The pathogenesis of the disease can be divided into 3 main components: static, dynamic, and histopathologic.
- Static factors are structural factors that cause canal narrowing. The degenerative cascade of DCM typically begins with the deterioration of the intervertebral disk. The disk collapses and bulges posteriorly causing a narrowing of the spinal canal. Decreased disk height causes the spinal column to shorten, leading to abnormal spine biomechanics. The ligamentum flavum can also cause compression by thickening and buckling into the spinal canal. Ossification of the posterior longitudinal ligament can also lead to DCM by direct compression of the cord. These changes often cause a stiffening of the affected structures. To compensate for the decreased motion at the affected levels, adjacent regions of the spine become hypermobile.
- Dynamic: Dynamic factors refer to abnormal repetitive movement of the cervical spine during flexion and extension causing spinal cord irritation and compression. Flexion might compress the spinal cord against anterior osteophytes and intervertebral disks. Hyperextension might lead to cord pinching between the posterior margins of the vertebral body anteriorly and the hypertrophied buckled ligamentum flavum posteriorly.
- Histopathologic: Mechanical compression of the cord leads to vascular changes causing ischemia and inflammation. Chronic cord compression can lead to neuronal cell loss, degeneration of the posterior columns and anterior horn cells, and endothelial damage resulting in a compromised blood–spinal cord barrier, which all accumulate to the functional decline of the patient. The effects of cord compression vary depending on the degree of compression; however, they conclude in a range of motor and sensory impairments, as detailed below. As DCM is a progressive, degenerative condition, it is estimated that 20% to 60% of those with myelopathic symptoms will further deteriorate over time.
- College of Family Physicians of Canada. See graphics below
- Link: Degenerative cervical myelopathy | The College of Family Physicians of Canada

Best Conservative Treatment

Spinal ligament injuries are not just “sprains”—they involve:

Mechanical instability (ligaments guide motion)
Proprioceptive loss (ligaments are sensory organs)
Pain sensitization (ligament nociceptors → chronic pain)
Poor healing capacity (low blood supply)

So treatment must focus on: stability + neurology + controlled loading.

Stability
- Microcurrent Therapy - Probes
- Galvanic Therapy - Probes
- Russian Stimulation Supporting Muscles
- Faradic Stimulation Supporting Muscles
- Chiropractic Biophysics - Spinal Curve Remodeling
Neurology and Controlled Loading
- Neuro-Kinetic Therapy
- Biofeedback

Fatty Infiltration

Loss of normal spinal movement is associated with progressive neuromuscular degeneration and structural deterioration of the spinal stabilizing tissues. When spinal segments become hypomobile due to pain, ligament injury, disc pathology, joint dysfunction, or protective muscle guarding, the deep stabilizing musculature, particularly the multifidus and other paraspinal muscles undergo reflex inhibition and reduced activation.

Over time, this disuse and altered neuromuscular control contribute to muscle atrophy, reduced oxidative capacity, and fatty infiltration within the spinal musculature. These changes impair spinal stability, proprioception, and load distribution, creating a cycle of chronic dysfunction, persistent pain, and further degeneration.

Studies have demonstrated that reduced spinal movement and chronic low back or cervical pain are associated with increased fatty infiltration of the multifidus muscles, decreased cross-sectional muscle area, and progressive degenerative changes involving the discs, facet joints, and supporting connective tissues.

Restoration of spinal mobility and neuromuscular activation is therefore considered an important component in reducing ongoing degeneration and improving spinal function.

Research

Changes in spinal curvatures can lead to Type II myofiber changes, reducing the overall size of the para-spinal muscles.
- Kiram A, Li J, Liu Q, Ling C, Xu H, Fan C, Hu Z, Zhu Z, Qiu Y, Liu Z. Proteome analysis reveals paraspinal muscle fiber type changes in patients with degenerative lumbar scoliosis. Spine J. 2025 Jun;25(6):1288-1303.
- Link: Proteome analysis reveals paraspinal muscle fiber type changes in patients with degenerative lumbar scoliosis - PubMed
In patients with chronic radiculopathy, disc herniation and severe facet degeneration were associated with altered paraspinal muscle morphology at or below the pathology level that included greater multifidus and erector spinae muscle atrophy or fat infiltration. Meaning the muscles that protect and support your spine, change from muscle tissue to fatty tissue.
- Cooley JR, Walker BF, M Ardakani E, Kjaer P, Jensen TS, Hebert JJ. Relationships between paraspinal muscle morphology and neurocompressive conditions of the lumbar spine: a systematic review with meta-analysis. BMC Musculoskelet Disord. 2018 Sep 27;19(1):351.
- Link: Relationships between paraspinal muscle morphology and neurocompressive conditions of the lumbar spine: a systematic review with meta-analysis - PubMed
In patients with facet joint degeneration, Atrophy of the multifidus muscle was significantly found in the spine.
- Guven AE, Schönnagel L, Camino-Willhuber G, Chiapparelli E, Amoroso K, Zhu J, Tani S, Caffard T, Arzani A, Zadeh AT, Shue J, Tan ET, Sama AA, Girardi FP, Cammisa FP, Hughes AP. Relationship between facet joint osteoarthritis and lumbar paraspinal muscle atrophy: a cross-sectional study. J Neurosurg Spine. 2024 Jun 14;41(3):360-368.
- Link: Relationship between facet joint osteoarthritis and lumbar paraspinal muscle atrophy: a cross-sectional study - PubMed
Without normal spinal biomechanics, spinal disc, facet and vertebral degeneration will progress and worsen over time. With restoration of the spinal curve, these degenerative process will stop, and in some cases can improve.
- Gullbrand SE, Kiapour A, Barrett C, Fainor M, Orozco BS, Hilliard R, Mauck RL, Hast MW, Schaer TP, Smith HE. Restoration of physiologic loading after engineered disc implantation mitigates immobilization-induced facet joint and paraspinal muscle degeneration. Acta Biomater. 2025 Jan 15;192:128-139.
- Link: Restoration of physiologic loading after engineered disc implantation mitigates immobilization-induced facet joint and paraspinal muscle degeneration - PubMed

Best Conservative Treatment

Fatty infiltration of paraspinal muscle is associated with spinal disorders. Intervertebral disc degeneration is commonly associated with back and neck pain, and standard surgical treatments do not restore spine function.

Gullbrand SE, Kiapour A, Barrett C, Fainor M, Orozco BS, Hilliard R, Mauck RL, Hast MW, Schaer TP, Smith HE. Restoration of physiologic loading after engineered disc implantation mitigates immobilization-induced facet joint and paraspinal muscle degeneration. Acta Biomater. 2025 Jan 15;192:128-139.

Motor Control Proprioceptive Biofeedback
Microcurrent Therapy - Probes
Galvanic Therapy - Probes
Russian Stimulation Supporting Muscles
Faradic Stimulation Supporting Muscles
Chiropractic Biophysics - Spinal Curve Remodeling

Neurology and Controlled Loading
- Neuro-Kinetic Therapy
- Biofeedback

Watch Video at
57 Seconds and 2:21 seconds

Cerebral Spinal Fluid and Blood Flow changes

Research suggests that the natural curve of the neck plays an important role in neurological and vascular function. The cervical spine surrounds and protects critical structures involved in cerebral blood flow and cerebrospinal fluid (CSF) circulation. When the cervical lordosis becomes reduced or abnormal, altered biomechanics, muscular tension, and ligament stress may contribute to changes in spinal motion, vascular dynamics, and neural function. Restoration of normal cervical alignment may help improve the mechanical environment surrounding the spinal cord, vertebral arteries, and CSF pathways.

In a 2019 study published in Brain Circulation, researchers evaluated brain magnetic resonance angiograms (MRA) before and after cervical lordosis correction using the Cervical Denneroll Spinal Orthotic. The investigators found statistically significant increases in cerebral blood flow following cervical curve correction, with measured increases in arterial pixel intensity ranging from 23.0% to 225.9% (P = 0.001). These findings suggest that improving cervical spinal alignment may positively influence blood flow to the brain and potentially support healthier neurological function.

Because cerebrospinal fluid circulation and cerebral blood flow are closely linked to posture, spinal motion, and upper cervical mechanics, maintaining proper spinal alignment may be an important component of optimizing neurological health, reducing mechanical stress on the nervous system, and supporting overall brain and spinal cord function.

Katz E, Katz S, Fedorchuk CA, Lightstone DF, Banach CJ, Podoll JD. Increase in cerebral blood flow indicated by increased cerebral arterial area and pixel intensity on brain magnetic resonance angiogram following correction of cervical lordosis. Brain Circulation, 2019.

Research

Brain MRA was obtained before and following cervical lordosis adjustment which was made using the Cervical Denneroll™ Spinal Orthotic. Still MRA images were analyzed using FIJI/ImageJ and their pixel intensities representing the fold change in measured blood flow were quantified. In each case, an increase in pixel intensity was observed ranging from 23.0% to 225.9%, and a Student’s t‑test showed that the observed increase was statistically significant within the population tested (P = 0.001). These data indicate that correction of cervical lordosis may result in an immediate increase in the amount of CBF of the brain.
- Katz E, Katz S, Fedorchuk CA, Lightstone DF, Banach CJ, Podoll JD: Increase in cerebral blood flow indicated by increased cerebral aterial area and pixel intensity on brain magnetic resonance angiogram following correction of cervical lordosis. Brain Circulation ‑ Volume 5, Issue 1, January‑March 2019.

Pain and Spinal Posture

Pain. This most commonly results from trauma and/or injury, with the spine as the most common injury site for producing chronic pain. When considering the topic of pain, it is important to define that pain is a combination of sensory and emotional experiences and nociception is the set of physiological responses that transmit the pain signals. Hyperalgesia and allodynia are two primary classes of behavioral responses. Hyperalgesia is an amplified response to a stimulus (mechanical, temperature or chemical) and suggests that more pain is perceived. Allodynia is characterized as pain that is evoked by a typically non-noxious stimulus. Hyperalgesia and allodynia provide quantitative measures of pain that relate to the clinical presentation of symptoms and why your spinal biomechanics can predict your pain outcome.

Yoganandan, Narayan; Nahum, Alan M.; Melvin, John W.; The Medical College of Wisconsin Inc. Accidental Injury: Biomechanics and Prevention (p. 549). Springer New York. Kindle Edition.

Research

The cell bodies of peripheral nerves are located in the dorsal root ganglion (DRG), which is particularly sensitive to mechanical loading, and even slight compression of normal DRGs can produce sustained neuronal activity and pain. Direct impingement on the nerve roots and/or DRG can occur by distortion of the normal size and shape of the neural foraminae, which can occur during extreme movements of the cervical spine, stenosis, or slow osteophytic growth, or even by a herniated disc. The mechanics of compression- and tension-based nerve root injuries, i.e. maximum load, rate of loading, and duration of loading, contribute to the extent of pain produced after injury. These and other mechanical parameters that control and modulate nerve root-induced pain and pathology.

Yoganandan, Narayan; Nahum, Alan M.; Melvin, John W.; The Medical College of Wisconsin Inc. Accidental Injury: Biomechanics and Prevention (p. 554). Springer New York. Kindle Edition.

Neck musculature has a dual role in neck pain by the potential for its own injury and by altering the kinematics and loading of other structures in the neck that may exacerbate existing cervical spine loading and neck pain. Loading of neck musculature can lead to pain since as many as one-half of the neural units in skeletal muscle have some nociceptive function, likely through Aδ- and C-type fibers with their numerous un-encapsulated free nerve endings.

Yoganandan, Narayan; Nahum, Alan M.; Melvin, John W.; The Medical College of Wisconsin Inc. Accidental Injury: Biomechanics and Prevention (p. 554). Springer New York. Kindle Edition.

Whiplash:

Example, during whiplash, loading of the cervical musculature induces strains that exceed injury thresholds, namely in the posterior cervical muscles (splenius capitis, semispinalis capitis, trapezius); these suprathreshold strains have been reported to correlate with reports of pain in the posterior cervical region following whiplash. Further, after such trauma, skeletal muscles also undergo substantial structural and functional changes, including fatty infiltration, tissue degeneration, and altered activation thresholds and contraction timing, all of which can contribute to chronic pain and motor impairment. These types of injuries can also lead to the development and maintenance of local inflammatory responses in the injured tissue that are a common peripheral mechanism for muscle tenderness and even further sensitization of nociceptors

Yoganandan, Narayan; Nahum, Alan M.; Melvin, John W.; The Medical College of Wisconsin Inc. Accidental Injury: Biomechanics and Prevention (p. 554). Springer New York. Kindle Edition.

Pain Cycle by Dr. Ming Kao of Stanford Medicine Pain Lab

Altered Biomechanics (Blue Arrow) results after the pain experience, and contributes to:

Pain
Altered Biomechanics
Myofascial Pain
Reflexive Guarding
Overuse Injury
Nerve Entrapment
Metabolic Dysfunction
Immune System Dysfunction
Hormone Dysfunction

Changes in Spinal Posture Trigger Mechanical Pain Signals to the Brain

Changes in Spinal Posture Trigger Myofascial (Muscle) Pain Cycle

Changes in Spinal Posture Trigger Cervical Nerves 1-3, Trigeminal Nerve, Vagus Nerve and Mid-Brain

Spinal Postural Changes lead to

Altered Spinal Mechanics
Changes in Nervous System Function
Changes in ANS Function
Changes in Blood Flow
Changes in CSF Flow
Spinal Degeneration
Nerve Compression/Injury
S1 Cortex (Brain) Changs
PAIN and LOSS of FUNCTION

Consequence of Chronic Pain

Loss of Gray Matter (Brain Shrinks)

Consequence of Chronic Pain

Appearance of Psychological Issues that are actually a Pain Response

Pain-Drs
Chiropractic

Patient Information
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Understanding Spinal Biomechanics & Pain