Dynamic Control of Movement is Key to Low Back Pain

Peo­ple with low back pain often also have poor con­trol of low back move­ment.  For­tu­nate­ly, we’ve come a long way from the days when all we knew about con­trol of low back move­ment was the idea of hav­ing “strong abs”.  The dynam­ic con­trol of pos­ture and spinal move­ment is far more sub­tle.  Sci­en­tists can now quan­ti­fy some of the details:

How well can you mon­i­tor and con­trol the exact align­ment and posi­tion­ing of your trunk?  

trunk rotation exerciseRemem­ber play­ing pin-the-tail-on-the don­key when you were a kid?  They blind­fold you and then spin you around to con­fuse your brain about which direc­tion is which.  Sci­en­tists use the same strat­e­gy in study­ing low back pain.  They test sub­jects by rotat­ing their spine and then ask them to repo­si­tion them­selves in their orig­i­nal align­ment.  Peo­ple with back pain do a poor­er job on this task.

 

How much mus­cle ten­sion do you use when you bend for­ward?

When a per­son with­out pain bends for­ward, the mus­cles on either side of their low back relax.  If you’re in pain, how­ev­er, it’s much more like­ly that these mus­cles will remain tense through­out the motion.

How well do you engage your trunk sta­bi­liz­ers when you move your arms and legs?

Sci­en­tists test for acti­va­tion of the abdom­i­nal mus­cles when you wave your arms around or catch a ball.  An indi­vid­ual with­out low back pain will typ­i­cal­ly engage their abs a split-sec­ond in advance.  They’re antic­i­pat­ing the need for trunk con­trol and auto­mat­i­cal­ly imple­ment­ing an effec­tive move­ment strat­e­gy.  If you have low back pain, you’re more like­ly to engage these mus­cles only after the fact.  You’re miss­ing out on this ben­e­fi­cial feed-for­ward strat­e­gy.

Engage the brain to enhance pain reliefsitting alignment

It makes sense that any approach to treat­ing back pain should also help improve someone’s brain con­trol over their pos­ture and move­ment.

In my office, I don’t wire you up with bunch­es of elec­trodes, but I do use move­ment and pos­tur­al obser­va­tion to gauge your gen­er­al lev­el of move­ment and pos­tur­al skill.  Then, part of my ther­a­peu­tic strat­e­gy is move­ment skills train­ing to build pos­tur­al aware­ness and improve mus­cle strength and con­trol.

How much does spine surgery help to improve move­ment con­trol?

A hand­ful of recent sci­en­tif­ic stud­ies have test­ed patients before and after disc surgery (dis­cec­to­my) to see if their move­ment con­trol had improved.  On the aver­age, patients had less pain after surgery, but the results on move­ment test­ing were less clear.  It did seem that patients had an improved pos­tur­al sense after surgery, but oth­er mea­sures didn’t improve as much.

Check out this study, and this one for some of the details.

If you’re one of the small minor­i­ty of patients who needs back surgery, don’t leave your recov­ery to chance.  Even those patients who require surgery can ben­e­fit from man­u­al ther­a­py and move­ment skills train­ing as part of their dis­cec­to­my recov­ery.

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About Ronald Lavine, D.C.

Dr. Lavine has more than thirty years' experience helping patients alleviate pain and restore health using diverse, scientifically-based manual therapy and therapeutic exercise and alignment methods.

His website, askdrlavine.com, provides more information about his approach.

Please contact him at drlavine@yourbodyofknowledge.com or at 212-400-9663.

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