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?
Remember 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.
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.
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.