motor control and low back pain

[chunkypuffin]

Hello all,

If I may, I'd like to put forward a few thoughts. As somasimple states, a 'normal' subject does not consciously activate TA (or any other deep stabilising muscle be it multifidus, infra spinatus or whatever) when undertaking a functional movement. Similarly not all people who experience back pain will suffer atrophy of their multifidus/TA or experience altered motor control timing/recruitment patterns. However, SOME WILL. The reason I state this is that I have witnessed these discussions in similar forums and it seems to me that the arguments become increasingly polarised, with both sides increasingly reticent to consider the other camps propositions.

Evidence is available that demonstrates localised atrophy of multifidus post first incidence of low back pain (1,2)(again it may be argued did the LBP cause the atrophy or vice-versa - until longitudinal studies are conducted it will be difficult to know). This same study(1) also identified that NOT ALL subjects experienced this atrophy!!
Further studies have shown that it is possible to train these areas and induce hypertrophy/increased function(3,4) through SPECIFIC STABILISING exercises.

The overall picture appears to be that altered control in trunk musculature is common NOT universal. These alterations may include atrophy and/or temporal alterations in motor control patterns. the return of these muscles to normal function is not automatic. These alterations can be corrected by specific stability exercises which MAY have to be commenced in a non functional situation but would then be graded into more functional positions and actions.

As a relative newcomer to the profession - I qualified as a mature student - I must admit to being somewhat dismayed at the 'all-or-nothing' attitude commonly displayed by many members of the profession. I am sure we can all agree that no single approach or idea could ever prove a universal solution to the problem of LBP, but by utilising the appropriate research at the appropriate time/instance we can hopefully improve the outcomes of our patients.

My apologies if this mail appears abrasive, but while I am far from being in the 'core-stability is all' camp I do feel that we do our patients a disservice by polarising our views and ignoring it totally. As always, if my arguments are invalid I welcome correction - it is a long road to experience and I need all the help I can get :-)

Yours

chunkypuffin

1.Hides J, Richardson C, Jull G (1996). Multifidus recovery is not automatic following resolution of acute first episode of low back pain. Spine. 21(23) pp2763-9
2.Yoshira et al (2003). Atrophy of the multifidus muscle in patients with lumbar disc herniation: histochemical and electromyographic study. Orthopaedics. Vol 26(5) pp493-5
3.Daneels et al (2001). Effects of three different training modalities on the cross-sectional area of the lumbar multifidus muscle in patients with chronic low back pain. British Journal of Sports Medicine. Vol 35 pp186-191.
4.O'Sullivan et al (1997).Evaluation of Specific Stabilizing Exercise in the Treatment of Chronic Low Back Pain With Radiologic Diagnosis of Spondylolysis or Spondylolisthesis. Spine. Vol 22(24) pp2959-67.