The Motor Control Approach to lumbopelvic stabilization is not easy to grasp, even if you are a physical therapist. It takes quite a bit of extra study and clinical practice to understand.

Transversus abdominis (TrA) is part of the local system (part of the deep myofascial corset which is part of the deep myofascial cylinder) along with the following muscles that are generally accepted: respiratory diaphragm, transversus abdominis, segmental lumbar multifidus, posterior fasciculus of psoas major, and pelvic floor. More research has probably been performed on the transversus abdominis because it is easily imaged with ultrasound imaging and therefore is a clinically relevant muscle to target. Paul Hodges has done the majority of the important research on transversus abdominis. I would suggest that TrA is a window to local system dysfunction because of certain characteristics that are viewed with real-time ultrasound imaging.

Motor control theory can be simplified as follows:

Your brain may choose from two motor control strategies for stabilization, this is dependant on the amount of load that an activity places on the lumbopelvic region. Contraction of muscles for lumbopelvic stabilization is automatic and dependant on muscle-recruitment threshold: low or high. There is a “low load-bearing strategy” for “normal” (unloaded) functional tasks with low muscle-recruitment threshold and a “high load-bearing strategy” for “loaded” functional tasks with high muscle-recruitment threshold.

In individuals who have never experienced back pain, specific muscles are selected to contract at a low muscle-recruitment threshold for lumbopelvic stabilization during normal activities, whereas other muscles are not used for lumbopelvic stabilization until a higher threshold has been reached during loaded tasks. A low muscle-recruitment threshold means that a muscle is easily recruited during low effort, unloaded tasks. A muscle that has a high threshold will not be recruited for lumbopelvic stabilization until higher effort, loaded tasks.

Scientific studies on individuals who have experienced pain in the region show that the brain stops using a low load-bearing strategy to stabilize the spine and pelvis during normal tasks. Instead, the brain uses the high load strategy for normal tasks (the threshold is lower than normal). Therefore, the brain starts using a dysfunctional motor control strategy for lumbopelvic stabilization after pain is experienced in the lumbopelvic region.

Global muscle over-compensation (which results in co-contraction rigidity) may cause articular degenerative changes from axial compression on the joints of the lumbar spine and pelvis. Physical therapy must focus on down-training global muscle system through relaxation exercises and manual therapy techniques, initially. This is where all the techniques we learned during continuing ed courses will pay off (hopefully).

But, if you do not treat the local muscle dysfunction then your patient is almost guarenteed to experience recurrence of back pain. This should not be ignorantly denied. Physical therapists should embrace the motor control approach and will do well to learn more about these concepts. We really do not have anything else to treat low back pain that has shown efficacy as a treatment technique. Nothing else shows evidence of a decrease in recurrence.

If we do not learn these concepts, someone else will... Or, worse we will continue to do what has always been done because of tradition or because the authoritarian "guru" said that this or that technique will cure pain. Don't confuse the motor control approach with guru therapy. Gurus never have time to do any research (accept anecdotal) because they are so busy developing their concepts to match what they read in a physiology textbook. The development of Motor Control Approach has been through massive amounts of peer-review clinical research using internal EMG, real-time ultrasound imaging, and more.

More info at: www.Back-Exercises.com