A common physical therapy axiom is to not put strength on dysfunction. The idea behind it can certainly be viewed a number of different ways but I've always interpreted to mean that if someone has pain they just shouldn't ignore it, keep pushing and training hard and they should try to "fix" whatever the underlying cause of the pain is.
Pain is weird - just ask the dude over at painscience.com. But understanding pain helps us explain pain and explain the sensations many people often feel. Understanding pain can both be a desensitizer in its own right and help facilitate behavioural changes that lead to good rehabilitation.
The low back pain literature suggests that a specific intervention (e.g motor control exercises, targeted strengthening etc) are no more effective than general graded activity interventions. Suggesting that treating pain is not really about fixing some sort of impairment that is causing the persisting problem.
This post was originally at Keynote at the Canadian Orthopaedic Manual and Fascial Therapy Division Conference on February 29, 2015 in beautiful Wawa, ON, Canada
I’ve been a mildly vocal critic of the thoracic ring and integrated systems model of treating pain and dysfunction for a number of years.
Whether the spine should flex repeatedly and under load is an old debate that we are still having having and we should be having it because I don't think its settled. I thought it was settled 20 years ago but I should have challenged my biases more. The basic question is whether you are at less risk for pain/injury if you minimize the flexing movement of the lumbar spine during activities and if minimize the flexed position when lifting heavy. The case to minimize flexion is laid out in this article here detailing how the Canadian Military has removed the sit-up and trumpeted the death of the sit-up. Link here. I have probably taught 1000s of people to hinge at their hips and try to minimize spinal flexion during many activities...certainly activities that demand high loads on the spine...But is this right?