The Challenge
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.
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Controlled trials of exercise for low back pain often suggest that the type of exercise doesn't matter. And if you love "stability" exercises then these results can really challenge what you think and could even make us expert clinicians feel like we have less "special" knowledge...always challenging to be confronted with this.
Read MoreThis post was originally at Keynote at the Canadian Orthopaedic Manual and Fascial Therapy Division Conference on February 29, 2015 in beautiful Wawa, ON, Canada
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In the attached video we look at my daughter who has a lot of spine extension and when she extends this leads to a “hinge” in her lower back. What is often advocated during spine extension is a gentle and gradual “rounding” that is equal at each segment.
Read MoreI’ve been a mildly vocal critic of the thoracic ring and integrated systems model of treating pain and dysfunction for a number of years.
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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?
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