Below is a video interview of Dr. Peter O'Sullivan who discusses current beliefs around spinal stabilization is regards to low back pain. You will be surprised to hear what he has to say.
Key points from the YouTube clip below:
-There is no single factor to cure low back pain.
-The current system leads us to believe that bracing the spine is good for our low back. This causes increased compression to the low back.
-Movement is healthy and physical activity is good for low back pain, but there is currently not enough evidence to say that stabilization training is not better than other forms of therapy or exercise.
-Positive thinking of the spine and developing healthy movement patterns is a fundamental component in the treatment of low back pain.
-Trust the strength of the low back and do not pre-tense the low back prior to movement.
-Our current society promotes that the spine is a vulnerable structure. We need to change this model.
*Please see my thoughts below*
My personal thoughts:
-As therapists we need to educate against the pathoanatomy as the cause of one's symptoms. For example, the MRI impression is often not the cause of the problem in mechanical low back pain.
-We need to educate patients that the spine is a strong structure.
-Certain individuals with low back pain are overworking the spine by performing too many core stability exercises and excessively pre-tensing. This is not a healthy movement pattern.
-Motor control is a key factor in the treatment of low back pain. We need to change the timing of the muscles around the low back and in turn change the poor movement pattern. While over-engaging the abdominals and low back stabilizers can be detrimental, it is necessary for the TrA to contract prior to movement initiation. Focus on the timing of muscle activation and educate against excessive bracing of the 'core muscles.'
-Gluteal muscle strength and the proper pattern of gluteal muscle activation is very important in the treatment of low back pain. Remember that each muscle needs to play a role (mobility or stability). If stabilizers are being used a prime movers or vice versa, problems will arise.
-A patient's daily posture (sitting, standing, sleeping, dynamic) will affect the muscle length-tension surrounding the spine. Changing one's daily postures is a great place to start if you are having difficulty with your lumbar evals.
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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