There was a time in my career when I thought general mobility exercises were practically malpractice. For those of you who are uncertain to which exercises I am referring, it was exercises like lower trunk rotation and cat-camel type of exercises that just encourage general mobility in all directions. At the time, my background in Sahrmann's Movement Impairment Syndromes (MIS) is what drove my preference for avoiding lumbar mobility exercises. If you are unfamiliar with Sahrmann theory, she believes that loss of mobility and development of pain stem from abnormal repetitive movements and prolonged postures that lead to repetitive microtrauma. Should a patient fall into a MIS category, the treatment plan would be to work on core stability, while challenging the spine through different levels of stress in various movements. For example, if a patient has lumbar extension syndrome, we would focus on keeping the spine in neutral while moving towards hip extension. For a better understanding on MIS, I recommend either checking out a Lumbar MIS lecture I gave last year or reading Sahrmann's text books.
While I continue to practice with components of Sahrmann theory, I believe general mobility training can play a role in pain modulation. As many of you are likely aware, the development of pain science research has shown there to be a significant lack of correlation between pathological findings (on imaging) and pain. Many patients that come into our clinics with low back pain have either a fear of movement in one or multiple directions or are unaware of how to achieve those movement directions or positions. Exercises that encourage mobility in various directions can play an essential role in addressing the sensitivity of the nervous system and thus pain.
-Dr. Chris Fox, PT, DPT, OCS
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