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Should We Rethink Core Stability for Low Back Pain?

10/15/2014

1 Comment

 
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.

-Jim
1 Comment
Steve
11/7/2014 06:56:38 am

He is speaking about core stability in relationship to chronic LBP, not all LBP. He also stretches, IMO, when he says, "what it tended to lead to is this idea that stiffening your back is better..." I completely disagree. I am surprised that someone of his intellect would speak of all LBP in one sentence. Maybe he is trying to keep it simple. But I have not observed anyone telling pts that stiffening their back is better.

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  • Home
  • About Us
  • Insider Access
    • About Insider Access
  • Online Courses
    • Hooper's Knee
    • Physical Therapist Entrepreneur Course
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    • Orthopedic Management of the Cervical Spine
    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test