Low Back Pain – A Movement Problem

As we walk, reach forward to open a door, or bend forward to put a plate in the dishwasher we rarely think to ourselves how we are going to accomplish these tasks. We simply move. But with any purposeful movement there is actually a complex, behind-the-scenes process that determines exactly how your body will move and position itself to accomplish the task.

In fact, instructions that control body movements are actually stored and managed by subconscious control centers in our brains.  Through experiences with the physical world (think of the infant learning to stand, then crawl, then walk…..) these control centers have learned various ‘motor patterns’ that enable us to move and interact with the physical world around us.  Amazingly, all of this just happens automatically with little to no conscious thought or effort.

But here is the problem…….in many cases our bodies can form bad habits and learn to move in improper, ineffecient ways.  These faulty movement patterns that develop over time can play a major role in low back pain.

 

How We Move: The Good, The Bad, and the Ugly Back Pain Consequences

It is rare that any purposeful movement involves just one joint.  Instead, real-world movements involve the combined and coordinated movements across many body segments. The implication of this fact is that to accomplish any particular movement task there are multiple ways in which the body can position and move itself.  Said another way, there are different paths through which the body can move in order to accomplish the desired movement goal.

Let’s look at a simple example to better illustrate this important point. Imagine bending forward to pick up a small box. The overall goal here is to position the body in such a way that the hands can reach the box. This may seem simple, but this basic movement actually involves the coordinated interaction and positioning of the foot and ankle, knee, hip, pelvis, all the joints of the spine, as well as joints of the upper extremity. As a result, to position the hands on the box there are actually countless joint positioning combinations the body can adopt to reach the box.

This principle is illustrated in the figure below. Note that in each example the feet and hands are in the same position, however, body positions are markedly different between the three figures. This demonstrates the principle of movement redundancy within the body, meaning there are multiple paths through which the body can move in order to accomplish the same movement goal.

 

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In one sense, this movement redundency is a positive feature as it allows us to compensate for parts of the body that do not work as well. From an evolutionalry or survivalist perspective, if the body were unable to compensate for muscle or joint problems we would not last long. On the other hand, these compensation patterns come at a cost as they can place abnormal and excessive stress on certain areas of the body. Eventually this stress will accumulate into tissue damage and pain. The lower back is particulary susceptible to this type of mechanical overload as it is often forced to move more than normal to compensate for tigth hip or hamstring muscles.

What Does This Mean for the Low Back Pain Patient?

So how does all of this relate to the person suffering from low back pain? Simple, it means that to get out of back pain, treatment must not only focus on managing pain and getting damaged tissues to heal, but must also address the bigger issue of how the patients body moves during day to day activities.  As you can see from the explanation above, the majority of low back pain is caused by poor or faulty movement patterns. These ineffective patterns are what has cased the back to become damaged in the first place. While treatment to help the injured tissues to heal is important, without addressing the underlying movement problem the tissues will just become damaged again and again. (Is it any wonder why the majority of low back pain goes away, then recurs again and again over the ensuing months and years)!