Are stability and instability relevant concepts for back pain?

N. Peter Reeves*, Jacek Cholewicki, Jaap H. Van Dieën, Greg Kawchuk, Paul W. Hodges

*Corresponding author for this work

Research output: Contribution to JournalReview articleAcademicpeer-review


Individuals with back pain are often diagnosed with spine instability, even though it is unclear whether the spine is susceptible to unstable behavior. The spine is a complex system with many elements that cannot be directly observed, which makes the study of spine function and direct assessment of spine instability difficult. What is known is that trunk muscle activation is adjusted to meet stability demands, which highlights that the central nervous system closely monitors threats to spine stability. The spine appears to be protected by neural coupling and mechanical coupling that prevent erroneous motor control from producing segmental instability; however, this neural and mechanical coupling could be problematic in an injured spine. Finally, instability traditionally contemplated from a mechanical and control perspective could potentially be applied to study processes involved in pain sensitization, and possibly back pain that is iatrogenic in nature. This commentary argues for a more contemporary and broadened view of stability that integrates interdisciplinary knowledge in order to capture the complexity of back pain.

Original languageEnglish
Pages (from-to)415-424
Number of pages10
JournalJournal of Orthopaedic and Sports Physical Therapy
Issue number6
Publication statusPublished - 1 Jun 2019


  • Iatrogenic back pain
  • Lumbar spine
  • Pain sensitization
  • Stability
  • Systems-based approach


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