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

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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
Early online date31 May 2019
Publication statusPublished - Jun 2019


1Center for Orthopedic Research, Michigan State University, Lansing, MI. 2Department of Osteopathic Surgical Specialties, Michigan State University, East Lansing, MI. 3Sumaq Life LLC, East Lansing, MI. 4Department of Human Movement Sciences, Vrije Universiteit Amsterdam and Amsterdam Movement Sciences, Amsterdam, the Netherlands. 5Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada. 6Clinical Centre for Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia. Dr Reeves is the founder and president of Sumaq Life LLC. Dr Hodges receives book royalties from Elsevier. Professional and scientific bodies have reimbursed him for travel costs related to presentation of research on pain, motor control, and exercise therapy at scientific conferences/symposia. He has received fees for teaching practical courses on motor control training. He is also supported by a Senior Principal Research Fellowship from the National Health and Medical Research Council of Australia (APP1102905). The other authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address correspondence to Dr N. Peter Reeves, 712 Audubon Road, East Lansing, MI 48823. E-mail: U Copyright 2019 Journal of Orthopaedic & Sports Physical Therapy® body of research was based, “State-of-the-Art in Motor Control and Low Back Pain: International Clinical and Research Expert Forum,” was supported by the National Health and Medical Research Council of Australia, in collaboration with the North American Spine Society. The forum was chaired by Dr Paul Hodges.

FundersFunder number
International Clinical and Research Expert Forum
National Health and Medical Research Council of Australia
North American Spine Society
National Health and Medical Research CouncilAPP1102905


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


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