Motor control changes in low back pain: Divergence in presentations and mechanisms

Jaap H. Van Dieën*, N. Peter Reeves, Greg Kawchuk, Linda R. Van Dillen, Paul W. Hodges

*Corresponding author for this work

Research output: Contribution to JournalReview articleAcademicpeer-review

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Compared to healthy individuals, patients with low back pain demonstrate differences in all aspects of trunk motor control that are most often studied as differences in muscle activity and kinematics. However, differences in these aspects of motor control are largely inconsistent. We propose that this may reflect the existence of 2 phenotypes or possibly the ends of a spectrum, with “tight control” over trunk movement at one end and “loose control” at the other. Both may have beneficial effects, with tight control protecting against large tissue strains from uncontrolled movement and loose control protecting against high muscle forces and resulting spinal compression. Both may also have long-term negative consequences. For example, whereas tight control may cause high compressive loading on the spine and sustained muscle activity, loose control may cause excessive tensile strains of tissues. Moreover, both phenotypes could be the result of either an adaptation process aimed at protecting the low back or direct interference of low back pain and related changes with trunk motor control. The existence of such phenotypes would suggest different motor control exercise interventions. Although some promising data supporting these phenotypes have been reported, it remains to be shown whether these phenotypes are valid, how treatment can be targeted to these phenotypes, and whether this targeting yields superior clinical outcomes.

Original languageEnglish
Pages (from-to)370-379
Number of pages10
JournalJournal of Orthopaedic and Sports Physical Therapy
Issue number6
Early online date31 May 2019
Publication statusPublished - Jun 2019


  • Back pain
  • Exercise
  • Postural control
  • Spine
  • Subgrouping


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