Abstract
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 language | English |
|---|---|
| Pages (from-to) | 370-379 |
| Number of pages | 10 |
| Journal | Journal of Orthopaedic and Sports Physical Therapy |
| Volume | 49 |
| Issue number | 6 |
| Early online date | 31 May 2019 |
| DOIs | |
| Publication status | Published - Jun 2019 |
Funding
1Department of Human Movement Sciences, Vrije Universiteit Amsterdam and Amsterdam Movement Sciences, Amsterdam, the Netherlands. 2Center for Orthopedic Research, Michigan State University, Lansing, MI. 3Department of Osteopathic Surgical Specialties, Michigan State University, East Lansing, MI. 4Sumaq Life LLC, East Lansing, MI. 5Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada. 6Program in Physical Therapy and Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO. 7Clinical Centre for Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia. Dr van Dillen was supported, in part, by funding from the National Center for Medical Rehabilitation Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, US National Institutes of Health (grant R01 HD047709). 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 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 Jaap H. van Dieën, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 9, NL-1081 BT Amsterdam, the Netherlands. E-mail: [email protected] U Copyright 2019 Journal of Orthopaedic & Sports Physical Therapy® to thank Dr Peter O’Sullivan and Dr Julie Fritz for reviewing a previous version of this paper. The forum on which this 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.
| Funders | Funder number |
|---|---|
| International Clinical and Research Expert Forum | |
| National Health and Medical Research Council of Australia | |
| US National Institutes of Health | |
| National Institutes of Health | R01 HD047709 |
| North American Spine Society | |
| National Center for Medical Rehabilitation Research | |
| Eunice Kennedy Shriver National Institute of Child Health and Human Development | |
| National Health and Medical Research Council | APP1102905 |
Keywords
- Back pain
- Exercise
- Postural control
- Spine
- Subgrouping
