Journal of Bodywork & Movement Therapies, Oct. 09:
"The neutral spine principle, M. Wallden DO".
"The migratory fascia hypothesis, P. Lelean."
From page 351, "being able to dissociate the spine from the hips is a foundational movement skill".
?
First of all, Dr. Wallden did a great job of articulating his view on the topic. However, I'm still not buying into this. Yes, the neutral spine is something to be desired, but is it something that needs to be taught? Or, is the neutral spine a chain reaction of everything that went before it? On page 358 he gives a chart of pathological findings, and corrective exercises to ameliorate them. The problem is every one of the exercises focuses in on the spine itself.
At GAIN '09 I spent about 3 hours going over 2 case studies of athletes I worked with personally with low back back pain. In both cases, there were upper & lower extremity reasons why the athletes could not maintain a neutral spine. Not one isolated "spine" exercise was performed.
I think the second article I referenced kind of backs me up. The author discovered abnormal fascial folds throughout the pelvis & hips in patients , which produced facial strain patterns , which could contribute to iliolumbar strain patterns. The concept of rather than a weak spine, a spine that is biomechanically fed erroneous neural input.
I'm not sure if there is one size fits all here. I'll continue to rehab it as I see it.
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2 comments:
Joe,
Thank you for continuing to write about this topic in an intelligent fashion. As a long term low back pain sufferer (past 5 or six years), I have learned to move my hips and legs without moving my spine in order to avoid tirggering muscle spasms and pain. However, for the first 50 years of my life I did not not thnk about how I moved my spine when I moved. I just moved. Healthy backs just move. These is some flexion, rotation and extension, all taking place in multiple planes of motion. Unhealthy backs do not tollerate this motions.
Learning good defensive movement skills is a good thing for a low back pain sufferer to do. But you can develop the best defensive movement skills in the world (move with minimum spine movement) and still not fix the underlying problem.
I think the underlying problem is misinterpritaton by the central nervous system of normal feedback signals. These signals are seen as being threatening and the response is to generate pain and spasm so as to encourage the individual to minimize motion. Fatigue and stress seem (at least in my case) to lower the threshold between tollerated and untollerated activity. Increasing general physical preparedness seems to raise the threshold.
I do not know what the solution is. Its not more bridging exercises or developing a better abdominal brace. You can minimize the problem by avoiding exacerbation but you are not sloving the underlying problem. Somehow, someway you must reprogram your brain.
Marshall
right now i've got a patient that has an increase in apin when he tries to anteriorly tilt his hips. However sitting with "bad posture" seems to relieve his symptoms. he has a hx of bone spurs and may have a structural issue I can't fix.
On the otehr hand, this past summer i had a person who had pain due to the lack of motion in her spine and hips. So what helped her? We added spinal rotation. I know, I know...I was taught that twisting an already pathologic spine is bad...not always.
As joe says, "rehab it as you see it."
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