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Back pain and lumbar stability
Compensatory mobility in adjoining joints In basic terms, loss of function (or mobility) in a given joint seems to affect joints on either side. If there is discomfort in the lumbar spine, it may be the result of loss of mobility in the hips or the thoracic spine area. In other words, if the hip or thoracic can't move, the lumbar spine will, thereby becoming less stable and subsequently painful. The process is simple at a basic level:
Compensatory mobility in other areas Looking at the body on a joint-by-joint basis, this thought process seems to make sense. An immobile ankle causes the stress of landing to be transferred to the joint above: the knee. This may not always be the case, however; an immobile ankle may skip the knee and affect the hip or even the neck. The more general principle is that stress is transferred and compensated in another area. Understanding joint stability and mobility It is clear that joints are in need of both stability and mobility, including agility, flexibility, adaptability and strength. Stability does not mean stiff or restricted movement; rather it means strength and agility. In fact, most of these qualities are needed throughout the body, although the actual range of motion will vary according to the area and type of joint. A mobility joint needs stability and a stability joint needs agility. It is when one area loses some of these qualities that impact arises on other areas of the body in compensation. When a given joint loses mobility, another joint may be forced into excessive mobility. Excessive mobility could push the second joint beyond its appropriate range of motion, leading to a defence response that causes the area to feel stiff, uncomfortable or painful. Although it is often our instinct, strangely enough the biggest mistake can be to try and stretch this area out. Here, the stiffness is actually a result of the area being pushed beyond its appropriate range of motion, thereby compromising its stability. To exercise this area further may not be helpful. Rather the exercise should focus on the original immobile areas – those that led to the compensating shift in the related joint. Using our hip/lumbar spine example, when the lower back is sore, it may make more sense to stretch and work the hips, enabling the lumbar spine to re-establish its stability. Often rotary exercises done for a painful lumbar spine are targeting the wrong area. Misdirected exercise Michael Boyle (www.strengthcoach.com) believes that most if not all of the many rotary exercises done for the lumbar spine have been misdirected. Both Sahrmann (Diagnosis and Treatment of Movement Impairment Syndromes) and Porterfield and DeRosa (Mechanical Low Back Pain: Perspectives in Functional Anatomy) indicate that attempting to increase lumbar spine range of motion is not recommended and potentially dangerous. Boyle believes our lack of understanding of thoracic mobility has caused us to focus on lumbar rotary range of motion; this he regards as a huge mistake. In summary It does not help to stretch out the lumbar area if the pelvis or thoracic area is immobile. The already stressed lumbar area could get further irritated triggering a defence response. After the pelvis or thoracic have been released and regained their strength and mobility, lumbar rotation may be applicable to release the compensatory response. Here, the main cause has been dealt with and the associated areas have stabilised. In all cases, however, this should be done in conjunction with a focus on core stability. This is because core stability is often compromised if the defence response has been in play over time. |
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Many people suffer from back pain, even with the advances of the past decade around core stability. The theory behind low back pain (apart from the wear and tear theory), is loss of mobility or too much mobility. Our experience suggests there is more to the issue.