There is a lack of consensus as to what is the appropriate exercise therapy in the management of low back pain and pelvic disorders. The division is over whether to engage in specific motor re-learning activities, that include ‘core’ activation or to ‘just get people moving’ in general strengthening and work hardening exercise programmes.
The evidence as to what approach is most effective remains unclear (1).
We do know that there is a lack of deep inner myo-fascial unit activation in people with back pain and pelvic girdle pain (2), but there is also truth in the statement that ‘what we don’t use, we loose.’
While the evidence catches up, I suggest we look at how the movement system functions and what this shows us about why people are in pain.
By correcting dysfunctional movement patterns and improving postural habits there is an increased likelihood of spontaneous activation of the deep inner unit. Breathing patterns and length tension relationships are critical for the engagement of the deep inner unit. Improving movement patterns enables people to keep moving, but without the continued irritation and load through the bothered tissue.
- Searle et al 2014. Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised control trials. Journal of Clinical Rehabilitation. 1-13. Published online: http://koresdsu.weebly.com/uploads/4/8/7/8/48783711/exercise_interventions_for_clbp.pdf
- Hodges & Richardson, 1999. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Journal of Physical Medicine and Rehabilitation 80:9: 1005-1012