Back Pain: Between Chaos and Rigidity.
Back pain is a prevalent issue affecting numerous individuals across the UK, highly ranked as one of the leading causes of disability and imposing a large economic burden on the UK. It is clear that innovative and informed strategies are crucial in combating this widespread affliction.
At The Project PT, we challenge the conventional 'one size fits all' mentality, understanding that back pain is multifaceted and demands a tailored, science-driven approach.
This blog delves into the pivotal role of movement variability in managing back pain, addresses the psychological aspect of fear avoidance and its impact on physical health, and explores the Goldilocks principle. It argues that, in complex issues such as back pain, finding the balance between too much chaos and too much rigidity is often the best course of action.
Understanding Movement Variability
A prevailing notion suggests that there is a 'one size fits all' approach to movement. Hidden somewhere, it seems, is an instruction manual designed for the perfect squat, created devoid of any deviation that might cause injury or be unsettling to the eye.
This notion of perfect movement, while appealing in theory, falls short in practice. Biomechanically, each individual brings their own idiosyncrasies to training, including variations in limb lengths, joint range of motion, and muscle architecture, to name just a few.
This all points to the fact that our squats will never be the same and will brilliantly differ in their own special ways. Delving into the world of psychology paints another picture, showing how a person's emotional state can affect motor outputs. Thus, the prevailing notion falls flat before you even step foot onto the gym floor.
This is where the principle of movement variability comes into play. Movement variability refers to the natural variations that occur in a movement, both within an individual (within-subject variability) and between individuals (between-subject variability). Both types of variability are important when considering back pain.
Historically, it was believed that limiting variability between repetitions of the same movement would be advantageous. This view was rooted in a mechanistic perspective on pain, suggesting that too much variability could lead to tissue pathologies due to excessive forces being placed on structures not strong enough to withstand them.
This perspective may be considered the chaotic end of the movement spectrum, which still holds some validity. For instance, you would not want to attempt a 300kg deadlift while balancing a poodle on your back and having a friend toss tennis balls at you. Not only would the structural demands on the tissues be too much, but the added sensory overload from poodles and tennis balls would create far too much chaos.
However, at the other end of the spectrum lies complete rigidity. To reference the aforementioned 'golden squat,' a movement with no deviation from a fixed pattern exemplifies this rigidity.
This approach falls flat in activities like running, where the task is quite repetitive in both patterning and stress. The variability in running gait and the loads placed on the individual are somewhat rigid, often leading to overloading of structures due to a lack of variation in training.
As an aside, this is why we advocate for strength training for runners, as it distributes the load and adds variability to the training regimen.
Pain-Limiting Degrees of Freedom
Another domain where variability is limited is in the presence of pain. Pain associated with certain movements often makes individuals reluctant to engage in those patterns, effectively rendering their movements less variable and more rigid. The idea of fear avoidance is another reason the middle ground between chaotic and rigid movement is needed when dealing with back pain. The idea behind adding graded variation in an individual's movements is that middle ground we strive for when training people with pain. The rigidity is inflicted by the pathology, as well as the avoidance of going into positions that may bring on those sensations, while the graded nature of the movements assures we do not drift towards the chaotic end of the spectrum. Once again, ensuring that the graded movements instil a sense of variable movement within the individual.
Putting It Into Practice
At The Project PT, we use these principles to guide our interventions accordingly. We prioritise approaches of movement through the lens of restoring some variability, while not pushing too far into the chaotic realm of overloading and complex movements for complexity's sake.
Key areas we address when creating our courses and training:
Motor Control: The body's ability to regulate movements based on interactions between the nervous system and the musculoskeletal system is paramount in regaining a sense of movement variability within individuals experiencing pain. The movements are graded to ensure that the system is not overloaded, but each movement allows for a degree of bandwidth, keeping in mind our notion that one size does not fit all and that is okay.
Myofascial Release: Stiffness and reduced tissue hydration can significantly limit movement variability, contributing to a rigid movement system. That is why we introduce myofascial release, which can lessen the constraints imposed by the named limitations, therefore increasing tissue health and promoting greater movement freedom.
Muscle Activation: A strong core is indispensable for the support of the lumbar spine and pelvis, areas often compromised by back pain. However, strength does not entail unnecessary strain or rigidity. We promote a balanced approach to muscle activation, focusing on engaging the core muscles in a manner that supports, rather than overburdens, the back. This strategy is instrumental in building a stable yet flexible foundation for all movements.
In conclusion, addressing back pain requires a nuanced approach that considers the interplay between physical and psychological factors, the necessity of movement variability, and the importance of tailored interventions.
At The Project PT, we are committed to guiding our participants through this journey, leveraging the principles of Motor Control, Myofascial Release, Muscle Activation, and Integration to build a resilient, adaptable, and pain free body.
If you are currently working through back pain or are interested in learning more, why not check out our back pain course linked here?
