There are three ways that your body controls movement, and if you misunderstand them or don’t recognize them, you can miss the reason that people have low back pain or shoulder pain or whatever. But I’m talking about back pain right now.
Whenever we look at movement, you can actually break it down into kind of three different control mechanisms from a brain-based perspective or from a neurology perspective. First, we have the obvious, which is what is called voluntary movement. So if I’m standing here and I’m like, okay, I have low back issues and you can try this with me. Stand up and you go, okay, I’m gonna do a pure lateral bend. When I think pure lateral bend, I just wanna tilt directly to the side. A lot of people with chronic low back pain, they try to do that, but they wind up going into flexion or into extension. It’s a really well-known phenomenon when you actually look at people with low back pain. There’s kind of different phenotypes for people that are worse in flexion, worse in extension, and they often avoid those. So we have voluntary movement where I make a picture in my head and then I try to recreate that picture. All right, that’s neurology, very simplified.
But then we have two other forms of movement control that are absolutely essential and very infrequently addressed. So number one is called reactive. What does reactive control mean? Well, it means that as I’m going through the world, stuff happens to me that I didn’t plan or I didn’t see coming. And if you know anything about the brain, the brain is a predictive organ. And what it does is it examines the environment externally, it examines the environment internally, and it tries to predict what’s going to happen next so that it can keep us safe. It’s a very, very simple idea with profound ramifications. So we have an entire subset of our neural wiring that is designed to keep us safe when something unexpected occurs. If I take a step and I hit a stone and I start to roll, if I am cooking, I get slammed into by my pitbull because she’s hungrier than I am and she hits me from behind, I wasn’t expecting it. We have to have reactive control.
And then third, very importantly, we have what is called anticipatory control. Anticipatory control is what our brain does to our body before we begin moving. And this is something that is incredibly important in low back pain that is often under addressed. So we have reactive, when life perturbs us and we didn’t see it coming. We have voluntary, whenever we’re trying to make an image in our head and we’re trying to create that with our body. And then third, anticipatory control, which is what our brain does before we try something voluntarily. And that’s the key piece here. Because very often, whenever I look at what people try to do for low back pain, we try to strengthen them, we try to mobilize them, we try to stretch them, all good ideas, often, not always, but good ideas. But they all involve movement. But the vast majority of them are what? They are voluntary in nature.
Now, some advanced thinkers out there will go, okay, once someone can, let’s say, do a nice pure lateral flexion standing, let’s have them try it eyes closed. So we encourage some more vestibular information. Let’s have them do it in some different lunge positions to see if they’re in a rearward lunge position with their head tilted back and their eyes closed, can they still create a clean lateral bend? That’s becoming more and more challenging, but it’s still falling into the voluntary component unless they’re losing their balance because you put them in this weird position and now we add some reaction to it.
Now, each of those is happening. Prior to any of those happening, however, is what is called the anticipatory postural adjustments, APAs. What we have found in the research is that people with chronic low back pain often have a poorly functioning neural system to initiate appropriate anticipatory postural control. So basically what that means is that even though they’re doing all these cool voluntary movements, there may be more that we need to do for them in order to ensure that their brain is able to prime their body before they begin moving so that they are safer. This is something that I think it sounds subtle, but in the real world, it actually plays an enormously large role in why people often have low back pain that gets better and then comes back. It gets better and then it comes back because we do stuff, their brain goes, okay, I’ve been able to do some voluntary movement, everything’s feeling a little bit better, but then when they go out into the real world, if that particular system, the anticipatory postural control system, is not as active as it needs to be, a lot of times their pain will come back.
Now, before I talk about what to do about it, if you are a doctor, a therapist, a coach of movement of any kind, from yoga to Pilates to martial arts, if you’re a personal trainer, you work in CrossFit competition, whatever, if you deal with movement and are interested in bridging the gap between biomechanics and neuroscience, we would love to chat with you. You can go to the pinned comment, you can email us or set up a call because this is the stuff that we’re really talking about and getting into with you. So we’d love to see if what we do is a good fit for what you’re interested in.
Now, back to APAs, how do we know about them and what do we do about them? Well, there is a part of your brain called the SMA, the supplementary motor area. And that area specifically seems to drive many of the anticipatory postural adjustments that we have to make. And what we see, again, in the research literature is that people who have chronic low back pain often have insufficient activity in the supplementary motor area. So how do we train it? Well, there’s a ton of ways that you can train it. Some things that we know about that particular area of the brain is that it’s highly involved in coordinated bilateral movement, right? So if you have people with chronic low back pain and you want to improve their voluntary movement through improving their anticipatory postural adjustments, you need to be including exercise programming that requires good bilateral coordinative exercises. All right, there are a lot of them out there. It’s something as simple as bilateral elbow circles, bilateral shoulder circles, to specific ways to do squats and lunges. We want to make sure that we’re requiring, again, both sides of the brain, both sides of the body to coordinate exercises. So that’s one way to work on it.
Now, a simpler way to work on this in some cases is to encourage bilateral activity of the body that is explosive. Now, this sounds a little bit scary if you have someone with low back pain. So I’m gonna show you some different modifications of it. But in the research world, whenever we’re trying to see what happens to the anticipatory postural system, one of the quickest and fastest tests is to simply have people stand in neutral, relax a little bit, and then on a signal, quickly raise their arms over their head.
Now, as fast as they can go before that happens, because they’re in charge of it, their brain will set postural tone to prevent this action from throwing them backwards. All right?
So any kind of fast bilateral movement in any direction will challenge the anticipatory control systems. This is one of the fastest and easiest ways to train it. Now, what that means from a training perspective is that you have to do pretty high repetitions of this. So my typical progression is we’re gonna aim for around 100 reps in a training session. If people are in pain, we’re gonna do it really safely, meaning they won’t go as fast as they can go. On the first signal, they’re gonna move fairly slowly. We’re just gonna go to shoulder flexion while in neutral. And then I’m gonna put them in different lunge positions and I’m gonna have them do that same thing. And they’re just going into a bilateral flexion. Over and over with the shoulders. And we’re gonna try to accumulate around 100 repetitions in a training session. We see how they do. If they are improving, if they’re feeling better, and if I notice that their voluntary movement, remember, we have three systems. If their voluntary movement has improved after going through that little iteration, then I know I’m on the right track.
You will be shocked at how often people come in, I’m stiff, I’m sore, I’m a little bit in pain. And you start off doing these really, really simple iterations. Then you have them go right back to testing and they think, or say to you, wow, that’s very, very different. It seems too simple to work, but it’s not simple when you actually understand the neurology behind it. Remember, we have three systems. We have reactive, we have voluntary, we have anticipatory. If you’re dealing with back pain, you have to deal with all three eventually. And because anticipatory sets the stage for better voluntary, it is often the place that we will get the biggest bang for our buck for a very low investment of time and energy.
So again, if you are a movement professional, you deal with people with back pain, and you’re interested in bridging modern neuroscience like we’ve been talking about with what you currently do, go to the pinned comment, click the link. You can set up a call with us or you can email us because we’d love to share more of this information with you.
