Stability training is one of the most over-prescribed and misunderstood aspects of dealing with low back pain. Hopefully now the hate email will start.
Whenever I start talking about this with movement professionals, I can get a little bit on my soapbox about this because I have seen for the last two decades, at least in this industry, people prescribing over and over spinal stabilization exercises for back pain.
Now I’m not saying, so again, before you hit send on the hate mail, just hear me saying they’re not bad exercises and the stabilization is not always a bad thing, but it is massively overused. And let’s explain this from a brain-based perspective so that it will make sense to everyone.
Whenever we start thinking about this and how we move in the real world, it’s a very common thing to see. Brains tend to have what they call phenotypes with regards to how they handle postural stabilization issues. And whenever I’m moving through the world, I’m walking, I’m turning my head, whatever, my brain has to make a ton of predictions about what’s going to happen and it has to stabilize my posture so that I don’t fall over. Our brain has a ton of built-in postural stabilization strategies. And whenever we look at people with chronic low back pain, what is very clear is that often their stabilization strategies are messed up when we compare them to people who don’t have chronic low back pain. Now, when I say messed up, that can take a lot of different forms. And so they will often point to what they call two different phenotypes of what is called reactive postural control.
That’s a lot of big words, but it basically means this. If I have someone and I’m having them move or I’m having them do an exercise, some brains, because they are scared of movement, will adapt what is called a tight postural control strategy. Basically, that means the brain is going to pre-tighten tons of postural muscles so that movement is very guarded. So they will be in this kind of protective mode.
Now, that doesn’t mean necessarily that if you’re gonna dive deeply into the stability protocols, that their TVA or whatever is doing what it’s supposed to do at the right time, that’s a separate topic. Right now, we’re just talking about the phenotypes. So we have some people that have this very tight phenotype where they are already bracing for all movement. What we tend to see with them is that they begin to lose progressive mapping capabilities of their movement.
If you’ve been watching Z-Health for any period of time, you know how we look at movement. You must understand that movement is brain-driven and is also mapped by the brain, which means that my brain should have a pretty good map of where my pelvis is in space, where my low back is in space, and actually down to a segmental level. And by segmental level, what I mean is that if I’m turning a certain amount, my brain should have a decent awareness of where my pelvis is versus L5 versus L4 versus L3. And in people with chronic low back pain, that area of the brain goes through what is called a smudging process where the map becomes less clear. That smudging happens more intensely when people tighten up all the time. And so whenever we have people who have this tight phenotype adding in more stability work and reducing movement variability may help them feel better in the short term, but it may be a very bad long-term strategy for them.
Now, before I talk about the next type, if you are a movement professional of any kind, a doctor, a therapist, a coach of any kind, Pilates, yoga, martial arts, personal trainer, athletic coach, and you’re interested in blending what you’re great at with applied neuroscience, go to the pinned comment, click the link there to either email us or set up a phone call.
Now, we’ve talked about the tight phenotype. There’s also a loose phenotype or a passive. Whenever we look at these people, they are exactly what it sounds like. They’re kind of floppy. Their brain is actually scared of engaging with any kind of tension. They will tend to move. And as they are moving, they are, I won’t say hypermobile because they’re not necessarily hypermobile, but they will have that look to them. They will typically also avoid engaging in anything that requires a high level of muscular tension or high degree of joint compression of any kind.
Whenever we look at these two different phenotypes, it should be pretty obvious that if we’re gonna stabilize people, we need to stabilize the people who have this passive phenotype, this looser phenotype. If we have the other people who are very stiff and guarded, like I said, having them tighten more may actually make them feel better briefly, but it’s a bad long-term strategy. So there is no such thing as this idea that I see all the time that if someone has low back pain or whatever, this is the exercise protocol, right? You gotta do this, you gotta do this, you gotta do this. A lot of times those are spinal stabilization exercises from breathing exercises to bird dogs. Again, great exercises, but they have to be applied to the right person at the right time.
And as we talked about at length in other places, if something’s not working and you’re not seeing an immediate benefit, that probably means that you’re not impacting what the brain is most interested in.
Now, if you have been kind of addicted to using spinal stability strategies with people, number one, I need you to go back and rethink. Who did it work for? Who did it not work for? And then secondly, I need you to also understand that what we’re talking about right now is what’s called reactive postural adjustments. So whenever you are thinking about stabilization strategies, one of the key things is if you’re going to use them, you have to add in variability to the practice because life is typically not lived in a straight line. We don’t have an opportunity in most instances to tighten our core and do a lot of stuff voluntarily. It has to happen, what, reactively. And the way then to practice that is to start to add more variability to movement. So let’s say you’re having someone just do standing brace work, right? So I’m standing, I’m gonna have them maybe do a little posterior pelvic tilt. I’m gonna have them do some hard exhale to try and get more activation through the entire core.
Now, cool, they can do that here. One way to add variability to this is start to add in head and neck positions. Repeat that same exercise. Put them into lunge positions. Have them do lateral bends with rotations and do their bracing work. And you can do this standing, you can do it seated, you can do it on the ground. Generally, whenever we’re teaching variability, we tell people to think about a compass where I’m gonna step forward and then I have eight directions all the way around. Now, I can also think about that from a rotational perspective or lateral bending perspective. I can bend in these different directions around the compass and I can practice my bracing exercises in each one of those.
I will tend to drive people in that direction regardless of the phenotype because sometimes what will happen is if I have a tight phenotype and I have them begin just working through these different movement iterations, I’ll get them there and then actually try to get them to relax into that position so they’re moving more freely. If I have them more passive, we may actually brace from the beginning and then have them slowly move into these positions so they can reconnect with the idea of putting tension into the system when it’s not in a perfect anatomical illustration position.
This is a lot to think about. I know it’s kind of a complicated topic, but I just wanna make sure that it’s very, very clear to everyone in the movement and rehab space that spinal stabilization exercises are often overused and misunderstood. You have to use them for the right person at the right time, all right? So keep that in mind as you go forward.
If you are a movement professional, again, click the pinned comment down below to email us or set up a call because you’re interested in blending what you do with, again, modern applied neuroscience. We’d love to chat with you.
