Kinesiopathology describes the patient’s deficits/defects during movement; the inability to plan and map movement patterns simultaneously preforming: (1) engaged spinal stability, (2) with core neutrality, (3) with proximal to distal sequencing, and (4) with accuracy of motor mapping. Of course, movement defects occur, patients do not have the knowledge, time, nor the scientific interest in researching and practicing movement excellence… but athletes do!
This 2-part article will describe the universal scope of kinesiopathology by first Zooming-Out to take a broad, collective look at the contributors to non-traumatic LBP, then Zooming-In to discuss the integration of the contributors into a spinal stability strategy. I want to bring the topic down to scale, so I am only going to discuss the solutions; solutions that, when applied to ANY low-back motor defect (faulty motor pattern; FMP) will correct it simply due to economy of the treatment, and not the details of the injury.
The purpose of this article is to change the usual recommendation of intake and examination; the clinician does not need to evaluate every muscle in the patients’ body, nor to perform specific muscle testing, nor to perform classical orthopedic exams. Instead, save time by zooming out; understand this biggest picture by evaluating the entire patient presentation with this 3-part exam: (1) evaluate the reproducible complaint, (2) evaluate the involved faulty movement patterns involved, (3) evaluate spinal stability (procedure in another article.)
“Spinal Instability is due to ‘defects’ and ‘deficits’ related to (1) the spinal motor experience with (2) articulations in multiple planes of motion of (3) meaningful, adaptive benefit, (4) utilizing both aerobic and anaerobic energy systems and (5) axial spinal loading (6) while avoiding risk-promoting activities of position, duration, intensity, and monotony and (7) perpetuating certain personal biases and attitudes about spinal health.” (Dean, 2016)
While other processes are to be considered (inflammatory, degenerative, organic, metabolic), in large part LBP complaints are due to spinal stability defects; spinal instability.
Spinal stability defects describe faulty patterns, either learned or acquired. Defects can be learned from poor instruction, ‘copy-catting’, and self-learning. Defects can be acquired due to poor observation or management, creep, mis-information, or personal bias.
In the case of bias, a patient may be working in a job doing an activity in a way that is not mechanically prudent, for example a housekeeper may vacuum in a risky outstretched body position only caring about cleaning and not low-back mechanics. I had a patient that worked each day suspended from a mast in a body sling doing rigging for Cirque Du Soleil. Certain jobs require walking on a concrete floor all day. In these cases, the lower back must deal with undesirable loading. Spinal stability deficits occur when the knowledge of spinal mechanics is absent, or the desire to learn spinal mechanics is absent.
Spinal stability requires that the spine have ongoing workloads in a variety of positions and patterns each day, and these workloads must be meaningful and not destructive. These workloads should support a desire to improve spinal stability as a priority. The spine must be primarily loaded vertically oriented with gravity, with episodes of rotation, lateral flexion, extension, and elevation (like standing from a squat), and minimally flexed. The workloads should occasionally represent aerobic work (duration at submaximal levels) such as vigorous long-stride walking, seated or standing rowing (better with rotation), locomotive calisthenics, and standing vinyasa yoga, for example. Aerobic workloads should cause breath-seeking (deeper ventilation.) The workloads should occasionally represent anaerobic work such as strength training, burst activities like ladder drills, Core X System™ basic drill sets, 100m sprints, tennis stroke drills, and baseball pitching, for example. Notice that the suggested spinal stability work is not gym-based, and it is not exercise-based, it is skill based (the opposite of physical therapy.) Diversity and meaningfulness in work should be explored, and monotony should be avoided such as walking every day on a motorized treadmill, or on an elliptical machine, or stationary cycling.
Finally, spinal stability workloads should avoid personal biases such as avoidance due to fear of pain, or flare-up, or avoidance due to dis-interest or claiming “Too busy.” The classic example is not working the spine in order to “protect it.”
This article is about the importance of the seven contributors for long-lasting spinal stability. Restoration of activities can usually begin the same day since the spinal stability skills will also relieve symptoms. These seven contributions should be discussed and provided with usual patient education in every case of LBP, regardless of the mechanism of injury, regardless of the type or location of the pain. In all LBP cases, re-establishing spinal stability prevails, since ‘pain is not the only problem.’
LBP Blog General information
These articles intend to (1) re-evaluate the prevailing clinical practices thought to manage low back ‘pain’, (2) submit and debate novel low back ‘pain’ contributors and mechanisms, (3) meet patient expectations & satisfaction and clinically meaningful results, (4) recommend a conservative non-surgical course of care to over-ride ‘pain’ instantly, and (5) restore ADLs and patient confidence on the first visit at low cost. This article has a companion podcast.
Dr. Dean Bio
Forester Dean is a chiropractic and physiotherapy sports medicine doctor practicing in Los Angeles, California. Dr. Dean is a lifetime athlete, and currently teaches tennis, track, boxing, yoga. The Core X System™ Campus flagship location was opened by Dr. Dean in 2020. www.preformancecxs.org
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