The relationship of lumbar flexion to disability in patients with low back pain

The relationship of lumbar flexion to disability in patients with low back pain,  by M Scott Sullivan Lisa Donegan Shoaf and Daniel L Riddle (Physical Therapy March 2000 vol. 80 no. 3 240-250)

is an interesting study

method

Patients completed the Roland-Morris Back Pain Questionnaire (RMQ), and the therapists assessed lumbar spine flexion AROM (active range of motion) using a dual-inclinometer technique at the initial visit and again at discharge.

Conclusion

Measures of lumbar flexion AROM should not be used as surrogate measures of disability. Lumbar spine flexion AROM and disability are weakly correlated, suggesting that flexion AROM measures should not be used as treatment goals.

Free full study here. it “sort of” breaks the link between spine mobility and future back trouble.

The study also draws some very interesting observations about therapist biases

As always,  this gives us another crop of references to follow up

6 muscles of the back are functionally different from limb muscles

Limb muscles create movement, torso muscles create stability.

The simple act of walking requires spine stability. There are no agonists and antagonists in the torso they are all required to stabilise force generated elsewhere in the body.

If your therapist treats your core muscles in the same way as limb muscles, they are simply going to extend the pain in your back

Elite performers generate force in their hips, and it is transmitted through a stiffened core.

Spinal Control: The Rehabilitation of Back Pain: State of the art and science
edited by Paul W. Hodges, Jacek Cholewicki, Jaap H van Diee

Do you slump?

I fix the backs of sedentary people and of several elite athletes, also middle range  Crossfit athletes.

One thing Ive notice about those with bad backs is their ability to push themselves beyond the call of duty.  In fact they have the reputation of being hard workers, motivated and always on the go!

The reality is , once the doors are closed, they  can head for the settee and slump. For hours!!!! They can happily stay in bed if allowed, and they can be very , very lazy.

Hard ( some would say obsessive) work can sometimes be matched by back destroying  activity elsewhere.

The twist. Is it deadly.

Several researchers have suggested that  twisting of the trunk is associated  with low back pain. the 1st issue we need to deal with is to distinguish  the idea of twisting  from generating twisting torque.

Torque  in the torso can be achieved  whether or not the spine itself is twisted.

In general moderate twisting isn’t dangerous. over the years the debates have included  twisting quickly and breaking the speed by hitting the end range of motion,  back in 1970, Farfan  suggested disc twisting  could damage  the collagen fibres  in the annulus, especially if a neutral arch had been lost.  Other reports say that twisting is less dangerous as the facet forms a mechanical stop , thus its the facets that can get injured.

What is  Twisting torque? Imagine a twist that applies or transmits force!.As no muscle  is designed (as a primary function),  to create twisting torque all muscles are  contracted, this increases compressive load. 50nm of extension, creates 800 newtons of spinal compression.

Generating high torque, when the  spine is twisted  is problematic. In short are you twisting… well, Ok!  or are you twisting through your spine to load up an axe swing … probably not so good!

Ill show you in a future “Note” how to generate force through your hips and not through your back. But for now, repeated spine flexion will, according to Aultman et al ( 2005), will lead to discogenic trouble.