Motor Control Changes in Low Back Pain: Divergence in Presentations and Mechanisms.
Jaap H van Dieën, N Peter Reeves, Greg Kawchuk and 2 others
PMID 29895230WHAT IT FOUND
People with low back pain do not all move the same way.
Some stiffen their trunk to protect themselves, which raises tissue load. Others lose control and move more loosely. Treating everyone with the same exercise ignores these two distinct problems.
Key findings
01Motor control changes in low back pain are not uniform; some patients show increased muscle activity (stiffening) while others show decreased activity or delayed responses (loose control).
02Two broad phenotypes are proposed: 'tight control' with high muscle excitability and tissue loading, and 'loose control' with reduced excitability and potentially excessive spinal movement.
03Clinical strategies should differ for these phenotypes, targeting reduced excitability for the tight group and augmented control for the loose group, though valid assessment tools are not yet complete.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a narrative review, not a systematic review with meta-analysis, so the selection of studies may be subjective. Most underlying studies are cross-sectional, meaning it is unclear whether motor control changes cause pain or result from it. There is no consensus on valid clinical tests to reliably identify 'tight' versus 'loose' phenotypes in practice. Heterogeneity in patient populations and measurement techniques across the cited studies makes direct comparison difficult.
The easy way to misread this
Do not treat 'tight' and 'loose' motor control phenotypes as established clinical diagnoses with validated tests. The review suggests these patterns exist based on research data, but clinicians currently lack complete tools to reliably identify them in individual patients.