CORE STABILITY FOR BACK PAIN

LUMBOPELVIC STABILITY AND LOW BACK PAIN:

CURRENT THOUGHTS AND EXERCISE GUIDELINES

By Rachele Fischer, BPhty, MCSP

The purpose of this article is to refresh our current ideas on the topics of lum- bopelvic stability and provide an explana- tion of how it is believed to work, how it relates to low back pain and the reduction of low back pain and how, practically, to approach retraining it. The article will also discuss why exercises must be neces- sarily specific and be performed with an exactness appropriate to ‘rewiring’ the way the nervous system activates the muscles. Finally there will be some discus- sion on the concepts relative to stability.

Lumbopelvic stability and balance

A stable lumbopelvic articular system describes a system in which the three subsystems, described by Panjabi (1) are working fluidly together to fulfil required movement and postural tasks (see Fig. 1).

The active subsystem (ie. the muscles which have ideal length and strength) is recruited by the control subsystem (ner-

10 SportEX Control their neutral positions with control. The

neutral position (2) is that in which the spine retains its anatomical curves and the pelvis has the anterior superior iliac spine (ASIS) aligned in the frontal plane and the ASIS and posterior superior iliac spine (PSIS) aligned in the transverse plane.

Active Passive Figure 1: The three subsystems of muscular control

vous system) in the correct order with precise force and velocity. It reacts to reasonable unexpected forces and operates a continual feedback and feed- forward system to monitor all stages of the movement task.

The passive subsystem has ligaments of perfect length and tension, within a connective tissue framework with the right degree of tautness and give, the bone is of adequate strength and density and the neural system moves fluidly.

The spine and pelvis move in and out of

Like other ‘ideal’ concepts of anatomy and function, this degree of perfection probably doesn’t exist, yet it remains what we should strive for.

The muscle system The question is how does each aspect of this ‘model’ affect active movement? Gossman, Sahrmann and Rose (3) maintain that stretch weakness is a physiological phenomenon, observed in animal muscle immobilised in an elongat- ed position (see Fig. 2). Extrapolating from this, a posturally elongated muscle may be weak while a shortened one is strong and more likely to be activated (4,5,6). It is hypothesised that this acti- vation is due to a bias generated in the