Purpose: To cherry pick a few research articles to suggest that even though our knowledge of core stability is very impressive its link to pain is poor.
Nutshell summary: People in pain have spines that function differently than those not in pain. Many treatments can influence pain. The spine stability model of low back pain does not explain how people have pain and takes an overly mechanical view of the pain experience. No test has ever shown that a spine is unstable or how “increasing stability” would lead to a decrease in pain. Thinking that our spines need more stability or control may be the completely wrong path in explaining how people have pain or how our exercises help them. Our treatment “corrections” occur not via one specific “corrective” mechanism (e.g. improving stability) but rather through global non-specific mechanisms that our better explained by our understanding of pain neuroscience. Making the shift from believing that “stability” is the issue with pain can thus free up to choose completely different exercise programs. Exercise and treatment prescription thus become simpler. We have preliminary evidence to support this view with the clinical studies that show benefits with the various exercise conditioning programs that train different schools of thought on stability or the just as effective programs that completely ignore any concepts of stability.
Purpose: Fascia is everywhere, provides a fantastic structural support for the body and has the ability to transmit force from force generating muscles. But we as therapists tend to get ahead of ourselves and make statements about treatments and the body’s function that I am not sure make sense and haven’t made sense for the past decade that I’ve questioned it.
Purpose: To highlight the poor link between the bogeymen found on imaging with pain or dysfunction.
Our current technology is amazing when it comes to viewing the insides of our body. The problem with this fantastic technology is that we can see something (e.g. a tear in a muscle or a joint with some osteoarthritis) and assume that there is something wrong or that this is the source of our pain. However, the link between tissue “abnormalities” on MRI, x-ray or Ultrasound is often quite poor. Many, if not most, people have “bad stuff” on their MRIs or x-rays yet have no pain. (more…)
This article is purely conjecture. I have no hard data and would not even know how to create a study to test for it. BUT, I consider it biologically plausible.
Tightness is a common sensation for people with pain and for athletes during training. However, when someone reports being tight in a region I find that they often are not in terms of their mobility. Their range of motion will be wonderful, perceptually their tissue will feel “loose” upon palpation (warning: highly subjective on my part) yet they report a sense of tightness. Main point being there are no objective signs of tightness or limits in their range of motion. So why does the perception of tightness occur? (more…)
Purpose: to provide some information about the pain experience
Why?: Understanding pain can help modify it
I don’t pretend to understand everything about pain. It is incredible complex and what we know is certainly involving. However, there is a lot of misinformation out there even from people that should know better. This article will link to a number of information sites that help explain pain. This is important because it helps you understand why things hurt. Understanding why something hurts can decrease pain but can also help you function better. Some basic concepts:
1. Pain is a perception. Signals (e.g. nociception or even pressure) come from the body and the brain creates an output that we perceive as pain. Ever heard of a soldier being shot and not feeling any pain until they were safe and out of harms way? If pain was some absolute thing that the brain has no choice to recognize than you would have no way but to feel pain any time a tissue was injured. We’ve all heard stories of people being injured but feeling nothing.
2. Your body does not have to be injured to feel pain. In fact you can lose a limb and later feel pain in that limb that no longer exists.
3. Tissue injuries (e.g. disc bulges, rotator cuff tears, tendinopathy) do not have to hurt. The body can have lots of so called “dysfunction” but this does not mean that you will feel pain. For example, 50% of people over fifty may have a rotator cuff tear but they experience no pain.
4. Emotions, beliefs, stress, past experiences etc can influence the pain that you feel. Pain is more than a punch in the arm.
5. The perception of pain can move around in your body and this does not mean that you are crazy. This is a normal finding when we experience persistent pain.
6. Pain changes how we move and how we function. Movement is often the key to resolving pain.
There is so much more than this but I will let the resources below provide better information.
1. The sensitive nervous system (D Butler): a great academic reference
2. Explain Pain (Butler and Moseley): a patient’s guide to pain