Pain Relief, Upper Back Pain and Low Back Pain: Movement Variability
If you’ve seen me in my office for nutritional advice, chances are I’ve told you how important it is to get a wide array of foods in your diet; we might call this “nutrient variability”.
We know that the more variable your heart rate is, the healthier your cardiovascular system is; this is called” heart rate variability”
Well, guess what…. there is a concept called, “movement variability” that seems to be the key component in pain relief for conditions like upper back pain and low back pain.
What is “movement variability”?
It is creating slightly different movements to perform certain tasks. In a 2010 study entitled, ”People with chronic low back pain exhibit decreased variability in the timing of their anticipatory postural adjustments“, authors found that people with low back pain had decreased movement variability when it came to postural adjustments. In another study (click here), upper back and neck pain was linked to the same decrease in movement variability.
Many clinicians and therapists (myself included) see this as one of the main reasons functional movement, functional training, joint manipulation and mobilization, massage and many other soft tissue and rehabilitative techniques help people in pain. What do all of these treatments have in common? Novel Movements.
Novel movements are movements that vary from those that you produce regularly throughout the day. Movements that exit outside of a stereotypical pattern. Novel movements help to increase your movement variability and also stimulate your brain to produce dopamine. Not only is dopamine a “pleasure” chemical, it is also part of our internal reward system. An increase in dopamine from novel movements and movement variability is like a messenger to the rest of the brain saying,
“Hey, good job! Everybody, wake up and pay attention, this is something new and good for us.”
Novel movements and increased movement variability creates an opportunity for your body to experience movements that are non-threatening and non-painful; this can help to decrease the pain signals from the brain with chronic pain problems.
We would be correct if we categorized decreased movement variability as our movement habits. To increase our movement variability and therefore, possibly find relief from chronic pain, low back pain, upper back pain and more, we should change our movement habits and introduce novel movements into your daily routine.
In other words, you need to improve your “Movement Diet” (I stole this phrase from Cory Blickenstaff, a PT in Vancouver Washington). Improve the variety of movements in your “movement diet” so that you have options for pain relief and finding comfortable ways to move.
Yours in Health,Tim Irving DC, MS, LMTOptimum Function: 819 SE Morrison St. ste. 215, Portland, OR, 97215Optimum Function = Optimum Health
Postural Rehabilitation: Let’s Sit-Up Straight and Look at the Evidence
The idea that poor posture contributes to neuromusculoskeletal pain, and that important, or even possible to properly rehabilitate posture, has been around for a long time and continues to be very popular. We have still been unable produce any good evidence to support this model. There is a ton of mis-information on this topic; a provider could choose any weekend during the year and probably find a seminar somewhere that is on postural treatments.
Here’s my take on posture:
It’s not an issue of posture, it’s an issue of the quality of your body position from which you move. This means, your posture can be crappy, as long as when you move from a biomechanically-sound position. Does you sacral curve need to be “x degrees”….. no! Does your head need to be exaclty over your shoulders…..no!
For every “guru” that’s out there selling this ignorant and potentially harmful (monetarily at the very least) idea, there are hundreds of examples of individuals who have what most clinicians would call “bad posture” and are completely, functionally ad biomechanically fine, in every way.
Existing evidence supports rehabilitation using a biopsychosocial model over a traditional biomedical (i.e., posture and body mechanics) model, but a biopsychosocial model has been very slow in adoption for various pain states. This model looks at the individual’s relationship, thoughts, ideas, and fears with regard to pain and the clinician helps to dispel myths about pain, teach the patient about why the pain exists and helps them resolve whatever issue is causing the pain. Posture is not usually one of them.
Postural-based approaches to pain have been found ineffective and no longer recommended by clinicians who are “in the know”. This shift has occurred in part because these biomechanical messages are not backed by very good evidence, they can often impede the resolution of a patient’s pain and can convey negative messages to patients about the cause of their pain.
The idea that we can change our posture via exercise, manipulation, soft-tissue work and the like is simplistic, attractive and makes sense to a lot of people. Unfortunately, this idea contradicts current evidence. Many ideas that were once thought to be “common sense” and logical have been proven wrong. Disease was once thought to be caused by evil spirits, the world was once thought to be flat and the earth was once thought to be the center of the universe, are you picking up what I’m putting down? The relationship between posture and pain is complex and there is no consensus on a valid definition of “good posture” or a reliable way to measure it. Postural evaluation procedures show poor reliability validity.
The correlation between posture and pain is tenuous at best, with most studies suggest there is no relationship. Therefore, the therapeutic investment in correcting postural and biomechanical factors is irrational, since it is unlikely to influence the course of a patient’s pain.
References:
- Linsmeyer A. “The Effect of Flexibility and Posture on Neck Pain and Common Treatments in Physical Therapy.” Aurora Baycare Annual Spine Conference, Nov. 8, 2011.
- Cote P, van der Velde G, Cassidy JD, et al. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. JMPT, 2009 Feb;32(2 Suppl):S70-86.
- Linton SJ, van Tulder M. Preventive interventions for back and neck pain problems: what is the evidence? Spine, 2001;26(7):778-87.
- Weiniger S. Strengthening Posture for Rehab, Performance, and Active Aging. Seminar sponsored by Northwestern Health Sciences University., Dec. 10, 2011.
- Waddell G. The Back Pain Revolution, 2nd Edition. Churchill-Livingston, 2004.
- Toward optimized clinical practice. Guideline for evidence-informed primary care management of low back pain. Edmonton (AB): Toward optimized practice; 2009 Mar 2.
- Lederman E. The fall of the postural-structural-biomechanical model in manual and physical therapies: exemplified by lower back pain. J Bodyw Mov Ther, 2011 Apr;15(2):131-8.
- Dagenais S, Haldeman S. Evidence-Based Management of Low Back Pain. St. Louis: Elsevier Mosby, 2012.
- Cecchi F, Molino-Lova R, Chiti M, Pasquini G, Paperini A, Conti AA, Macchi C. Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up. Clin Rehabil, 2010;24:26-36.
- Hrysomallis C, Goodman C. A review of resistance exercise and posture realignment. J Strength Cond Res, 2001 Aug;15(3):385-90.
- “Good Posture Defies Easy Definition.” The BackLetter, 2003;18(11)124.
- Dunk NM, Chung YY, Sullivan D, Callaghan JP. The reliability of quantifying upright standing posture as a baseline diagnostic clinical tool. JMPT, 2004 Feb;27(2):91-6.
- Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado M, Pareja J. Neck mobility and forward head posture are not related to headache parameters in chronic tension-type headache. Cephalalgia, 2007;27:158-64.
- Van Nieuwenhuyse A, Crombez G, Burdorf A, et al. Physical characteristics of the back are not predictive of low back pain in healthy workers: a prospective study. BMC Musculoskel Disord, 2009;10:2.