Balance Posture and Muscle Control in Low Back Pain

Balance in Low Back Pain
Studies show postural balance is important in low back pain


Low back pain (LBP) has always been a bit of a mystery for medical researchers. Why does it develop in certain people, What are the contributing factors, and What can be done about it? Even scoliosis, a condition discovered by Hippocrates over 2000 years ago, is considered to be idiopathic (unknown cause) in most cases. Even giving a specific diagnosis for low back pain can be challenging. Consider that many times, not just one, but several irregularities show up on imaging: arthritis, stenosis, disc herniations, etc, so nobody knows which finding is responsible for the pain. There are also many instances where there is significant pain, but there are no abnormal findings on X-ray or MRI. There is also the opposite: A patient has no symptoms, but the images show many abnormalities including significant disc herniations and degenerated joints. It is also common to have findings on one side of the spine (like a herniated disc pressing on a nerve), but the patient has pain on the other side of their body. The clinical picture is not clear because symptoms are not reliably associated with findings on imaging or other physical findings.

However, that may be changing. Research in the past few decades seems to be indicating a clear pattern in patients with low back pain. There is a strong correlation with pain/symptoms and dysfunction in muscle control that affect balance and posture. In other words, it looks like the clear answer to “Why does this person have back pain?” is that their muscles are not able to correctly stabilize their spines. This lack of balanced support causes uncontrolled movement that damages the spine as it attempts to remain vertical against gravity.

Researchers back in the 1990s found that LBP is caused by spinal instability that results in injury to embedded mechano-receptors. In individuals with LBP, there is disturbed motor control patterns and changed physiologic properties. Panjabi theorized that spinal stability relies on 3 interconnected systems:  1. Passive Articular 2. Active Muscular 3. Neural Control. Bergman divided muscular system into local for fine movements and global that ties it all in.

Vikari-Juntura published their findings in Spine in 2000. They discovered that patients who had lack of balance and/or symmetry on a one-leg standing test tend to have more back problems.

Rupal Metha and Sheri P Silfies of Drexel University Research in 2006 found that Chronic LBP patients move differently. They sequence and time muscle activation patterns differently. An experiment with EMG on core muscles showed that chronic LBP patients had delayed recruitment, and less symmetry in recruitment.

A meta study published in Spine in 2013 showed that specific motor control exercises targeting symmetry in balance and posture was more effective than traditional Physical Therapy and Spinal Manipulation.

Arthritis & Care Research 2014, D Steffens, et al found an 8x increased risk for LBP for people working in “asymmetric and biomechanically awkward labor”.

Silva et. al in a 2018 publication in the Journal of Disability & Rehabilitation found that people with chronic LBP have poor balance control.

Hlaing et al in 2020 in the Journal of Pain Research found patients with low back pain (LBP) have poorly coordinated neuromuscular control, which may alter the normal postural stability of the spine. Altered movement control may occur at any stage of LBP.

This is just a sampling of the evidence. The message seems to be clear: balanced motor control of the core stabilizers of the spine is extremely important to spinal health. In short, If you have low back pain, despite your medical diagnosis, the reason is likely faulty muscle control. That lack of control has likely led to repetitive damage to spinal structures such as discs, ligaments, muscles, joints, or even nerves.

If you are interested in getting more information or want help with your back pain, please do not hesitate to reach out to our clinic at 918-600-2969.