A new insight on back pain

In the early 20th century the SI joint was thought to be the main source of law back pain and was the focus of many scientific investigations. But recently two newest theories have been developed.

First, the theory of rotational malalignment known today as the Malalignment Syndrome which includes: SI joint upslip/downslip (superior/inferior shear), sacral torsion (hip anterior/posterior rotation), hip outflare/inflare (lateral/medial rotation), (Schamberger, 2002, 2006). Diagnosis of these syndromes is very straight forward, as is the treatment of each is

Second, the past 15 years, a well-known group of PTs, have been developing a newer theory that is known as the Joint-By-Joint Approach. This theory is based on understanding the primary role of the different major joints.

Of course all joints need a combination of mobility and stability, but interestingly, each joint displays a predominant need for either mobility or stability.

Lets start from the bottom which joint require mobility or stability…..

Ankles – mobility

Knees – stability

Hips – mobility

Lumbar Spine – stability

Thoracic Spine – mobility

Scapulae – stability

Shoulders – mobility

Cervical Spine (C7-C3) – stability

Cervical Spine (C2, C1) – mobility

Our CNS chooses mobility over stability depending on when we move. Another prospective , when a joint which predominantly requires mobility, reaches its mobility barrier ( it may be physiological or pathological), the surrounding joint will give up their stability to accomplish the mobility requirement. This is involuntary survival technique that is controlled by CNS.

How this above phenomenon will work with Hip and Spine lets understand.

[restrict]When the CNS perceives lack of mobility (at hip joint) in movement, the lumbar spine automatically leaves behind its stability to accomplish the hip mobility requirement. This phenomenon opens the door to risk of injury/ inflammation/ pain in the lumbar spine (L5-S1).

These may be contributing factor when Lack of hip mobility may happen

1. Pathological restriction of hip
2. Lack of dissociation of hip and pelvis (dysfunctional movement pattern)
3. One or more than one muscles of the hip joint is tight.

The key here is to increase mobility at the hip joint or create dissociation between hip and pelvis so that the lumbar spine can maintain its stability.Therapist may go for Hip mobility drill . Here are some exercise therapist can improve hip mobility

Referances :
Schamberger, Wolf. The Malalignment Syndrome. Churchill Livingstone, Elsevier Science Limited (2002, 2006).

Boyle, Michael. Advances in Functional Movement Training. On Target Publications, Santa Cruz, CA (2010).

Cook, Gray. Movement: Functional Movement Systems. On Target Publications, Santa Cruz, CA


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