Back Pain: Mobility or Stability

Early in the 20th century, the SI joint was the subject of several scientific studies since it was believed to be the primary cause of low back discomfort.  This research soon shifted course once Mixter and Barr’s work on intervertebral disc rupture was published in 1934. The SIJ was largely disregarded throughout the next four decades in favor of the disc as the main culprit of back pain.

Since the 1970s, there has been a resurgence in interest in the SI joint due to the following reasons:

1. A significant portion of patients who have disc resection fail to experience relief from low back pain, leading to last-ditch fusions.
2. The understanding of the immediate and long-term effects of chymopapaine “discectomy.”
3. The development of computed tomography scanning and later magnetic resolution imaging, which allowed for the identification that disc protrusions were frequent but weren’t always associated with back pain (Magora & Schwartz, 1976).

More recently, two things may have contributed significantly to the interest in rehabilitation involving the SI joint:

1. The understanding that the SI joint itself and/or the surrounding ligaments, muscles, and other soft tissues involved in the joint’s functioning are responsible for around 20–30% of low back pain and referred pain (Maigne et al., 1996; Schwarzer et al., 1995).
2. The Interdisciplinary World Congress on Low Back Pain and its Relationship to the Sacroiliac Joint, held in San Diego in 1992 and 1995, Vienna in 1998, and Montreal in 2001, which serves as an international venue for current research on the SI joint and the lumbo-pelvic-hip unit

 

Two of the newest hypotheses have emerged as a result of these factors:

First, the hypothesis of rotational malalignment, often known as the Malalignment Syndrome, which comprises hip outflare/inflare (lateral/medial rotation), sacral torsion (hip anterior/posterior rotation), and SI joint upslip/downslip (superior/inferior shear). Both the diagnosis and the appropriate therapy for each of these illnesses are quite simple.

Second, a renowned team of physical therapists, chiropractors, and strength and conditioning specialists has been working on establishing a more recent approach known as the Joint-By-Joint Approach for the last 15 years.  Understanding the basic function of the several major joints is the foundation of this idea.

Of fact, all joints need both mobility and stability, but it’s fascinating to note that each joint shows a predominance in one of these needs.  Here is how it appears when we start from the bottom.

 

 

Think of stability as a quality (resistance to movement) and mobility as quantity (freedom to move).  Our CNS prioritises mobility over stability as we move. In other words, the surrounding joints will sacrifice their stability to meet the mobility demand if a joint that prioritises movement encounters a mobility obstacle.  It indicates that the central nervous system is in charge of this automatic survival strategy.

For example, the hips need to be mobile.  The lumbar spine immediately gives up its stability to achieve the hip mobility requirement when the CNS detects a lack of mobility (the initial mobility barrier) in movement.  When this stability is lost, the lumbar spine is more susceptible to injury, inflammation, and discomfort, most often around L5/S1.

 

 

 

In order to preserve the stability of the lumbar spine, it is important to develop hip mobility.

First, the dysfunctional tissue extensibility at the hips (lack of mobility) must be corrected, and then the core stability dysfunctional movement pattern at the lumbar spine must be corrected.  Here, mobility (consider structure) must come before stability (consider function). But much more crucial is the knowledge that core stabilization’s functional stability is pattern-specific.  Working the abs, which is what we often think of as conventional core exercises, will be incorrect and counterproductive.  You need to use a process called corrective functional movement training. (This is the main stabilisation work particular to the pattern.)  Sometimes the whole procedure may be finished in only two weeks.