Thursday Thoughts: Lumbar Flexion is NOT Bad For You

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How many times have you been afraid to have your low back pain patient forward bend? Or backward bend? Or move at all after they mastered a bird dog?

Bending forward and backward, plus twisting are NOT bad for your spine!

Me in 2004 after I got CertMDT

Repeated Motions Approaches

There are many approaches that make clinicians and patients think that forward bending is bad for them. Take a repeated motions style for example, when educated improperly the patient thinks every forward bend makes a disc herniate. Stop using the jelly donut theory! While patients "get it" Sx centralize and function/ROM returns, sometimes the nucleus migrates with repeated motion, sometimes it doesn't.

Many clinicians forget the recovery of function phase; once the patient is pain free for 2-3 days, you actually have them start forward bending again if extension was their directional preference. Both the patient and the nervous system have to get accommodated to as close to full motion as possible.

Stabilization Approaches

Let's examine a stabilization approach. These exercises seem to help, but the connotation again is that not only flexion, but lumbar movement is bad for you. Function is restored because the patient learns to move with the threatened area "stabilized." In the end, once threat is removed, exercises should be prescribed to restore both flexion, extension, and rotation.

It's the last part of this rehab that patients are often discharged (or self discharge) without learning that it is ok to move, or not given motor control/repeated motions strategies to restore mobility loss. Does this lead to recurrences? Possibly, but not always.

Imagine if the average clinician treated the elbow like they do the lumbar spine. You do not often hear,

"Don't flex your elbow so much!" or
"Keep up with those elbow extensions, but DO NOT flex it!" or
"Let's concentrate on moving your forearm and shoulder more so that your elbow does not have to move." - (stabilization or bird dog like movements)

It just doesn't make sense when you apply the same approach to areas other than the spine. Of course movements and positions become sensitized and associated with threat. Our job is to educate and use movement and manual strategies to dissociate the threat. After that, make sure to "Stabilize" the area by loading it; in addition, make sure they can handle repeated motions opposite of the directional preference.

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...