Dr Ryan Hislop
As Chiropractors we tend to focus upon the spine and nervous systems in all of its complexities – always looking for ways to better improve its health and function. If you have been part of our practice you will know that a manual approach is one of many methods we use, and the role of exercise is seen as a pivotal intervention to ensure good results. This being said, the general understanding of how exercise works, doesn’t always match up with how it actually works.
In the past, we thought that exercises were used to address theoretical muscle weakness, therefore improving “core strength” or “spinal strength” would improve this weakness thus improving the pain and health of the person. This simplistic model of weakness as the reason for the spine “going out” or having recurrent spinal pain has gradually evolved to a new appreciation for a deficiency of control of the spinal musculature. If this were to be an analogy, it’s not how LOUD (muscle strength) an orchestra can play that makes music (spine function), it’s how IN TIME (muscle control) the whole orchestra can play that makes the song (a healthy spine).
The evidence is now quite convincing that spinal dysfunction changes the way we move and the way these joints communicate with the brain through the nervous system. This leads to stiffness of the spine and over activation of the larger strap muscles, which compensate for a lack of underlying deep muscle activity. We start to move differently, we activate muscles inappropriately, we overuse and underuse certain muscle groups and often change patterns of those contractions (think back to the orchestra playing the notes out of time, but playing them loudly..what a mess!). Although the muscle is often blamed as the problem, ultimately the problems can be traced back to the way the nervous system is activating these muscles (specifically the motor cortex in the brain). Not surprisingly, small problems in spinal movement can build over time to create larger problems, often elsewhere in the body. Thus the common presentation of, “I just bent down to pick up the newspaper and my back went out”. It was never the newspaper or that one off bend. The problem had been developing over a long period due to that slow deconditioning.
The unfortunate situation is that if these poor patterns are maintained and the spinal dysfunction continues, the specific muscles are not being controlled appropriately, stabilization of the spine continues to be compromised and there is ongoing deconditioning of the postural control and stability systems within the brain that are responsible for coordinating strong, appropriate spinal and joint movement. This leads to higher injury rates and overall poor function of the human frame.
So the question arises, what can we do about all of this?
While the role of exercise doesn’t seem to be in dispute, the type of exercise that is most effective is far from clear. There has been a recent enthusiasm for spinal stability exercises and core strengthening strategies but have these actually improved patient outcomes? There are currently questions being raised in the research and a gradually building voice of dissent within the chiropractic, exercise physiology and physiotherapy literature whether we have over-refined our approach to such specific exercises. It seems that our ever increasing efforts to target specific movement dysfunctions and weakness to muscle contractions does not reflect the normal day to day movement and exercise of most people. Unfortunately it seems that our attempts to become more specific in our exercises have not amounted to much at all.
When we think of the way the human frame was designed, modern exercise is an artificial concept. Up until the last several hundred years, it would be fair to say that few of us would have set out deliberately to lift heavy items or move unnecessarily for the purpose of improving our health. We would have done this as part of our daily activities, whether that be collecting food or seeking shelter. Modern 21st century life suffers from movement malnourishment. We don’t move enough, and we definitely don’t move in the richness and fullness of movements that the human body can achieve on a daily basis.
In our quest to rehabilitate the muscles, brain and connections between the two, over complicating things appears to have little benefit from more natural and less complex movements. Recent studies have highlighted the simple act of walking is just as beneficial as the most intense tailored spinal stabilization approach. To me this makes sense, as walking is probably the most natural movement a human can express. For thousands of years, humans have populated the entire globe, largely by walking across its surface.
Regarding walking as an approach to improving spinal pain and muscular strength and control, some researchers have found over-ground walking superior to treadmill walking, which makes sense if our thoughts on a ‘natural movement is better’ approach to exercise. Furthermore, faster paced walking increases the activation of deeper spinal muscles and leads to improved fluid dynamics in the intervertebral discs which improves their health and movement. All of which are beneficial for a strong healthy spine.
Overall, it appears to me that we need to take the time to re-think some of our exercise strategies for lower back and neck pain. Our attempts to specifically target individual muscles that we deemed to be weak/tight/sluggish does not seem to improve outcomes beyond having someone “move more” with natural movements such as walking. The human brain stores patterns in terms of desired functions, whether that be walking, writing your name or swinging a hockey stick. As such, targeted exercises that aim to “activate core muscles” while laying on an exercise mat, will not help me next time I go to lift the shopping out of the car boot or mop the flow. Ultimately, the human brain needs to practice real world movements to learn how to coordinate, activate and maintain spinal stability.
We are now entering a new paradigm of exercise rehabilitation where the research is demonstrating that simple functional movements are replacing targeted ‘specific’ back exercises.
Thankfully, most people will be relieved to hear that walking seems like a good place to start as this may well be ‘good enough’ to get them on the road to recovery.
