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Are Stability and Instability Relevant Concepts for Back Pain?

N Peter Reeves, Jacek Cholewicki, Jaap H van Dieën

    The Journal of Orthopaedic and Sports Physical Therapy
    |April 26, 2019
    PubMed
    Summary

    Back pain diagnoses often cite spine instability, but its true nature is complex. A broader, interdisciplinary view of spinal stability is needed to understand and treat back pain effectively.

    Keywords:
    iatrogenic back painlumbar spine stabilitypain sensitizationsystems-based approach

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    Area of Science:

    • Biomechanics
    • Neuroscience
    • Pain Science

    Background:

    • Spine instability is frequently diagnosed in patients with back pain, yet its precise definition and clinical relevance remain debated.
    • The spine's complex, multi-element structure hinders direct observation and assessment of instability.
    • Trunk muscle activation patterns demonstrate the central nervous system's (CNS) active monitoring of spinal stability threats.

    Purpose of the Study:

    • To critically examine the concept of spine instability in the context of back pain.
    • To advocate for a broadened, interdisciplinary perspective on spinal stability.
    • To explore the potential application of stability concepts to pain sensitization and iatrogenic back pain.

    Main Methods:

    • Literature review and theoretical commentary.
    • Analysis of neural and mechanical coupling mechanisms in spinal control.
    • Discussion of traditional biomechanical and control perspectives on stability.

    Main Results:

    • The spine employs neural and mechanical coupling to prevent instability from aberrant motor control.
    • These protective mechanisms may become detrimental in injured spines.
    • Instability concepts may extend to understanding pain sensitization and iatrogenic pain.

    Conclusions:

    • A contemporary understanding of spinal stability requires integrating knowledge from biomechanics, neuroscience, and pain science.
    • Current definitions of spine instability may be insufficient to capture the complexity of back pain.
    • Rethinking stability offers new avenues for investigating and managing back pain, including iatrogenic forms.