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Why do some patients keep hurting their low back?

 Approximately thirty-four percent of people who experience acute low back pain (LBP) will have recurrent episodes. It remains unclear why some people experience recurrences and others do not, but one possible cause is a loss of normal control of the back muscles. The control of the short and long fibres of the deep back muscles was different in people with recurrent unilateral LBP from healthy participants. Short fibre EMG onset occurred later in participants with recurrent unilateral LBP than in healthy participants (p=0.022).

The short fibres were active earlier than long fibres on both sides in the healthy participants (p<0.001) and on the non-painful side in the LBP group (p=0.045), but not on the previously painful side in the LBP group. Activity of deep back muscles is different in people with a recurrent unilateral LBP, despite the resolution of symptoms.

Because deep back muscle activity is critical for normal spinal control, patients must engage in corrective exercise as part of therapy. I can teach you what to do but you must be consistent with your homework.  Using the Functional Movement Screen (FMS) & especially the squat assessment in my practice helps to guide functional muscle mobility & stability.  

MacDonald D, Moseley GL, Hodges PW. Pain. 2009 Apr;142(3):183-8. Epub 2009 Jan 30.

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