Stability Vs Mobility: Whats more important for my back?
12th January 2017
Over recent years our understanding of spinal stability has evolved considerably. Notions of static misalignment, or simple muscle
weakness, have gradually changed to incorporate newer evidence about the role of dynamic control, and how these might go awry.
We have seen in our clinic that many of our patients are likely suffering from deficits in sensorimotor control. In other words,
injury occurs when a patient fails to detect inappropriate motion and rein it in with a precisely matched muscular response. This is
not a conscious task, but one the body should automatically perform when there spine and nervous system is functioning well! The
human spine is a hugely complex structure that is simultaneously juggling two competing interests – to remain flexible and to
remain stable. The only way that these two opposing demands can be reconciled is to provide sensitive feedback mechanisms that
can monitor the shifting loads and stresses upon spinal tissues and report back to the brain in a timely fashion. But the literature
now suggests that our patients can and do suffer from problems of spinal positional awareness. Furthermore, the implications
of any such deficiency are quite profound.
Information sent back to the brain in regard to posture and spinal alignment is directly to the centre for visual control, hence it is
not surprising that people with spinal pain can suffer from dizziness, blurry vision and headaches. Anxiety has been shown to
increase in those with greater postural sway (poor spinal stability and control), which makes sense if we consider the survival
implications of decreased stability. As confidence in our ability to move decreases we necessarily have to increase our vigilance,
prompting heightened anxiety. With all of this in mind it is worth pausing to reflect upon what it is that chiropractors are trying to
achieve when adjusting the spine. Is it really a repositioning of errant bony structures? Or are we actually using manipulation as a
novel sensory tool to improve proprioceptive feedback from the spine to the brain?
A recent paper assessed jerk index (smoothness of motion) among other parameters on people with back pain. Following a course of
Chiropractic care there was a significant improvement in smooth movement. This is important, as smooth motion is a pre-requisite
for fine control. Many of our patients suffer acute episodes of pain during innocuous daily movements, and it is suggested that
failure to adequately control smooth movement lies at the core of the problem. So it just might be that spinal manipulation has an
important role in restoring joint sensitivity and movement control, and thus help in a number of profound ways.