Does this guy need more strengthening for his low back pain? Really?

I like to put up a slide of this chap when teaching courses to raise the obvious question.

This chap came in to see me in 2004 with left sided low back pain for 6 months duration.

His only aggravating factors was prolonged standing. It was an insidious onset. It was relieved with sitting or bending. It was not improving and was getting slightly worse in that it now came on with about 20 minutes standing whereas at the beginning it was about an hour.

So does he need more strengthening? It was probably not possible to get this guy any stronger. He had numerous provincial power lifting records at the time. I think one or two Canadian records as well (but not sure).

During left prone over bed hip extension, his ASIS moved anteriorly almost immediately then his lumbar lordosis increased. He also had a positive one leg standing test on the left.

I asked him to do an isometric contraction of gluteus maximus and then perform this movement and stop when his ASIS moved. I also asked him to do his lumbar multifidus.

This chap had strong beliefs about strengthening as you can imagine. He had mechanical pain, had good motor skill learning, no symptoms of low grade inflammation and an obvious movement control pattern issue with articular related pain. Some basic education on movement and motor control was required and he was happy to do the rehab. He got good temporary pain control from the exercises and it was better than sitting or bending. He felt he was fully recovered in 3 sessions.

The purpose here is not to get in to the clinical reasoning of my assessment or rehab, but to highlight the gross problems with a one size fits all approach as strengthening as a rehab tool. With appropriate sub-classification, specific motor control rehab is an effective rehabilitation strategy.

Equally, specific motor control rehab as a one size fits all approach is also inappropriate.Specific motor control rehab is suitable for someone if they have:

• Mechanical pain
• Good Motor Skill Learning
• Low Behavioral Factors
• Low co-morbid medical symptoms (which are a surrogate for low grade systemic inflammation)

Related post

https://smarterehab.blogspot.com/2019/12/some-issues-to-consider-with-strength.html