BRACING COMES UNDER SCRUTINY...A SOCIAL MEDIA TREND
Mary O'Keeffe explored the value of abdominal bracing and found little evidence to suggest it makes much of a difference.
It caused quite a media flutter.
And rightly so:
Here are some thoughts:
Movement is changed in pain and is the target of clinical interventions
Hodges 2011, Pain and Motor Control From Laboratory to Rehabilitation. Journal of Electromyography & Kinesiology 21(2) 220-228
Theory is moving from a 'stability' model to a neurophysiology model
Moving differently in pain: a new theory to explain the adaptation to pain Hodges PW, Tucker K
New theory for the motor adaption to pain - key points:
Pain leads to redistribution of activity within and between muscles
Modifies the mechanical behaviour = protective response
Adaptation to pain involves changes at multiple levels of the motor system
Adaptation to pain has short-term benefit, but with potential long-term consequences Abnormal brain structure and function is seen in patients with chronic pain along with hyerexitability of the CNS - Nijs J et al A modern neuroscience approach to chronic spinal pain: combining pain neuroscience education with cognition-targeted motor control training. Phys Ther. 2014 May;94(5):730-8.
So pain can influence motor control and the capacity to control movement and a brain constantly processing pain experience does not maintain circuitry for fine motor control and postural control
We need to assess our patients for movement control impairments and reason what effect chronic pain is having on these patterns. We can use movement control tests to identify movement impairments and cognitive motor control retraining to change the brain and movement control. Of course with pain neuroscience education.
Look forward to seeing the results of this study...
Dolphens M, Nijs J, Cagnie B, Meeus M, Roussel N, Kregel J, Malfliet A, Vanderstraeten G, Danneels L.Efficacy of a modern neuroscience approach versus usual care evidence-based physiotherapy on pain, disability and brain characteristics in chronic spinal pain patients: protocol of a randomized clinical trial. BMC Musculoskelet Disord. 2014
LET'S MOVE FROM CORE STABILITY TO MOVEMENT CONTROL