• Lincoln Blandford

Recurrence And Features Of Recruitment; Is It Coming Back Round?

A recent systematic review (Devecchi et al., 2021) explored the evidence related to characteristics associated to movement and recurrent low back (LBP) and neck pain (NP). Studies considering individuals in periods of remission compared to those without a history of pain were explored.

Check the label

To the authors’ credit, rather than labelling the changes as ‘dysfunctional, aberrant, or even atypical’ the term ‘neuromuscular adaptions’ was employed to describe a range of features to include muscle activity, kinematics, muscle properties, and sensorimotor control; literature highlights these features may contribute to not only pain but also recurrence (Hodges et al., 2011, 2015; van Dieen et al., 2017).

In the acute presence of pain, muscle activity, spinal kinematics, and sensorimotor control ‘adaptations’ have been observed (Falla et al., 2008; Falla & Hodges, 2017; van Dieen et al., 2003, 2019). Such changes may persist in the wake of pain and subsequently influence pain’s return (recurrence; Hodges 2011; Hodges et al., 2009; Macdonald et al., 2009).

Something or nothing?

With respect to findings, the review identified very low-level evidence supporting the existence of changes in motor behaviours in during periods of remissions for individuals reporting LBP recurrence. Specifically, these findings included increased muscle co-contraction, muscle synergist activity redistribution, and altered (delayed) onset of deep axial muscles. Additionally, recurrence appears to possess an association to limited sagittal plane ROM. Evidence considering NP was identified as ‘very limited’. In all cases, the authors highlight the need for further insights on the mechanisms corresponding to these observations.

Beyond strength

While clinicians may routinely observe an array of ‘neuromuscular adaptations’ within their patient populations, the existing body of evidence is clearly far from compelling. Evidence-based practice may see the results of the review as a stumbling block; evidence-led practice may see enough of a narrative within the studies as to allow it to aid their patient management.

The review highlights something is happening, yet what research tools or questions are required to make these outcomes overt? An alternative perspective on the paper as a whole, would be to welcome the re-appraisal of the complex interaction of muscles and their synergists (e.g., Hodges et al., 1996) in respect to the bigger picture of human movement. If we are still living in the epoch of ‘can’t go wrong getting strong’ the review may act as an impetus for research to further inform on the subtle, but seemingly real features of clinical scenarios and recurrence.


Devecchi, V., Rushton, A. B., Gallina, A., Heneghan, N. R., & Falla, D. (2021). Are neuromuscular adaptations present in people with recurrent spinal pain during a period of remission? a systematic review. PloS one, 16(4), e0249220.

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van Diee¨n JH, Flor H, Hodges PW. Low-Back Pain Patients Learn to Adapt Motor Behavior With Adverse Secondary Consequences. Exerc Sport Sci Rev. 2017 Oct; 45(4):223–229. https://doi.org/10. 1249/JES.0000000000000121 PMID: 28704216

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van Diee¨n JH, Reeves NP, Kawchuk G, van Dillen LR HP. Motor Control Changes in Low Back Pain: Divergence in Presentations and Mechanisms. J Orthop Sport Phys Ther. 2019; 49(6):370–9. https:// doi.org/10.2519/jospt.2019.7917 PMID: 29895230