Imagine that you sprain your ankle. Automatically you will move a bit different, and depending on the circumstances, you will increase the tension around the joint, you will move in a more stereotypical way (limping), and you will move less than before. This is all adaptive: these behavioural changes are beneficial for optimal healing.
Music to read by: Newen Afrobeat with a Fela Kuti cover: Opposite People
But, as everyone knows, while the injury is healing, the amount of limping should start to decrease. Because, as everyone knows, limping is not a good movement pattern, it causes compensation in other structures and areas, and it limits what you can do. So people want to get rid of this limping… (this does not mean that the limping goes away spontaneously in all people, but that’s another story)
Now, imagine that you sprain your back. Automatically you will move a bit different, and depending on the circumstances, you will increase the tension around the joints, you will move in a more stereotypical way (back straight), and you will move less than before. This is all adaptive: these behavioural changes are beneficial for optimal healing.
But, as everyone knows, once your back pain improves, it is important that you continue keeping your back straight, right?
Now, why should it be different for a back compared to an ankle (or to any other joint, for that matter)? There’s been quite a bit of discussion about this ‘keeping your spine neutral’, and more and more people are convinced (by the science) that it is at least not necessary to ‘keep your back neutral all the time’, that it is not necessary to ‘contract your core’ all the time.
What I find interesting is the question: how did we ever think that keeping your back straight all the time would be a good thing?
First of all, there are some biomechanical considerations and some studies that made us think this way (the load on the back is less in a neutral position compared to any other position). Now we know that there’s a lot more to it and that these studies have been ‘overinterpreted’. Just think of these two points:
If you immobilise a joint, it will become weaker and less healthy. What do you think will happen if you keep your back straight all/most of the time?
Load is not bad, on the contrary, appropriate loading of a joint is what keeps it healthy (same as with muscles).
Unfortunately, the message of ‘keeping your back straight’ is now so widespread that all people ‘know’ that they should do it. Add to this knowledge the following:
People with acute back pain experience that keeping their back straight actually reduces the amount of pain they have (on average). The body experiences what the cognitive part of the brain knows! This is really powerful and deep learning! There’s only one problem, it is true only in a specific situation, i.e. acute pain.
Think of the example of the ankle sprain. As the healing proceeds, you want to get rid of the limping. Limping restricts your freedom of movement, your functionality, your adaptability, your balance, and loads other parts of the body in ways it does not really like.
So there’s a mixture of logical thinking, knowledge from authority (doctors, physio’s), circumstances and experiences that causes these maladaptive movement behaviours. So, don’t blame yourself, or your patient for this behaviour. It is understandable. It is logical. But it is not healthy.
What is also interesting to note, is that, in my experience, not all people are equally susceptible to this. It appears that some personality traits increase the risk: perfectionists and anxious people seem more susceptible.
Most people are actually too lazy, to easy-going, to careless, to follow ‘keep-your-back-straight-rule’. And for once, this is probably a good thing (on average).
Cheers,
Pieter