Chapter 18 - Motor control changes and low back pain: cause or effect?

Abstract

The objective of this chapter is to present a state-of-the-art overview on the question whether motor control changes are a cause and/or an effect of low back pain (LBP). It is based on a discussion among all the authors of this volume and a review of the literature. We have attempted to avoid overlap with the preceding chapters as much as possible, but have found it necessary in some places to repeat arguments made there or refer to data reported there.The question at hand has obvious implications for the feasibility of motor control training as an approach to primary and/or secondary prevention of LBP. However, it should be kept in mind that even when, for example, poor motor control can cause LBP, this does not necessarily imply that motor control training is an effective, let alone the most effective, approach to primary prevention.The first section of this chapter reviews observations on motor behaviour in individuals with LBP. In the second section, we discuss the evidence that motor control changes can be a primary cause of LBP. In the third section, we discuss evidence that LBP causes changes in motor control. Subsequently, we address the question whether these changes are adaptive, i.e. help the individual to deal with LBP-related impairments, or maladaptive, i.e. contribute to the transition to chronic pain and/or recurrence of pain. The final section summarizes the main conclusions and presents implications for clinical research and practice.