Article by Simon Bell (osteopath)
The term motor control refers to the ways in which the human body controls movement. This is theorised to be a multifactoral process including input, output and central processing (i.e. what the body responds to, what it does and how it processes data). When we move, there is a surge of information that floods our nervous system; from the stretch of muscles, to the contact of the ground with our feet, to the touch of an object against our skin and everything in between. This is called input.
What makes us different from inanimate objects is, for the most part, our movements are purposeful. This means the other two elements must come into play; output as in our movements in response to a stimulus and central processing as the mediator or 'middle man' that controls exactly what that response will be. This includes reflexes, writing, typing or even more physical and complex activities such as walking. Things are then further complicated as to whether motor control is finite or general and this affects other stuff like synergy or redundancy. As you can probably tell it’s pretty complex, hence the recommended reading below!
So, What Does This Mean for Me?
It presents us with some important information for dealing with pain. Most notable of which is motor control can be affected by the experience of pain itself. Several papers have demonstrated that muscle excitability (i.e how active a muscle is) can be increased in both painful and non painful muscle groups when a person is in pain. The most recent evidence suggests this likely occurs in a non uniform way and as a response to a threat or as part of a protection mechanism. So, the body changes its motor control in the presence of pain as a way of protecting us. It’s possible, therefore, that this can become problematic for your movements and even inhibit how you perform day to day activities, whether or not this is indeed a cause or effect of the pain itself.
Motor Control Exercises:
Evidence presented by authors such as Hodges and Ferreria and the results of several review papers have demonstrated that, in back pain patients there is a delay in the timing of motor control or activation of core muscles such as the transverse abdominis (TVA). This has led to the notion that a lack of ‘core stability’ is a potential cause of back pain and developed the whole ‘core stability’ phenomenon. This is where exercises are chosen to help increase spinal stiffness and reduce instability as a way of reducing the timing delay and possibly leading to a faster recovery.
What specific motor control exercises have in their favour are several papers have discovered performing exercises designed to help activate core muscles (i.e the abdominals, the TVA and the pelvic floor group) can be an effective way to help reduce pain. Some authors have shown them to even be more effective than manual therapy (such as that provided by a physiotherapist or osteopath) and other forms of rehab exercise over short term periods (i.e. during the initial painful phase).
There's still much to learn regarding motor control and its relationship to back pain. However, motor control exercises is a potentially very useful addition to our arsenal of pain management!
Developing Your Programme
Easy Physio has been designed to help with all aspects of your journey back to a pain free life. Therefore, it’s important we don’t just stop with motor control exercises. As your fitness score improves and your pain reduces, your program will automatically progress to maximise the chance of a full recovery. These aspects of progression include factors like strength, complexity, speed and graded exposure within the exercise program itself. Our wellness review also aims to help you as an individual. Factors such as psychology, diet and sleep - all potential predictors of pain - are taken into account to reduce the chance of recurrence and persistence and give ou a fully rounded approach to achieving your goals.
Get a FREE lower back pain assessment today. Click the link to start your assessment and take the first step towards recovery from chronic pain.
Recommended Reading:
Moseley G, Hodges P, Gandevia S; (2002).’Deep and Superficial Fibers of the Lumbar Multifidus Muscle are Differentially Active during Voluntary Arm Movements. Spine. 27:29 –36.
Cameron M, Adams R, Maher C; (2003) ‘Motor control and strength as predictors of hamstring injury in elite players of Australian football’ Physical Therapy in Sport (4) 159-166.
Macedo LG et al; (2009) ‘Motor Control Exercises for Persistent Non-Specific Low Back Pain: A systematic Review’ Physical Therapy 89(1) 9-25.
Latash ML; (2010) ‘Two Archetypes of Motor Control Research’ Motor Control 14(3):41-53.
Hodges PW; (2011) ‘Pain and Motor Control: From the Laboratory to Rehabilitation.’ Journal of Electromyography & Kinesiology 21(2);220-228.
Macedo et al; (2012) ‘Effect of Motor Control Exercises Versus Graded Activity in Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial’ Physical Therapy 92(3) 363-377.
Vasseljen O et al; (2012) ‘Effect of Core Stability Exercises on Feed-Forward Activation of Deep Abdominal Muscles in Chronic Low Back Pain: a randomized controlled trial.’ Spine 37(13) 1101-1108.
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