In recent years an abundance of research has surfaced with regard to musculoskeletal care demonstrating abnormal motor patters (movement compensations) relating to pain syndromes.

This means, for instance, in someone with low back pain the muscles producing “core stability” don’t work in the same manner as a “normal” person.  The internal oblique muscle, for example, may turn on too early, too late, too much or too little.

These studies are often a very close variation on one theme.

Step one: take some people without pain. Strap on some EMG pads (this is an electrical machine that can read muscular output). Have them do a movement and record the amount of each muscles contribution to that movement.

Step two.  take some different people, this time with pain (usually a specific complaint like anterior shoulder pain, low back pain, hip pain etc.) and then have them repeat the same tests. Record the results.

Step three: compare and contrast.

Differences are often found in the groups between the sequencing of muscles used, amount of effort used, or even which muscles are used.

Step four: interpret and apply to practice.

This is a stellar example of scientific method. It also happens to produce some of the most important information concerning musculoskeletal care.

My problem with it isn’t the study itself, but usually in how the research gets interpreted or applied.

Take the 2003 study in Spine by Hungerford and Hodges. Their study found significant differences in activation of core muscles in people with and without sacro-iliac pain during routine tasks.

Great research. Very promising and worth looking into more. Great application to clinical practice too.

Then I read a review of the study.

The reviewer came to the conclusion, based on this study and some others, that patients with SI pain and low back pain, in fact, should be treated with exercises re-teaching their core how to work properly.

Whoa there. Don’t you think we should ask some more questions first?

Like:

Do the patient’s have pain because their motor pattern is different, or is the motor pattern different because they have pain (does the compensation lead to the pain or vice versa)?

What if some of the subjects without pain had a sub-acute low back issue or had a developing issue that hadn’t become symptomatic yet? Couldn’t that change the normative data?

Did any of the subjects have other contributing pain syndromes (hip, leg, shoulder pain etc.) that could have affected results?

Etc. etc. etc.

Which brings me to my point.

There is so much variation between subjects (people), environments (jobs, social activities, recreational activities) and pain syndromes (superior SI pain vs. lower SI joint pain etc) that its hard draw real clinical conclusions from most research.

The manner in which your body deals with musculoskeletal pain, by way of compensation at least, could be very different than someone else based on the above factors.

One person with low back pain could hyperextend his spine while walking, another, because he’d had a previous hip injury could shorten his stride.

Different factors, different result.

This is why we see chronic problems will to frustrate both patients and providers alike.

Especially if you’re not asking the right questions—or all the questions.

Moral of the story: beware of providers carrying research—me included.