The Missing Link in Protecting Against Back Pain

image Sometimes we need to take a step back and think about some of the traditional recommendations for people with low back pain.  One such is the emphasis on abdominal strength, which alone may even cause more low back issues in some people.  Craig Liebenson has done an excellent job, as usual, highlighting this and giving some examples for working on the spinal extensors in the latest issue of the Journal of Bodywork and Movement Therapies.  Definitely good information.

A special thanks to friends Craig Liebenson and Leon Chaitow for giving me permission to share this from the Journal of Bodywork and Movement Therapies.  This is a great journal that I look forward to arriving in my mailbox.

The Missing Link in Protecting Against Back Pain



Liebenson, C. (2010). The missing link in protecting against back pain Journal of Bodywork and Movement Therapies, 14 (1), 99-101 DOI: 10.1016/j.jbmt.2009.10.002

12 replies
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  3. Back pain
    Back pain says:

    I agree that strength is a big help for preventing back pain, but there are some conditions that will not allow much of any exercise. Best is to find the root cause of the pain and treat that. For example, in lower back pain the adrenal glands are almost always the cause, they just need to be strengthened and de-stressed.

  4. Craig Liebenson, D.C.
    Craig Liebenson, D.C. says:

    The Bird Dog is one of the cornerstone exercises for training the multifidus. The column is not a Clinician article, but rather a Self-Care (i.e. patient) hand-out.

    It is not dogmatic to use the bird-dog for back pain, but evidence-based. the UPitt Treament Based Classification proposes decision rules for determining which patients require directional-preference; manipulation; or stabilization treatments. Bird-Dog is ideal for the stabilization patients.


  5. Anonymous
    Anonymous says:

    Mike – I am really disappointed in your endorsement of this article. The extensors? Clinical research has concluded that the stabilizers (multifidi) are the muscles that are significantly impacted by LBP.

    Sciatica? What is that? More jargon too. You should have renamed this article – Confusing the Clinician and Consumer with the Missing Link.

    Peer reviewed journal? Doesn't look like it.

    Better to stick to RCTs & systematic reviews.

    Let's clarify not perpetuate dogma. Dr. Liebenson, do you adjust and realign the spine and free people from the darths of subluxation? Adjust for colic? Read what your colleague Bronfort published about these treatments.

  6. Anonymous
    Anonymous says:

    I agree the article is very simplistic. It is a Self-Care "hand-out" for patients. I also agree wholeheartedly that the UPitt Treatment Based Classification Scheme is awesome. I use it w/ all my patients. This self care paper refers to LBP not sciatica so the use of the Bird Dog would be a cornerstone of management of a Stabilization patient (non-acute, non-radicular patient w/out yellow flags). However, I would say that a yellow-flags pt would benefit from a Cog-Behavioral approach involving exposure to movements associated w/ pain expectancies & the Bird Dog is generally a fearful movement for yellow flags patients.

    Additionally, a sciatica patient as they recover from directional -preference treatment such as end range extension would likely benefit from the bird dog.

    Other key points – the bird dog is low load, esp. if started as quad arm or leg reach. Trunk extensor endurance is decreased in asymptomatics w/ increased risk of FUTURE LBP. Tr ext/flexor ratio is biased to flexors in chronic LBP pts.

    Finally, there is an overwhelming bias towards trunk flexion exercise in the public consciousness & the bird dog is an exercise to consider as a "missing link". This does not make it a panacea though.

    Craig Liebenson, D.C.
    [email protected]

  7. Anonymous
    Anonymous says:

    Apparently, common sense and grammar don't go together either.

    And I don't believe the article said anything about "Benefiting all individuals."

  8. SnippetPhysTher
    SnippetPhysTher says:

    Nothing has been substantially proven to prevent low back pain. The likelihood is that most humans will experience low back pain.

    In physical therapy with regard to treatment for low back pain, the best evidence we currently have is the treatment based classification system.

    What is being suggested in the article you are sharing is quite simplified and probably won't benefit all individuals. From a common sense view, those exercises aren't going to substantially strengthen the back extensors.


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