Neuromuscular Control Training

What is neuromuscular control training?

Neuromuscular control training is a method of training your brain to use your body in an efficient manner. That is, training your brain to use your body in a way that works with our natural biomechanics. Because of injury and inefficient ergonomics, people can inadvertently train the problematic postures and ways that they use to move. We can consciously correct that through training. For many, this is retraining movement patterns that you learned during your developmental years. It is surprising to many that they cannot do certain movements that newborns can do. By using mindfulness, biomechanical instruction, ergonomic adjustments and biofeedback, you can consciously program the way you move. When this is done well, people will experience better performance, more power and less pain.

This is a form of training that invests in improving your skillset. While it may feel like going to school, it tends to be a quicker approach in the long-term than status quo passive therapies most patients receive.

How is neuromuscular control training relevant mechanical lower back pain?

Neuromuscular control training addresses the mechanisms responsible for keeping lower back pain patients in pain. 90% of those with lower back pain are said to have mechanical lower back pain which is to say that they are not using their back properly. To understand its relevance you will need to understand some general anatomical and biomechanical principles. The next session has an introduction (also presented in our page OHIP-Funded Lower Back Pain Counselling).

The biomechanical underpinnings of mechanical lower back pain

What is mechanical lower back pain?

Every patient is shaped differently, moves differently and engages in different activities. Some people have very good movement strategies for their body types and what they are doing, and others don’t. When we don’t use our bodies efficiently, structures in the back get strained, pinched or banged which ends up creating inflammation and possibly post-traumatic anatomical changes. When this happens, patients become even more susceptible to irritating these tissues further. Ironically, patients start to (reflexively) change the way they move (almost always for the worse) further aggravating these tissues which are already more trigger happy for inflammation.

To get a better idea of the types of structures that can be injured, it’s good to get an anatomy lesson. Each of these structures need to be protected by you by selecting appropriate ways to do activities and by bracing your body in ways that prevent injurious forces to work on them. Most people who injure their backs injury them by doing exercises/activities with inappropriate form (even under the guidance of personal trainers!) or being too sedentary. Virtually nobody has formally learned how to use their body with proper biomechanics. However, most of us did know how to move well at some point of our lives (usually when we were younger) as most of us naturally developed with ideal biomechanics.

In order to allow these inflammed tissues to heal, we need to protect them from forces working on them. We need to train our bodies to move the way we should have been moving in the first place. In doing this, we start to strengthen the ideal muscles we should be using (i.e., the work-horses of our body) and give rest to the scapegoats that are injured.

What does neuromuscular control training for lower back pain look like?

Take a moment and observe how young children (yet to be trained to be sedentary), athletes and wild animals move. Why do they move like that? Contrary to popular belief, moving this way is actually easier, more powerful and less likely to cause injuries. That’s because it works with the biomechanics of your body: that’s the way you were designed to use your body. Neuromuscular control training reconnects you with this. So, it’s actually somewhere in our muscle memory although for many lower back pain it’s rusty and hasn’t been accessed for a long time. It could be an injury caused you to change your movement/muscle recruitment formula; or poor ergonomics; or chronic stress; or being taught to do exercises/activities with inappropriate form. For most people, this detraining (or training the wrong neuromuscular control patterns) happens unwittingly. For example, someone who was very active in sports all through their schooling may find themselves working an 8-hour–day desk job upon graduating. Many of them don’t realize that they are actually training whichever posture they find themselves in at work, for 8 hours of the day. This will change their neuromuscular control formula and express itself in all their activities, often making them more susceptible to injury. However, if they can consciously understand the biomechanical principles behind how we’re supposed to use our bodies, – which was unnecessary for them up until then since they did it well automatically – then they can prevent this.

So, imagine what it felt like to take your first steps. What did it feel like? How did you do it? Many of us are conditioned to move inefficiently that we have forgotten what is the most efficient approach. In neuromuscular control training, we take people through normal neuromuscular developmental milestones in retracing our steps to our ideal movement formula. And, as we layer on level by level, the exercises start to look like sports performance exercises rather than the typical “rehab” exercises you see on handouts handed out at medical offices.

Wouldn't it be enough just to start exercising more regularly or get a personal trainer?

About half of all the lower back pain injuries we see are from patients who hired a personal trainer to help them get fitter and ended up hurting their backs. The problem is not the exercise per se. The problem is how people recruit their muscles – amount of recruitment of muscles, which muscles to recruit, and with which timing – that winds them up with mechanical lower back pain. So, as we mentioned in the previous section, somewhere along the way – maybe only after this injury – patients default movement formulas change to inefficient. If they do exercises with this default movement formula, they would likely be better off doing nothing. That is, if you think back to when you were fit and you think that you should do more bench press and squats like in those days, you likely aren’t doing bench press or squats the same way you used to. And even then, those exercises may not be the ideal exercise selection for your current goals anymore. The key is to reset one’s default movement pattern so that they can exercise again on their own terms.

Some people hear blanket statements like you should swim, or you should do yoga, or you should do pilates. This advice may wind you up with aggravated mechanical lower back pain by the same principles just discussed. Many of these exercises may expose you to circumstances where you will adopt non-biomechanically-sound positions and just set you back. For example, if someone does flutter kick in the pool, depending on how they do their flutter kick – most untrained people don’t do it efficiently – they may end up “cheese-gratering” their lumbar discs, further aggravating their problem. Moreover, they may start to feel helpless because if an expert orthopaedic surgeon told you to swim and it made you worse, then naturally you may feel that your case is beyond help: this is not true!

Who is a good candidate for managing their mechanical lower back pain functionally using neuromuscular control training?

Anyone who is willing to put in the work to get strong so that back pain has no place to start up are good candidates. This is a real project. It involves education, motivational support, and training. It’s not much different than what athletes do when training for better performance.