[IS-03-1] Challenges for Spinal Pain and Motor Control
Back pain is a common and debilitating condition for which physiotherapists provide a range of treatments, with variable levels of evidence. Unfortunately, treatment outcomes are not optimal. The physiotherapy profession faces a range of challenges to consider in order to achieve the best outcomes for patients, including selection of the right treatment for the right patient at the right time. Exercise is one of the most effective treatments and exercise that targets motor control is one of the most promising. Motor control training aims to optimise the loading on the spine and pelvis by consideration of posture, movement and muscle activation. This intervention has moved through the cycle from being considered the panacea for all back pain to a more balanced view where it is targeted and individualised to specific patients. The weight of basic and clinical evidence supports the role of exercise focused on motor control issues in the treatment of low back and pelvic pain, but the contemporary view is that it must be individualized, and requires a broader view than reductionist consideration of a few muscles. Contemporary research is highlighting adaptation in motor control across the motor control domains of movement, posture/alignment and muscle activation, and these observations parallel clinical interpretations of how patients present in practice. The understanding of optimal neuromuscular mechanisms for control of the spine and pelvis has evolved with greater understanding of the muscles and control strategies involved. Research is also highlighting the mechanisms that underpin the changes in motor control, which involves mechanisms from the spinal cord, to the motor and sensory regions of the brain, and higher cognitive functions and the relevance of consideration of different types of pain（e.g. nociceptive, neuropathic, central sensitization）. This has implications for treatment. The aim of this presentation is to present the basis for contemporary understanding of the changes in the motor control system in low back and pelvic pain and the application of this understanding assessment and management of patients in clinical practice.