by Bret Contreras June 17, 2013
Back pain is a crazy topic to examine in the literature – it’s all over the place. In the video below, I discuss two different models of back pain: one pertaining to the body’s structure, posture, and biomechanics, and the other pertaining to biological, psychological, and social phenomenon. It is very important for those who work with individuals in back pain to understand each model. These two distinct but interrelated models help explain both acute and chronic low back pain.
Here are the notes I took for the video:
Postural Structural Biomechanical (PSB) Model
Applies more to athletes & lifters and acute pain
This model makes sense to strength coaches – they’ve witnessed it
Shape, size, length, strength balances, posture
Anatomy does influence likelihood of pain & injury in sport and weightroom
Merging of functional anatomy & physics
Anterior pelvic tilt/lumbar hyperlordosis
Posterior pelvic tilt/lumbar hypolordosis
Sleep in awkward position – hurts next day
Round back deadlift – hurts next day
In lifting, often biomechanical explanation
Knees hurt due to knee valgus
Back typically hurts due to excessive motion under heavy load
Hip mobility, core stability, glute activation, motor control – doesn’t work for everyone
If all you have is a hammer, everything looks like a nail
Biopsychosocial (BPS) Model
Applies more to non-athletes and chronic pain
MRIs – most of us are jacked up at most joints and also discs
Pain = brain, nerves – pain signal must go up and back down
PSB not highly correlated to chronic pain – pain is a physiological process
Depression, # of friends, confidence (and even smoking) correlated with chronic back pain
Knowledge is first step
Movement, exercise, and manual therapy work but often by different reasons
Altering brain’s perceptions and nervous system’s response
Decreasing fear and threat-response
Start with pain-free movement and gradually progress
Increase confidence, decrease depression & fear
The post Back Pain: The Postural-Structural-Biomechanical (PSB) Model & The Bio-Psycho-Social (BPS) Model appeared first on Bret Contreras.
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