Using Physical Therapy to Improve Your Postural Trunk Control

Scientists have been studying the role of trunk postural control in the development and persistence of low back pain through testing. Trunk postural control is the ability to keep your torso (middle part of your body, like chest and belly) steady and balanced. The understanding emerging from these scientific studies is informing physical therapists to tailor exercises that focus on improving postural control to help treat low back pain.

Completing everyday activities requires a complex interplay of sensory and motor processes that are involved in the postural control of the trunk. Your brain sends commands to muscles based on the input from sensory processes (vision, sense of body position and inner ear) to work in a coordinated fashion to control your trunk posture thereby allowing you to walk, sit, bend over to pick something from the floor and do many other activities. Three types of postural control strategies have been identified:

• Static postural control is when your body uses it senses and muscles to stay balanced and hold a position, like standing or sitting still.
• Anticipatory postural control comes into play when a planned movement occurs, such a picking a book from a table.
• Reactionary postural control is when your body quickly adjusts to stay balanced if something suddenly pushes or pulls you off balance.

In a recent meta-analysis¹, scientists analyzed reactionary postural control data from 64 studies and concluded people with low back pain had worse reactionary trunk control than those without low back pain. Also, those older in age and/or overweight had a bigger negative impact on the reactionary trunk control. This puts them at greater risk for experiencing chronic and recurrent lower back pain. Fortunately, reactionary trunk control can be improved upon with appropriate training. Exercises programs that focus on challenging the trunk muscles to respond quickly and effectively are key to improving reactionary control. Performing exercises sitting on a Swiss ball and incorporating dynamic movements such as arm or leg movement while maintaining trunk stability can be a good starting point. Exercises can be made progressively challenging by introducing weights, resistance bands, closing eyes and incorporating head movements.

The role of trunk postural control in recurrence of low back pain has also been extensively studied. In a recent study², it was found that individuals with recurrent low back pain show reduced correlation between thoracic and lumbar spine while performing standing tasks. Movement scientists have particularly focused on understanding how the upper back moves in relation to the lower back while doing different tasks. Performing exercises that target postural control can be a key to preventing recurrent back pain.

If you are experiencing low back pain or have experienced recurrent low back pain, talk to a physical therapist to help you design an appropriate exercises routine to improve your trunk control that will help reduce low back pain and potentially prevent it from recurring.

Upender Singh, D.P.T., PhD(c), is a physical therapist who specializes in treating spinal pain and is board certified in orthopedic physical therapy. He sees patients at the Campus Ridge Building located on the campus of MyMichigan Medical Center Midland. To schedule an appointment, call the office at (989) 837-9100. He is also involved in researching novel methods of analyzing trunk control using smart phones and other technology in collaboration with a team of researchers from the University of Michigan-Flint. For information on participating in a study related to this topic, visit Research: Measure Your Trunk Control.

References

Alshehri, Mansour Abdullah, et al. "Trunk postural control during unstable sitting among individuals with and without low back pain: A systematic review with an individual participant data meta-analysis." Plos one 19.1 (2024): e0296968.

Rowley, K. Michael, Jo Armour Smith, and Kornelia Kulig. "Reduced trunk coupling in persons with recurrent low back pain is associated with greater deep-to-superficial trunk muscle activation ratios during the balance-dexterity task." Journal of Orthopaedic & Sports Physical Therapy 49.12 (2019): 887-898.