Core stability: mal di schiena tra mito e scienza

Mal di schiena cronico: che fare? I consigli sono molti, forse troppi, purtroppo a volte poco sensati.

In generale, si consiglia il rinforzo dei muscoli della schiena e della parete addominale in modo da ‘proteggere’… ma proteggere che cosa?
Da metà degli anni, un fisioterapista australiano (PW Hodges) dimostrò che persone con mal di schiena avessero un ritardo nell’attivazione del trasverso dell’addome, muscolo appartenente al gruppo ‘core stability’. Da allora ci si concentrò molto sul rinforzo e attivazione  del core, pensando che avere una colonna vertebrale ben fissata potesse evitare movimenti che avrebbero portato poi ad algie vertebrali o potessero addirittura risolverli.
Oggi, studi scientifici e statistici, dimostrano che forse quella soluzione fosse un tantino ‘affrettata’. Tale rinforzo infatti non fa altro che bloccare, ‘irrigidire’, la colonna vertebrale.
Sorpresa: da circa 10.000 anni la colonna vertebrale è progettata per essere flessibile: una svista dell’evoluzione?
Altra sorpresa: da uno studio emerge che l’obesità, nel senso di parete addominale lassa, non è causa del mal di schiena (il problema è dovuto piuttosto al sovraccarico).
Sorpresa n°3: il mal di schiena nelle donne incinta tende a risolversi in breve tempo dopo il parto, mentre il ritorno alla normalità della parete addominale impiega all’incirca 8 settimane.
Se ne deduce che la pratica del rinforzo del core, non solo non aiuta e probabilmente peggiora, ma crea altre problematiche a importanti schemi motori funzionali.
Avete notato come si muovono le persone con dolori lombari? Vogliamo aumentare ulteriormente la rigidità? E’ come voler piegare un’asta unendola ad un bastone…
Quindi pare che il mal di schiena sia piuttosto dovuto all’adozione di abitudini di movimento createsi per diverse e possibili cause e la scarsa consapevolezza di come ci si muove porta a dimenticare come potersi muovere in modo diverso.
La paura di provare dolore ci irrigidisce, è una difesa del sistema nervoso per proteggerci: non muoversi per non sentiere il dolore (suona familiare?).
Forse abbiamo più bisogno di sentire come poterci muovere e riconoscere le abitudini che portano alla protezione ed alla tensione per poter rilasciare, piuttosto che rinforzare.
Movimento per la liberazione della colonna… 🙂

Citazioni bibliografiche:

– Radebold, A., et al., Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain radebold2000.pdf – Urquhart, D.M. and P.W. Hodges, Differential activity of regions of transversus abdominis during trunk rotation urquhart2004.pdf – Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain- a randomized clinical trial with 3, 6, and 12 months follow-up postpartum nilsson wikmar 2005 – Multifidi muscles median frequency before and after spinal stabilization exercises sung 2003 – Stabilizing training compared with manual treatment in sub-acute and chronic low-back pain rasmussen barr 2003 – Abdominal muscle activation of elite male golfers with chronic low back pain horton 2001 – Akupunktmassage nach Penzel versus klassische Teilmassage und Einzel- versus Gruppenkrankengymnastik bei chronischen RuÈ ckenschmerzen ± eine randomisierte, kontrollierte klinische Studie in 2 ´ 2-faktoriellem Design franke2004 – Assessment of the abdominal wall after pedicled TRAM flap surgery- 5- to 7-year follow-up of 150 consecutive patients mizgala 1994 – Body weight and low back pain. A systematic literature review of 56 journal articles reporting on 65 epidemiologic studies leboeufyde2000 – Contraction of the human diaphragm during rapid postural adjustments hodges 1997 – Differentiating temporal electromyographic waveforms between those with chronic low back pain and healthy controls hubley kozey 2002 – Effectiveness of a tailor-made intervention for pregnancy-related pelvic girdle and/or low back pain after delivery- Short-term results of a randomized clinical trial bastiaenen 2006 – Effects of abdominal muscle coactivation on the externally preloaded trunk- variations in motor control and its effect on spine stability brown2006 – Electromyographic recordings of low back pain subjects and non-pain controls in six different positions- effect of pain levels arena1991 – Exercise therapy for low back pain- a systematic review within the framework of the cochrane collaboration back review group – In vivo ultrasound assessment of respiratory function of abdominal muscles in normal subjects misuri1997 – Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis hodges1996 – Low-back pain in pregnancy. Abdominal muscles, sit-up performance, and back pain fast 1990 – Motor control problems in patients with spinal pain- a new direction for therapeutic exercise jull2000 – Neural aspects of cognitive motor control georgopoulos 2000 – Radebold, A., et al., Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain radebold 2000  Radebold, A., et al., Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain radebold2000.pdf – Urquhart, D.M. and P.W. Hodges, Differential activity of regions of transversus abdominis during trunk rotation urquhart2004.pdf – Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain- a randomized clinical trial with 3, 6, and 12 months follow-up postpartum nilsson wikmar 2005 – Multifidi muscles median frequency before and after spinal stabilization exercises sung2003 – Stabilizing training compared with manual treatment in sub-acute and chronic low-back pain rasmussen barr 2003 – Abdominal muscle activation of elite male golfers with chronic low back pain horton2001 – Akupunktmassage nach Penzel versus klassische Teilmassage und Einzel- versus Gruppenkrankengymnastik bei chronischen RuÈ ckenschmerzen ± eine randomisierte, kontrollierte klinische Studie in 2 ´ 2-faktoriellem Design franke2004 – Assessment of the abdominal wall after pedicled TRAM flap surgery- 5- to 7-year follow-up of 150 consecutive patients mizgala 1994 – Body weight and low back pain. A systematic literature review of 56 journal articles reporting on 65 epidemiologic studies leboeufyde2000 – Contraction of the human diaphragm during rapid postural adjustments hodges 1997 – Differentiating temporal electromyographic waveforms between those with chronic low back pain and healthy controlshubleykozey2002 – Effectiveness of a tailor-made intervention for pregnancy-related pelvic girdle and/or low back pain after delivery- Short-term results of a randomized clinical trial bastiaenen 2006 – Effects of abdominal muscle coactivation on the externally preloaded trunk- variations in motor control and its effect on spine stability brown2006 – Electromyographic recordings of low back pain subjects and non-pain controls in six different positions- effect of pain levels arena1991 – Exercise therapy for low back pain- a systematic review within the framework of the cochrane collaboration back review group – In vivo ultrasound assessment of respiratory function of abdominal muscles in normal subjects misuri1997 – Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis hodges1996 – Low-back pain in pregnancy. Abdominal muscles, sit-up performance, and back pain fast 1990 – Motor control problems in patients with spinal pain- a new direction for therapeutic exercise jull 2000 – Neural aspects of cognitive motor control georgopoulos 2000 – Radebold, A., et al., Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain radebold 2000

Fonte citazioni bibliografiche:
Gianluca Italiano, fisioterapista osteopata
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