Patients with chronic low back pain (cLBP) can be a challenge. A constant struggle with discomfort if not pain, perceived and actual limits on mobility and activity, along with frustration with attempts to “fix” the problem changes people- physically & behaviorally, psychologically and physiologically, structurally and functionally.
Successful neuromusculoskeletal (NMS) professionals are skilled at managing symptoms, but the challenge lies in effectively addressing the root causes of LBP to prevent recurrence and improve long-term outcomes.
As a posture expert, I’ve spent years developing the StrongPosture® methodology, a melding of biobehavioral somatic interceptive exercise and common-sense education designed to enhance the benefits of other exercises by improving awareness and perceived accuracy of posture, balance, and motor control.
Today, I want to share insights from a fascinating study by Ippersiel et al. and show how StrongPosture® techniques can amplify your approach to LBP care, grounded in science and tailored to your clinical practice.
The Science of Movement and LBP
The study, published in Gait & Posture (2021), dives into the biomechanics of bending in adults with, and without, low back pain (LBP). They focused on inter-joint coordination and the flexion-relaxation phenomenon (FRP).
For clinicians who don’t regularly dive into academic journals, here’s the gist: the researchers compared how people with LBP move differently than healthy individuals during a forward bending task. They measured coordination between the hips, lower lumbar spine, and upper lumbar spine, as well as muscle activity in the erector spinae (longissimus, iliocostalis, and multifidus).
From a StrongPosture perspective, their focus was observing patterns of buckling in the kinetic chain.
Key findings include:
- Altered Inter-Joint Coordination: People with LBP showed more out-of-phase coordination between the hip and lower lumbar spine compared to healthy individuals. This means their movements were less synchronized, potentially reflecting a guarded or compensatory strategy to avoid pain. Interestingly, coordination between the lower and upper lumbar spine showed no significant group differences, suggesting that regional lumbar differences might not matter.
- Reduced Flexion-Relaxation: The FRP—where back muscles like the erector spinae typically “relax” at full spinal flexion—was significantly reduced in the LBP group. This suggests that individuals with LBP maintain higher muscle activity (less relaxation) during bending, likely to protect painful spinal structures. The multifidus muscle showed the most pronounced difference, which is not surprising considering that they along with intertransversarii are the deepest and shortest intervertebral muscles, closest to the center of movement of each motor unit.
- From a StrongPosture perspective: this underlines the clinical value of retraining subtle, single arcs of coupled control, and its critical role in restoring LBP movement patterns.
- Muscle-Specific Differences: The study found that the extent of reduced FRP varied by muscle, with multifidus showing the greatest guarding behavior in LBP patients. This muscle-specific insight highlights the need for targeted interventions. The challenge is preventing well meaning patients from substituting more accustomed compensatory patterns of motion that feel “easier”.
- Heterogeneity in LBP: The researchers noted variability, with some LBP patients (outliers) showing coordination patterns similar to healthy individuals. This underscores that LBP is not a one-size-fits-all condition—individual motor control strategies vary, which aligns with clinical observations of diverse patient presentations.
These findings point to a core issue: altered movement patterns and muscle behavior in LBP reflect compensatory strategies that may protect in the short term but likely increase spinal load over time, especially in conjunction with episodic reinjury. This is where StrongPosture® comes in, offering a framework to retrain these patterns and empower your patients.
StrongPosture: A Biobehavioral Approach to LBP
StrongPosture is built on the idea that posture is more than just “standing up straight.” It’s a dynamic interplay of awareness, balance, and motor control that shapes how we move and load our bodies. For LBP patients, who often exhibit guarded movements (like those seen in the study), StrongPosture® provides a structured, interceptive approach to retrain the body and mind.
Here’s how it applies to your clinical practice:
1. Enhancing Postural Awareness
The Ippersiel study highlights that LBP patients move differently, with less synchronized hip and lumbar motion. In other words, poorly coupled patterns of whole body recruitment of kinetic chain musculature.
StrongPosture exercises focus on somatic awareness towards more accurate control of their body’s mass is space. We advocate teaching patients to consciously perceive, and then more accurately control their body’s zones of postural mass (aka their 4 PostureZones- the lower extremity, the pelvis, the torso and the head).
Initially, clinicians observe static erect stance bipedal stability and symmetry with an IPP (Interoceptive Posture Picture), and then challenging the ability to balance and maintain erect posture in single leg stance. Improvement with discrete and small but observable arcs of motion allow progression to dynamically challenging regional motion, and observing changes in whole body symmetry, by PostureZone, and then building to whole body ADL movement (Activities of Daily Living) and sports specific movement pattens.
2. Restoring Flexion-Relaxation through Motor Control
The reduced FRP in Ippersiel’s LBP patients suggests a protective strategy where muscles like the multifidus stay “on” to guard the spine. This can lead to fatigue and increased spinal stress over time.
With the StrongPosture® method, stabilizing compensating arcs of the kinetic chain becomes the target of MUST vs TRY cues which focus attention and control on single arcs initially, and progressing quickly to the core (which is why we focus on the Torso-Pelvis musculature early and often- beginning with the StrongPosture Pelvic Tilt). Combined with in-sync breathing, it’s a surprisingly easy and elegant way to address the out-of-phase coordination seen in the study.
The basic exercise removes Lower Extremity (PZ1) compensation by having the person lean against a wall to stabilize the postural base of support. This allows a subjective alignment of the Pelvis (PZ2) and Torso (PZ3 to objective vertical), the somatic perception of which is proprioceptive and cognitive, as well as interoceptive.
Maintaining tight stabilization of the lower body and head, then focusing to tilt the pelvis forward and then back, phased with inspiration on the lumbar spine arch, and expiration on flattening with a tuck defines the StrongPosture® Pelvic tilt. It’s an interoceptively aware motor control exercise that trains patients to relax muscles appropriately during movement, helping them regain the ability to “let go” at end-range flexion, reducing unnecessary muscle tension and promoting the natural FRP seen in healthy individuals.
3. Targeting Muscle-Specific Patterns within Whole Body Movement
The study’s finding that the multifidus showed the greatest FRP reduction in LBP patients is a game-changer. StrongPosture emphasizes this value for functional muscle retraining, particularly for deep stabilizers like the multifidus. After incorporating whole-body balance awareness during exam with an Interoceptive Posture Picture, incorporating StrongPosture Stork one-leg balance with core engagement engages the multifidus in a controlled, low-load environment, helping patients strengthen this muscle without triggering pain. By improving multifidus control, you can help patients shift from a guarded to a confident movement pattern.
4. PFF-RoC: Addressing Individual Variability
The heterogeneity in LBP movement patterns noted in the study aligns with what you see in practice: no two patients are the same. StrongPosture is adaptable, allowing you to tailor exercises to each patient’s unique motor control profile. We call this PFF-RoC- their Pain Free, Functional Range of Control. For those “outliers” with healthier coordination patterns, you might focus on maintenance and refinement, while for patients with more guarded movements, you can start with foundational awareness drills to build confidence and control.
Why StrongPosture Works for Clinicians
You don’t need to wade through academic journals to know that LBP is complex. The Ippersiel study confirms what you’ve likely observed: patients with LBP move differently, often in ways that protect but ultimately perpetuate their pain.
StrongPosture bridges the gap between science and practice by offering an interoceptive biobehavioral framework that’s easy to teach, patient-friendly, and adaptable to your existing protocols. It enhances other exercises—whether rehab, chiropractic adjustments, or physical therapy—by giving patients the tools to own their posture and movement.
By incorporating StrongPosture into your care, you’re not just treating symptoms; you’re empowering patients to retrain their bodies for better somatic function. This aligns with the study’s call for better understanding movement characteristics to guide treatment. Plus, it’s a low-cost, low-risk approach that boosts your professional credibility by delivering measurable improvements in patient outcomes.
Take the Next Step
Ready to bring StrongPosture into your practice? Start by assessing your LBP patients’ bending patterns.
- What moves first, and most?
- What stops first, and limits other movement?
- Where’s the compensation, and the pain?
Guarded movements and maintaining contraction at end-range can be indicate of functional compensation &/or structural adaptation.
Introduce StrongPosture basics, step-by-step with the BAM protocols, and observe how patients respond. Connect with the patient education concepts using the 5 Posture Principles to engage the patient, and empower them to inform others.
StrongPosture Training
Enroll in the Posture, Balance and Motor Control Exercise course and other programs at CEsoup.com, where you’ll find clinician-focused tools to integrate posture retraining into your practice.
Let’s help our LBP patients move better, feel better, and live better, standing tall, one step at a time.
Dr. Steven Weiniger, Posture Expert and Creator of StrongPosture®
