Blog

Is your low back pain caused by synergistic dominance?

 

Synergistic Dominance is the neuromuscular phenomenon that occurs when synergistic muscles take over the function of a weak or inhibited prime mover (The muscle considered primarily responsible for generating a specific movement).

Prime movers are designed to move a joint in a particular direction. These muscles require synergistic muscles to help control the movement.

A synergist muscle is a muscle which works in concert with other muscles to generate movement or provide stability.

Synergists  can work with the agonists (prime movers) or the antagonist muscles, which move in the opposite direction.

Synergistic muscles stabilize muscle movements and help to provide movement efficiency.

Example of how the muscles work with Hip Extension

Agonists (Prime movers)– Gluteus maximus and posterior fibers of the gluteus medius

Antagonists– Psoas, Iliacus, Rectus Femoris, TFL and Sartorius

Synergists- Hamstrings and Superficial Erector Spinae (back muscles)

Stabilizers (The core)- Transverse Abdominus, Internal Oblique, Multifidus and Deep Erector Spinae

 

How do muscles become synergistically dominant?

Acute injuries or chronic malalignments (i.e poor posture, repetitive strain, joint dysfunction and myofascial adhesions) can lead to altered muscle recruitment patterns (compensations) and altered reciprocal inhibition.

Altered reciprocal inhibition occurs when an over active agonist causes a dysfunctional reduction in the nerve transmission to its functional antagonist, resulting in synergistic dominance and fault movement patterns.

Example of dysfunctional hip extension and synergistic dominance

Tight hip flexors (Psoas/TFL/Rectus/Sartorius) decrease neural drive and optimal recruitment/force production of the primary hip extensor (gluteus maximus). This altered recruitment and force production of the gluteus maximus leads to compensatory movement substitution by the hamstrings and erector spinae. This can result in low back pain, hip pain and/or hamstring strains.

Is your low back pain caused by synergistic dominance?

Unfortunately, It’s not uncommon for a healthcare practitioner to focus treatment on the compensatory synergistic dominance pattern (pain generator) rather than the underlying cause (pain originator).

Your tight superficial back muscles and hamstrings may be tight for a reason, i.e. they are trying to provide stability. Therapy or measures designed to decrease this tension can destabilize the pelvis and low back, resulting in injury or tissue and joint damage.

Differentiating the cause from the compensation can be done through a systematic process that includes:

  1. A history of the pain, along with a past medical history (e.g. surgeries, past accidents and injuries)
  2. Static postural exam
  3. Movement screen
  4. Range of motion and muscle testing based on the movement screen
  5. Palpation for trigger points and joint dysfunction based on  range of motion and muscle testing

This protocol identifies:

  1. Overactive muscles that need to be inhibited and lengthened
  2. Underactive muscles that need to be strengthened
  3. Joints that need to be mobilized
  4. Where to focus corrective exercises

If your low back pain is caused by synergistic dominance, then a treatment could include:

  • Inhibiting and Lengthening of the Hip Flexor Complex, e.g. dry needling, myofascial release and stretching
  • Isolated Strengthening of the Gluteus Maximus and Intrinsic Core Stabilizers  Isometrics and corrective exercises
  • Integrated Dynamic Corrective Exercises, e.g. Squat to row

 

 

 

 

 

Key Take Home:

Managing low back or other pain should involve identifying and differentiating the pain generator from the pain originator and treating the cause vs the symptom.

About the Author

Dr. Geoff LecovinNaturopathic Physician/Chiropractor/Acupuncturist/Certified Strength and Conditioning Specialist/Corrective Exercise Specialist/Performance Enhancement Specialist/Certified Sports Nutritionist/View all posts by Dr. Geoff Lecovin

kk