The System you NEED to be Including in Every Spine Assessment
How consciously aware are you of your lumbar multifidi muscles right now? Can you isolate and “activate” these muscles that we’ve been told for so long are imperative for a healthy, pain-free back. If this were the case, back pain or any other spinal pain-related issue wouldn’t be such a common complaint. The reason we cannot truly isolate those particular muscles Is because a lot of the neural communication from the brain to the spine is REFLEXIVE, and not conscious. The tone or tension that’s held around our midline is heavily dictated by the visual and vestibular systems, and so we need to combine this with the great work many therapists are already doing to get the spinal joints moving better, in order to allow for robust movement in the real world. In the real world, you’re not consciously thinking about your spine, or at least you shouldn’t.
In a recent Instagram post, we spoke about the eyes being the fifth extremity. Our extremities allow us to interact with the environment and dissipate load through their long and tendinous musculoskeletal structures. To do this, they need to be able to dissociate from the midline, so the midline can allow for a REFLEXIVE platform to move from. At IKN, we want the visual system to express the same qualities. We want the eyes to be able to tolerate load in multiple vectors without the midline getting involved, and once we achieve that, we can integrate both. What we see clinically, in those with midline-related pain experiences, is that individuals do not like to move their eyes (without bringing their spine along for the ride). Their eyes cannot dissociate, but instead stay “stiff” you can say. For example, if you’re walking across a tightrope, what’s the one thing you want to do in order to keep your spine “stable?” Keep your eyes fixed on a target! This helps you in the moment, because if you were to move your eyes around, you may lose your balance (spinal adaptation).
But what if people used a similar strategy to maintain midline stability when walking & moving in real-world environments? It doesn’t allow us to dissociate the eyes from the spine. The neural communication from the eyes to the spine may not be of high quality to truly allow for that nice reflexive platform to move our limbs from. Remember, our eyes have muscles too that are LOADED with mechanoreceptors, so they need to move through their range of motion too. From an evolutionary standpoint, if we have a muscle that possesses a large amount of mechanoreceptors (nerve endings that tell the brain what’s happening), you can pretty much guarantee that those muscles were designed to MOVE!
So, if we’re using this visual strategy to help maintain midline stability, from an IKN perspective, it means our visual system & midline lacks the ability to tolerate load. It means our nervous systems doesn’t trust the information coming from the eyes and the spine. Of course, we would determine this with quick assessment strategies to identify the load tolerance of the spine through specific movement and hands-on strategies first. We would initially work towards allowing for better communication from the midline structures to the nervous system using specific movements, and layering this with coordinated breathing strategies. Once we are happy that the midline structures can tolerate load on their own, then we can move to the eyes. Assess the loading capacity of the visual system, specifically load the movement vectors that aren’t moving well, and then INTEGRATE with your midline/spinal rehab strategies. Our approach doesn’t try to establish any causal relationships between the eyes and someone’s pain, but we’re mostly concerned about enabling the subsystems that allow for robust movement to accept and tolerate load well. If we build a robust movement environment within the individual, then we can facilitate an environment where pain no longer holds any significant value.
The eyes will always have an influence on the spine, and this communication between the two can be seen in the attached paper. When the eyes move in a particular direction, there will be a REFLEXIVE increase in tone on one side of the body (particularly around the neck), and a reduction in tone on the opposite side. For example, if I move my eyes to the RIGHT, the muscles that would help me turn my head to the RIGHT will increase their tone, and the muscles that help me move to the LEFT will decrease in tone. This makes sense from a movement standpoint, because why would we want high levels of tone in all our muscles when we move? Having that REFLEXIVE change allows for efficient movement. BUT, for us at IKN, the issue arises when the eyes cannot dissociate, and when a lot of our movement becomes more CONSCIOUS. With poor load tolerance through eye movement, we may express increased tone around the neck and spine as a protective response. If we lose the ability to move our eyes in different directions, then it may make it more difficult for these reflexive connections to occur. If our movement becomes more conscious, then we lose variability. If we lose variability, we have fewer options to adapt. And with less adaptive movement, we may become less robust in our movement. It all comes back to building a more robust human and mover for us.
If you’re a fan of using gentle isometrics to help load and desensitize the cervical muscles, perhaps integrate specific eye positions. In many stubborn cases, poor eye muscle load tolerance and increase the workload of the cervical musculature. So, for example, if you’re trying to increase right cervical rotation, pair a right-sided gaze (focus on a target, but don’t strain too much), with a gentle isometric contraction into right rotation. Start in neutral, and slowly move further into rotation, shifting the gaze to another target each time. Allow the eyes to move further than the neck. Of course, a unique assessment is the most crucial element to determine what someone needs, but considering this connection can offer you more options to facilitate change.