I like to classify patients with motor control impairments into two basic types:
- Tight Control
- Loose Control
Tight Control: Too Much Stiffness, Not Enough Freedom
Patients with tight control tend to have minimal curve reversal when flexing or extending their spine. Their erector spinae muscles might be visibly contracting even when they’re just standing there, supposedly “relaxed”.
These patients need to do one thing: RELAX—which, of course, is easier said than done when they’ve been living in fear of movement for months or even years. Many of them are diligently doing core exercises, unknowingly making themselves even stiffer in the process.
For tight controllers, the focus should be on pain education—not dismissive reassurance, but validating assurance. They often need to take a break from core strengthening exercises, which may only be reinforcing their muscle tension. Adding to that tension is their frustration: “I’ve been working so hard to strengthen my core… why am I still in pain?”
Here’s something that usually blows their minds: I actually encourage slouched sitting. Yep, you heard that right—slouched. Most of these patients have been told their entire lives that perfect posture is everything and that slouching is a sin. But for tight controllers, letting go of rigid posture and learning to move with ease is a game-changer.
These patients don’t need more abdominal or erector spinae strengthening. What they truly need is graded exposure to functional activities—the very movements they’ve been avoiding for months or years due to fear.
Loose Control: Finding Strength in Movement
On the other end of the spectrum, we have loose controllers—patients with full spinal mobility and often lower muscle tone in their abdominal and lumbar muscles. Many of them lead sedentary lives and are afraid that the wrong movement will “damage” their spine.
For these patients, I emphasize graded spinal loading through bending, lifting, and twisting—yes, the very movements they’ve been warned about by other healthcare providers and countless YouTube videos.
One of my favorite exercises to build spinal confidence and strength is what I call “the lawnmower.” This movement helps people become stronger, more resilient, and less afraid of everyday tasks that naturally involve bending, lifting, and twisting.
The Lawnmower Exercise
This movement mimics a PNF (Proprioceptive Neuromuscular Facilitation) pattern, engaging the entire body by pulling a load up while rotating away.
- Start with a light load.
- As confidence increases and symptoms decrease, gradually increase the load.
- Perform the m
- ovement on both sides for balanced strengthening.
Since most people don’t have a weighted pulley system at home, a resistance band (with a knot at the end placed under a closed door) works just as well.
Whether someone has tight control and needs to loosen up, or loose control and needs to build strength, the goal is the same: help them move with confidence, without fear.