Core Cognition Walking: Recalling the Moment of Automatic Postural Control During Everyday Walking — A Hypothesis for Chronic Low Back Pain

Dae-Young Lee,1,2 Si-Young Park21Department of Orthopaedic Surgery, Saegil Hospital, Seoul, Republic of Korea; 2Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of KoreaCorrespondence: Dae-Young Lee, Department of Orthopaedic Surgery, Saegil Hospital, 59 Yeongjung-ro, Yeongdeungpo-gu, Seoul, 07251, Republic of Korea, Tel +82-2-1522-0075, Email saegil2015@gmail.comBackground: In chronic low back pain (CLBP), the anticipatory postural adjustment (APA) of transversus abdominis that precedes limb movement is delayed, and this impairment tends to persist after pain relief and after surgical decompression. Cognitive Functional Therapy addresses beliefs, motor control exercise trains voluntary deep-muscle activation, and the Alexander technique re-educates habitual postural responses in everyday activity. None specifies a procedure by which a patient recognizes the moment in which trunk control occurs and subsequently recalls it against a single defined target.Objective: We describe a maneuver observed in clinical practice and state a testable hypothesis.Observation: When a patient flexes and extends the arm slowly while walking, keeping speed and effort uniform, the lower abdomen activates without any instruction to brace, and foot landing softens. When uniformity breaks, the response is not observed. The observation arose during clinical practice between March and June 2026; no structured data were collected, and neither response rates nor effect sizes are reported.Hypothesis: We interpret the maneuver not as teaching gait anew but as making momentarily accessible a control that a diminished APA had concealed, and as allowing the patient to recall that moment. This interpretation is a hypothesis and not an established mechanism. The object of recognition is the quiet stability of the lower abdomen; the arm movement is the procedure that elicits it.Testing: We propose a 12-week randomized trial with the Oswestry Disability Index and pain as primary outcomes, using a 2× 2 control structure that separates uniform arm movement from sensory attention. Immediate response is measured before allocation and pre-specified as a treatment-effect moderator rather than used as an eligibility criterion. Foot-landing loading rate, APA timing, and lumbar proprioceptive accuracy are exploratory measures.Conclusion: Core Cognition Walking is offered as a falsifiable hypothesis that warrants testing.Keywords: chronic low back pain, anticipatory postural adjustment, gait, rehabilitation, sensory attention, Oswestry disability index