In message <[log in to unmask]>, [log in to unmask] writes
>On 10/5/00, Tonio Agius<[log in to unmask]> writes:

>***Has anyone successfully applied these methods to train those whose task it
>is to lift the heaviest possible loads in sport, namely weightlifters and
>powerlifters? Some folk have suggested that experienced lifters do not
>need that sort of training because they must have acquired optimal patterns
>of recruiting TA and other trunk muscles via all their usual training. If
>that is true, that supports my original remarks that all those isolation
>techniques for spinal stabilisation may be redundant if one simply learns the
>correct way of lifting.
>
>Since "the body knows only of movement, not muscles", the acquisition of
>efficient lifting skills in weightlifting seems to achieve quite naturally
>what all of those tedious TA , multifidus, muscle X regimes try to achieve
>over a longer period. Is this contention correct or is there some
>compelling evidence which shows that the muscle isolation approaches offer a
>superior form of stabilising the trunk and reducing the incidence of lumbar
>pain and disability?
>
>Dr Mel C Siff
>Denver, USA
>http://www.egroups.com/group/supertraining

Dear Mel

I think another contributor to this debate (Glenn) hit the nail on the
head when he noted that there are two debates going on here (1) is there
any point in teaching T/A 'core stability' to a non-low back pain
community and (2) do T/A 'core' stability exercises reduce pain or
recurrence of pain in a community with low back pain ?

We have discussed this before on the list and I feel that your
experiences are largely borne out of the health and fitness world where
T/A exercise are being taught prophylactically, to prevent back pain in
a community that don't have a problem. Here, I think the evidence for
efficacy is ambivalent and any prospective study would have to be on a
long-term and of a substantial size.

But in the low back pain community there is evidence that T/A or
Multifidus training does reduce recurrence rates quite dramatically. The
evidence for this is primarily published in the journal SPINE by Jull,
Richardson, Hides and Hodges over the recent five years. The research is
best summarised in their book on lumbar stabilisation programmes the
name of which I cannot relate as I lent my copy to a colleague and
haven't seen it since. (Amazon.com will have it no doubt)

To summarise briefly. In a low back pain population they have
demonstrated through ultrasonography a reduced cross-sectional area in
multifidus in people with low back pain on the side of pain and at the
vertebral level of dysfunction as assessed by a therapists through
palpation. (Both the therapist and ultrasonographer were 'blinded' as to
each others findings and the ultrasonographer was 'blinded' as to
whether she was testing an individual from the LBP population or a non-
LBP sufferer). The Ultrasonographer's ability to judge cross-sectional
area was confirmed by a number of correlation with cross-sectional MRI
scans of the multifidii.

This loss of cross-sectional area was seen to remain unaffected (ie it
remained) in a population where we no specific training of multifidus
was undertaken for 12 months. In a parallel group which received
multifidus and T/A stabilisation exercises the multifidus recovered
normal cross-sectional area in the trial period (which I believe was a
10 week period). This recovery, as is noted later, was associated
strongly with a considerable reduction in recurrence of low back pain.

As for T/A the research has indicated that in a LBP population the
muscle has a significant delay in firing when perturbed under low loads
when compared to a non-LBP population. Again, a rehabilitation programme
has demonstrated a return to normal firing patterns of this muscle over
a ten-week training period.

As to outcomes such rehabilitation programmes have demonstrated a
reduction in recurrence rates in LBP sufferer from a 60-80% recurrence
rate over a 12 month period in the untreated group (or conventionally
treated group) to a 30% recurrence rate in the treated group over 12
months. The 3 year follow-up is due to be published shortly and shows
similar patterns (personal comment).

You may be a little confused if you see this rehab programme as being an
'isolationist' approach in that although the muscle is initially
isolated (in as much as it can be), its activity is quickly bought in to
functional situations, first static (eg sitting) and then dynamic (ie
walking) and then specialised skilled areas (ie sports).

I think some of the confusion in this debate is caused by people
continuing to talk about 'strengthening' these muscle when the authors
in this area don't use that term at all, in fact they are explicitly
averse to it. They see T/A or Multifidus as a recruitment dysfunction in
that the fine wire EMG studies show a considerable DELAY in recruitment
of this muscle in situations of unexpected or expected perturbation.
There is some evidence that attempts to STRENGTHEN this muscle (ie use
high loads rather than low load) make the delay in activation WORSE.

Interestingly, these studies don't look at the muscle function under the
loads that weightlifters use but rather under low load perturbation (eg
the movement of a single limb). The importance of this is that so many
of the acute LBP patients we see suffer their injury under these light
loads. They may have been playing rugby the week before with no problems
then they go to brush their teeth one morning and their backs 'go'. So
it is relevant that the research looks at this low-load perturbation
problem.

Dynamic stability training programmes stress the probability that
correct posture (eg the correct lifting technique you refer to) may in
itself be a vital part in initiating correct recruitment of the deep
stabilisers. So you may have a point that correct lifting in these
sports reduces injury through optimal recruitment of muscles. However,
it is a long jump of logic to suggest that teaching correct lifting
technique alone will help correct the dysfunctions we see as therapists
when so many injuries occur outside of this context (eg tying a
shoelace, getting out of the car, turning over in bed). I would think
that the principle of specific training for specific function would run
counter-intuitively to your suggestion of teaching correct lifting
technique for these patients.

So to answer your question:
> Is this contention correct or is there some
>compelling evidence which shows that the muscle isolation approaches offer a
>superior form of stabilising the trunk and reducing the incidence of lumbar
>pain and disability?

I would have to say that yes, the evidence is out there and ask in
return:
"is there some compelling evidence which shows that teaching of correct
lifting technique based on that developed by weightlifters and
powerlifters offers a superior form of stabilising the trunk and
reducing the incidence of lumbar pain and disability in a (non-weight
lifting) population?
--
John Spencer (MCSP)


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