Dear Scott
The main reason for shaking off the shackles of single school guru led
physiotherapy (which you clearly have), is that it opens your mind to other
treatment possibliities.
In severe and complex cases, I rarely find one treatment approach solves the
problem. This chap may need a cocktail of reasoning, from exercise, manual
and pain therapy, tailored made for his syndrome. Or more commonly one
approach takes us so far, eg a percentage better and then they plateau. It
is at this point we must either adopt a different approach in rationale or
technique or concede defeat.
The exercise regime you have given him has clearly served him well, however
perhaps it is time to rty something new. The patient also clearly has a
responsibility of their own and if he is not complient with your advice,
this may be the reason for his slight worsening.
Another possibility exists, and this is true of us all so don't take it
personally. His improvement may not have been due to the initial treatment,
but the passage of time placebo etc.
My final point is that the efficacy of a treatment does not validate or
underpin the rationale behind it completely. It is just a good indicator.
Perhaps Sood may give us an update on his recent patient request and this
may well give us some insight into either medical problems mimicing
musculoskeletal, or the lack of MRI result releability; a similar case in
hand.
Good luck and remember not to beat yourself with a stick. Don't look at the
10% lost, rather the 90 % gained.
Warm Regards Kevin Reese PT UK
----- Original Message -----
From: Scott Epsley <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, January 05, 2001 11:42 PM
Subject: Re: Correct Muscle Action?
> Along the lines of previous discussions on this list of Transversus etc. I
have an observation to put to Mel and the list for comment.
>
> As I have said, I was trained at the University of Queensland where much
of the TA research has been based, thus it was hammered into me how
important it is. As I also have said I do not believe it to be the "guru"
concept it has been suggested it is.
>
> Last year I had a patient who presented with severe back pain, radiating
into both legs, almost nil lumbar flexion, two centralised disc bulges etc.
>
> I spent about six months all up supervising a rehab program consisting of
gluts, abdominals, erector spinae, and supposed transversus exercises
without being paranoid about the isolation component of these exercises -
thus they were more generalised abdominal exercises.
>
> He attained a significant level of relief, could walk for 40 minutes, had
very little leg pain, but was still in discomfort with certain activites
such as sitting, standing and high levels of physical activity. I suggested
he continue his exercise program and join a gym to continue an overall
fitness and strengthening program.
>
> I saw him at the movies last night, and he is still at the same level as
when I last consulted him, though he did not take my advice about the gym
program. He has been to a back clinic set up here in Brisbane which
ultrasounds transversus and shows its activation/isolation during isolated
contraction. Apparently he is in the worst 10%.
>
> I would have thought that generalised exercise would have improved the
recruitment of TA - therefore why is he supposedly in the worst 10%?
Secondly, does actively isolating a muscle necessarily mean that you use it
during movement etc and vice versa, does inability to isolate and contract
it mean that you don't recruit it during movement? Does Mel or the likes
have references supporting this?
>
> Any comments would be welcome.
> ---
> Scott Epsley
> PHYSIOTHERAPIST
> Northside Sports Injury Centre
> Brisbane, Australia.
>
> e-mail: [log in to unmask]
>
>
>
>
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