Dear Barrett,
I think I'm in a position to say that McKenzie contradicts himself here. A
rather important point in his book is avoiding loaded flexion during the
first hour or so after rising, because of nocturnal imbibition of the disc,
which makes it more susceptible to (kyphotic) loading. Logic dictates that
if one still has to lift something in the early hours, one would better do
it squatting, with a hollow back (like the weight lifters).
As a matter of fact, McKenzie also makes a clear point about *always* using
this technique when something heavy has to be lifted.
What else can we call this but... stabilization?
If he actually wanted to say that stabilization alone will be less curative
in case of a derangement, compared to his rearranging exercises plus
stabilization, I can agree with him.
Henry: you asked about proper sitting posture. Basically, it would be with a
*supported* lumbar lordosis (using lumbar rolls if necessary, for some
seats/chairs/couches), fully agreeing with McKenzie (and many others, for
that matter). See his book for the details (R. McKenzie, The Lumbar Spine,
Mechanical Diagnosis and Therapy, Spinal Publications, Waikanae, New
Zealand.) For scientific foundation of the importance of this way of
sitting, see the in his book included reference list, and my message of the
27th of July.
One thing one should be aware of though, with the increasing age of the
average patient: some elderly pts. can have osteophytical stenosis, which
will then show an opposite effect to sitting lordotic. How to diagnose such
a stenosis is not 100% proven yet, but it looks as if it is quite certainly
characterised by a negative Slump/SLR, negative cough/sneeze/strain/Valsalva
manoeuvre/Naffziger manoeuvre, and a history of not being able to walk long
distances with sitting down abolishing the radiating pain in a matter of
seconds (the neurogenic claudication history). McKenzie's assessment of
repeated movements is also very valuable to diagnose this, if you ask me.
R.,
Frank
----- Original Message -----
From: "Barrett Dorko" <[log in to unmask]>
To: <[log in to unmask]>
Sent: dinsdag 7 augustus 2001 21:06
Subject: Core stability questions
In an interview recently published in "Worldwide Spine" Vol. 1 Issue 1,
Robin McKenzie, perhaps the world's best known physical therapist involved
in the management of spinal pain, was asked: "Do you believe strengthening
should play a role in treatment of the spine? and What do you think of
stabilization exercises?"
McKenzie answered: "My philosophy is to rid patients of pain, recover
function and return the patients to normal activity. They will regain their
strength in due course. However, there may be cases where specific
strengthening exercises may be necessary. I believe the concept of
stabilization exercises is noble but futile. Activity on this planet is
spontaneous and I doubt very much that many patients in pain stop,
stabilize, and then carry out the required activity."
The concept of "core stability" is often evoked as essential for spinal
health, optimal functioning, prevention of pain and disability and even
reduction of pain, yet for many it remains a confusing and nebulous notion.
An entire industry has risen around its production and maintenance,
primarily for backache, but (if I'm interpreting him fairly) McKenzie
himself does not see it as an essential aspect of conservative spinal care.
Any comments?
Barrett L. Dorko, P.T.<http://barrettdorko.com>
Barrett L. Dorko, P.T.
"The Clinician's Manual" <http://barrettdorko.com>
Also at <http://rehabedge.com>
And <http://prorehabonline.com>
And <http://physicaltherapist.com>
And <http://rehabmax.com>
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