Mel wrote:
"In other
words, what happens to TVA is merely of academic and laboratory interest and
cannot be assessed clinically, so regimes to rectify presumed problems are
outside the scope of the practitioner's world."
***Mel has mentioned an important point, and I think this is the problem not
just on TVA research, but on most conceptual studies done in Physiotherapy.
What is presumed as academic research may not carry over to the clinical
field, and there has traditionally been this gap in evidence based
Physiotherapy. Nevertheless, I do not understand why the pessimism towards
TVA and multifidus when we can accept the effects of joint mobilisations,
joint manipuplation, exercise therapy (most of which are still based on
anectodal evidence rather than solid RCT's). As I said before, only the test
of time will tell whether TVA/Multifidus is just another fad like the
faradic foot bath and microwave, or some concept worth grasping. From the
clinical studies that have been done so far, it sure does look promising.
Henry***
ps - Mel, I like John are concerned that we are not on the same wave length.
Have you read those paper and studies done by Jull, Hides, Richardson and
Hodges, or are there other papers that I am not aware of on this topic? You
do realize that the studies that have been done by Jull and Hides have
involved using needle U/S to view the TVA and multifidus both in a
laboratory setting (university of queensland) and in a clinical setting
(Mater Hospital)? This is usually done in a static position and the
contractions are isometric, and clinically, they have shown the correlation
between a increase in control of the muscle control and a reduction in back
pain. If only there were some sort of tool to view this muscle during
dynamic movements (such as weight lifting as you suggested)... hopefully,
this will be possible in the not near future.
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