I'm going to jump in here with an analogy. The rationale for core
stabilization is that multifidi are inhibited by injury to the spine,
presumably to the nerve roots. Then, the segmental weakness prolongs the
healing process.
My analogy is a shoulder post-stroke. (I am working with such a person now
for whom this description is true.) Shoulder elevation, a normal, functional
movement, is painful. External rotation, not a movement which is usually
isolated, causes the joint to approximate in a more normal position, and my
patient can then raise his shoulder without pain. During the first
treatment, the painfree result was of short duration. Now, a few weeks
later, the positive effect lasts a few days. I hope for complete recovery
eventually.
Could not the insult to the local multifidus be resolved in much the same
manner, with a course of core stabilization exercises?
Sarah Fern Striffler, PT
----- Original Message -----
From: Robin Shutt <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, December 17, 2001 6:58 AM
Subject: Re: Core Stability?
> As an interested 'lurker' on this and 'supertraining' mailbases and as a
> lecturer in physiotherapy, I feel I must add comment to this discussion.
>
> I am constantly advocating my students to review all 'instant cures' and
> quick fixes utilising what should be common physiological and
biomechanical
> knowledge, supported by recent academic publications. Thus I have been
> questioned many times on the principle of 'the body knows not of muscle -
> only movements' - and how this fits with 'core stability' exercises. well
to
> me it doesn't!
> I will quote from one of many references with regard to this:
>
> Mulder T, Hulstyn W: 'Sensory feedback therapy and theoretical knowledge
of
> motor control and learning'. Am J Phys Med 63:226-244, 1984.
> "Normal movement does not consist of isolated actions that are cortically
> controlled. rather it is a sequence of synergic movement patterns that are
> functionally related. Besides initiating muscle activation, which produces
> the movement, synergies also serve to maintain equilibrium. Therefore,
> another goal of treatment may be to improve dynamic postural and movement
> synergies available, decreasing the tendency for excessive and prolonged
> recruitment of muscle activity to stabilise posture during movement. Thus,
> muscle reeducation sequences should NOT be performed in isolated
movements.
> Instead they should be incorporated immediately into functional,
> goal-oriented tasks".
>
> whilst I am aware that this may be somewhat old now, it is quoted as it
> covers many of the aspects discussed so far, such as equilibrium and
> balance - as well as the so called 'isolation'.
>
> More up to date research also questions the rehabilitation benefits of
> antagonistic GROUP actions, let alone the so called ability to isolate in
> functional activity.
>
> Helewa A, Goldsmith CH, Lee P, Smythe HA, Forwell L. "Does strengthening
the
> abdominal muscles prevent low back pain - a randomised controlled trial" J
> Rheumatol 1999;Aug26 (8) 1808-15
> Without quoting the whole study, the results showed no difference between
> back ex's only and abdominal ex's and back ex's'. this was @ 3mnths,
6mnths,
> 12 mnths and 24 mnths. It would appear that the 'functional ex's' taught
to
> and by the students incorporate sufficient rehabilitatory affects - even
if
> they are 'exercises that incorporate the L-spine to the ankle from the
> get-go'.
>
> I might also add that the advocates of 'core stability' that are quoted in
> references, almost always appear to be the same people - no one else
appears
> to be replicating this? So In conclusion the whole concept of 'isolation',
> 'core stability' et al' is only discussed as a good medium for academic
> discourse, and contrasted with the physiological and biomechanical support
> for such as PNF.
>
> Robin Shutt
> Lecturer in Physiotherapy.
>
> -----Original Message-----
> From: - for physiotherapists in education and practice
> [mailto:[log in to unmask]]On Behalf Of [log in to unmask]
> Sent: 16 December 2001 19:15
> To: [log in to unmask]
> Subject: Core Stability?
>
>
> [log in to unmask] writes:
>
> <I have to agree with Jason that you have misunderstood the relevance of
the
> research in dynamic lumbar spine stability work."Compensatory stepping
> response" and "Change of support response" are not really that relevant to
> 'core stability' research so to quote them in an attempt to negate to
'core
> stability' concept seems unwise.>
>
> *** I have not misunderstood that research, but have tried to reconcile
it
> with other work which has examined motor control and spinal stability from
a
> broader point of view than mere localised action. Even though
> intersegmental
> stability has been studied, the only studies that I have seen which
isolate
> the vertebrae from connection with adjacent parts of the body are those
> which
> have been done on cadavers or spinal preparations (such as those subjected
> to
> Instrom tests that we did in our engineering lab) and these really do not
> show that stability can be defined in isolation from their role as part of
a
> whole kinetic and static chain of processes, especially the pelvis and
> distal
> muscles that attach to it.
>
> If you read the reference to that Zajac article (Zajac & Gordon
Determining
> muscle's force and action in multi-articular movement 'Exer Sport Sci
Revs'
> 1989, 17: 187-230) that I cited previously, you will note that action that
> is
> distant from a given joint (such as the vertebrae) and which can involve
> muscles which do not cross the joints concerned in real daily activities
can
> exert torque or produce accelerations across the joints in question. Many
> other articles in biomechanics and functional anatomy are now questioning
> the
> understanding of movement, motor action and pathology on the more
> traditional basis of local action. It is equally unwise to ignore such
> findings.
>
> << Muscles such as Transversus Abdominus are positioned well to act as
> stabilisers of the lumbar spine and research by Paul Hodges (published
again
> in SPINE - I will get you the exact references) show that the
> majority of people with low back pain (that they tested) had a timing
> dysfunction in Transversus which when corrected had a dramatic effect of
> reduction in recurrence rates of low back pain (the holy grail of LBP
> treatment). >>
>
> ***While this research was carried out under static laboratory style
> conditions, there has, been to my knowledge, been no research that has
> examined Transversus Abdominis involvement during complex, dynamic or
> ballistic daily and sporting actions. In referring to the "majority" of
> people with low back pain, this research certainly did not offer an
> extensive
> study of a large number of subjects whose back pain was the result of
> sporting events or spinal disability. Several studies have shown that the
> majority of cases of non-traumatic back pain eventually resolve themselves
> with no treatment at all and that no single form of physio, chiropractic
or
> occupational therapy has been shown to be superior to another, whether or
> not
> attention was paid to TVA activity.
>
> <It seems here that you are quoting people saying ridiculous things and
> then,
> by criticising what they have said, hope to negate the whole area of
> research. If there are people out there saying that stabilisation takes
> place
> "in the absence of attachment or influence from adjacent or more distal
> structures" please give a reference for such statements, I would love to
see
> them.>
>
> ***Note that what you quoted below placed a definite emphasis on local,
more
> isolated processes, rather than more global strategies (unless, you are
> assuming that the "core stabilising muscles" include muscles that are not
> located in the "core" of the body). Such comments, including those about
> isolated attention being paid to TVA, iliopsoas, etc, are very common, as
> your own remark shows. Certainly, there is a role to attend to more local
> processes, mainly in cases of pathology, but far too often the more global
> picture is vaguely assumed or ignored.
>
> " Pathologies such as spondylolisthesis which involve local dynamic
> instabilities in the lumbar spine have been shown to be very treatable by
> training of the core stabilising muscles."
>
> Numerous articles (just carry out any Medline or metasearch engine search
> for many references) refer to the core muscles as being the most
fundamental
> to core stability and ignore mention of the central role played by more
> distal and peripheral contacts and events. Conference presenters are
> especially prone to make such remarks.
>
> Dr Mel C Siff
> Denver, USA
> http://groups.yahoo.com/group/Supertraining/
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