Robin

I do think Henry makes some good points in his reply to your message.


In message <[log in to unmask]>, Robin
Shutt <[log in to unmask]> writes
>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!


### Have you read the core stability researchers saying that there work
is a 'quick fix' or 'instant cure'? My experience of this area is that
re-education of the dynamic stabilising system is one of the most
laborious, skilled and persistent training regimes you could ever ask a
patient to engage with and the researchers have never called it
'instant' or even 'quick'

>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".


### The irony here is that ALL the core stability research I have ever
read agrees with these sentiments exactly. Can I ask - have you read any
research or been on any clinical course that suggests core stability
work is carried out from isolation from functional activities and that
it can be effective if taught in such 'isolation'? Like Mel, you seem to
have been sorely mis-led if people have been telling you the rehab is
carried out in isolation from functional activities - can you supply any
references?

Like Henry, having studied with Gwen Jull, Julie Hides and Paul Hodges
(here in the UK) - they would decry any attempt to re-train TVA or MTF
in isolation. There goal is to incorporate conscious activation of these
muscles into functional activities as soon as possible. They even have a
'hierarchy' of functional activities to work through from static
functional activities like sitting to moving activities like walking to
highly skilled activities such as sports-related movement - all
functional.

Do you have any quotes from published articles of any type that suggest
TVA or MTF should be activated in isolation from functional activities?

I wonder whether there is some commonplace misunderstanding here,
perhaps promoted by fitness trainers and gurus but certainly not
initiated by the researchers and educators that I know of in this area.

>
> 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'.
>

### Again, I think there is confusion here. The 'core stability'
research has NOTHING to do with strengthening abdominal muscles.
Strengthening is a word I have not really heard used (in fact positively
avoided) by the educators I have encountered. The goal is to re-educate
motor control of the dysfunctional core stabilisers, together with
addressing dysfunctional global mobilising muscles in a progressive
manner.

To compare this subtle and skilled re-education of complex recruitment
patterns with a simple exercise regime to 'strengthen abdominals' and
negate the former research because the latter is ambiguous seems to be
falling into the same trap as Mel. You have to quote relevant research
if your criticisms are to be valid.

It is a bit like saying that McKenzie rehab doesn't work because a study
that gave people "push-ups to strengthen their back muscles" was showed
no effectiveness in treating back pain.


>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.



### Perhaps you should read the book that has been produced by the major
researchers in this area which is filled with hundreds of relevant
research articles (mentioned by Jason).

Richardson C, Jull G, Hodges P, Hides J.  Therapeutic Exercise for
Spinal Segmental Stabilization in Low Back Pain: Scientific Basis
and Clinical Approach.  Churchill Livingstone, New York.  1999

The work carried out in Brisbane is not carried out in isolation but
rest upon the foundations of respected researchers who have done work in
this area over decades (such as Panjabi). Admittedly many of the
concepts are relatively new (so there will be relatively few researchers
devoting time to replicating the research).

I don't understand why you feel the concept of core stability "is only
discussed as a good medium for academic discourse" when the research
shows that it appears to be so effective in preventing recurrence of low
back pain ie a practical tool for rehab. I would be interested in seeing
any research which indicates PNF being effective in reducing recurrence
to any degree at all.


>


--
John Spencer