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PHYSIO  December 2001

PHYSIO December 2001

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Subject:

Re: Core Stability?

From:

John Spencer <[log in to unmask]>

Reply-To:

- for physiotherapists in education and practice <[log in to unmask]>

Date:

Sun, 16 Dec 2001 20:32:20 +0000

Content-Type:

text/plain

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In message <[log in to unmask]>, [log in to unmask] writes
>[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.
>
John Replies: Well, this is my point really. I am curious as to which
research DOES assume that stability can be defined in isolation from a
whole kinetic and static chain of processes. You note that this is
occurring but I would still like to read quotes from researchers as I
have NEVER heard researchers say this. I think if you say that spinal
stability researchers have been saying this it should be easy to support
it with references.

Quite clearly it is a ridiculous thing to say which is why I am
sceptical as to whether any serious researcher has actually ever said
it. I still think it is unwise to say that researchers have been saying
this and thereby try and negate all the research in this area.

I applaud your efforts to examine motor control and spinal stability
from a broader view than "mere localised action" (I would contest the
use of the word 'mere' as it seems localised action is, in fact
enormously important in painful states - much more so that globalised
action).

However, quoting articles that show there are many potential reflex
responses to the centre of the body's mass reaching the stability limits
of the base of support is IRRELEVANT to the research on localised
stability of the lumbar spine. Instability in terms of someone falling
over is not the same as instability in terms of local instability WITHIN
the lumbar spine. To quote research in this area is not only irrelevant
it is misleading - where is the connection?

Can you please explain again how research in this areas rebuts the
research on local spinal stabilising mechanisms? No researcher in his
(or her) right mind would deny that the human body has such global
mechanisms for stability.

These mechanisms seem to be working perfectly well in people with low
back pain and dysfunction. The fact that the LOCAL stabilising system
CAN be shown to be dysfunctioning in these people and that
rehabilitation (using core stability) has been shown to be a very
successful strategy in reducing recurrence of low back pain (in a 1 year
and 3 year follow-up) seems to contradict your assumption that this
research is bogus or flawed.

Could you supply more details of the research by Dr McGill which you say
contradicts ideas about enhancing core performance?




>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.
>

John Replies: How does this contradict the Core Stability research which
acknowledges all that you have noted above and insists that Core
Stability is ALWAYS related to more general considerations of distant
actions and forces? Sorry, I don't understand your point.

><< 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.

John Replies: I don't understand how you can say that this research
"certainly did not offer an extensive study of a large number of
subjects whose back pain was the result of ......... spinal disability".
BY DEFINITION this research studied subjects with spinal disability. It
was disability in their spinal stabilising systems (passive and active)
that bought them pain and dysfunction in the first place.

In fact the research was not static either. If you read the research on
timing of Transversus Abdominus it was carried out looking at active
voluntary movements of the subjects and external perturbations.


> 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.

John Replies: Well, I think you are wrong on both counts. This idea that
LBP spontaneously resolves is a myth based on poor research. The recent
South Manchester Back Pain study looked at thousands of people on first
attendance at a GP clinic for low back pain to test GP assumptions that
most of them recovered spontaneously. At follow-up 12 months later 75%
of them had continuing problems (it is EXACTLY these ongoing, recurring
problems that core stability work is so effective at combating). I would
be interested to see good, prospective studies that show otherwise.

Secondly, the research at Brisbane University showed that treatment with
attention directed to TVA activity DID prove to be much more effective
that treatment without TVA activation - and longer lasting.

>
><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.
>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.

>" 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.

John Replies: If you saw a therapist actually carrying out rehab on a
patient you would note that all rehabilitation takes place in a more
global context. By definition rehabilitation means helping people back
to their normal daily activities, all rehab has that global context.
Don't be confused by articles which focus on the local stabilisers -
this is where the RESEARCH is focused but that doesn't mean that the
REHABILITATION ignores the broader picture.
>

--
John Spencer

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