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Robin, Thank you for your interesting comments. You wrote: "Thus, muscle reeducation sequences should NOT be performed in isolated movements. Instead they should be incorporated immediately into functional, goal-oriented tasks". ***If you read my previous comment, the work on core stability does agree with this. It states that while it is good to perform these isolated movements, they are quite meaningless unless it becomes incorporated in functional tasks. Have a read of the paper in Manual Therapy 1995 Vol 1:pp2-10 by Jull and Richardson entitled "Muscle control - pain control? What exercises would you prescribe?" People such as O'Sullivan and Twomey also suggest incorporating the TrA/Multifidus work with functional activities. I am just curious as to where you and Mel found comments relating to activating these muscles in isolation ONLY - could you please publish your references because been a University of Queensland graduate, this was certainly not what I was taught (and certainly not what is stated in the available literature that I have read so far... but I could have missed something?). You stated the following research. "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." ***I would just like to quote the abstract from this study. "OBJECTIVE: To investigate the effects of abdominal muscle strengthening exercise on low back pain (LBP) risk reduction. METHODS: We compared the effects of abdominal muscle strength (AMS) exercise and back education with back education only on 402 asymptomatic subjects with weak AMS. The primary outcome was the percentage of subjects with at least one episode of LBP at 24 months. A diary was used to monitor compliance. RESULTS: There were no statistically significant differences between experimental (E) and control (C) subjects at 24 months for LBP episodes (E: 34.7%, C: 30.4%; C-E = 4.2%, P2 = 0.481; 95% CI -16.1%, 7.6%). The LBP episodes were also not statistically significantly different at 6 months (E: 13.2%, C: 16.1%; C-E: 2.9%, P2 = 0.493; 95% CI -5.3%, 11.0%) or at 12 months (E: 24.8%, C: 23.6%; C-E = -1.2%, P2 = 0.818; 95% CI -11.6%, 9.2%). Adjusting the data for strata and baseline AMS did not alter the findings. Imputed results for LBP episodes at 6 months (C-E: 4.8%, P2 = 0.191; 95% CI -2.4%, 12.0%), 12 months (C-E: -1.0%, P2 = 0.821; 95% CI -9.5%, 7.6%), and 24 months (C-E: -3.3%, P2 = 0.483; 95% CI -12.6%, 5.9%) were also not statistically significantly different. CONCLUSION: Back education and abdominal exercise instructions are similar to back education alone. There were no group differences in LBP episodes, possibly due to noncompliance with the exercise program. While the estimated benefit of 2.9% at 6 months from the complete data and 4.8% from the imputed data were not statistically significant, a larger study or future metaanalyses may be needed to confirm whether there is a clinical benefit or whether these results should be considered a chance finding." If you read the comments made by Jull and Hodges in J Rheumatol. 2000 Sep;27(9):2286-8. UI: 20443664 and the authors replies, you would find that this study alone does not show anything for or against core stability. Furthermore, abdominal muscle strengtening does not equal isolated isometric local muscle activation, and this was emphasized by Jull and Hodges. I think we have to be very careful when interpreting the results - even the authors do not make bold comments regarding core stability, and suggest that future studies may be needed (even suggest that noncompliance with exercise may be a problem in this study!!!). This reminds me of Cherkin's study that showed no difference between Mckenzie techniques, chiropractic manipulations and a educational book alone in the treatment of low back pain. So does this mean that we stop Mckenzie techniques and spinal manipulations, and simply give educational book on low back pain since financially, it seems more viable? Your final comment: "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." ***Core stability was developed in Australia and is still in its prime stages. The concept has definitely evolved over the last four years, and continues to change. Actually, O'Sullivan and Twomey have replicated these studies initially done by Jull, Hides et al. But does having studies done by the same people negate the power of these studies - it is not a valid argument. Are there any Physiotherapy concepts out there today that we can just shut up and accept? Of course not, and if there was, then it is not scientific :D I think at the end of the day, with the available research at the moment, we can continue to discuss this forever. I believe the questions asked by Mel and others are quite important, and it is up academics and clinicians to develop good studies to answer these questions... with the rate of journal articles per day, hopefully, we won't have to wait for too long! Henry*** _________________________________________________________________ Join the world’s largest e-mail service with MSN Hotmail. http://www.hotmail.com