Thanks Jason
I will try and be patient.
My frustration is that some list members seem to
pay great lip service to high-quality evidence in terms of well-controlled
research - except when it contradicts their own belief systems.
In response to accusations of Dynamic Stability
being 'basically flawed' and "a fashionable fad" I have provided
considerable lists of high quality research ('extraordinary evidence' to use
Mels's phrase), performed by whole departments of well-qualified academics with
Doctorates and post-graduate degrees, research that has been published in some
of the most heavily peer-reviewed journal in the world (eg 'Spine'), research
that has won awards from professional bodies that specialise in this area,
research that has been funded by some of the most pedantic funding bodies in the
world (eg The European Space Agency), research that has been repeated by
academics around the world, supporting the initial researchers conclusions.
In return I have received NOT A SINGLE REFERENCE
(ie a reference with author's names, title of article, Journal name, volume
number and page numbers) that contradicts this research. Nor has the list seen
even a single attempt to intelligently criticise the basic premise of Dynamic
Stability and I must be honest in saying that some contributors are betraying a
profound ignorance of the actual research - when I ask (as I have done on
several occasions) for an explanation of why they see a flaw in the basic
premise it all goes very quiet.
I would be so delighted if some of the
academics on this list that disagree with my conclusions would quote this
research directly and criticise it with an acute eye for contradictions. I would
be happy if they would just supply me with references for a few articles that
counter these researcher's conclusions. Unfortunately the response seems to be
one of "I disagree with their basic premise" - or "I have tried this
techniques and it doesn't work for me and other colleagues have reported
difficulties with it - so the reseach must be flawed", or "I'll believe it when
I see the evidence" - or "I have other techniques that work better" -
So far we have had (some months ago now) articles
quoted that related to people being unstable on their feet - (the person who
referred these articles to the list thought that Dynamic Instability was about
people being unable to stay upright) and lots of anectdotal stories. Frank has
been good enough to refer to articles that he says contradict my contentions but
unfortunately we have to pay to read them - (but at least he referred to
research). Apart from that - nothing of substance. I am totally sympathetic to
practitioners writing in like Emilie who find outcomes are dissapointing (though
she admits to the convincing outcomes that other seem to have had). My
frustration is with academics who are unable to use basic principles of
academia to counter an argument.
I have news for this list - the techniques that
physiotherapy have used for the last 100 years ARE FAILING TO DEAL WITH THE
EPIDEMIC OF LOW BACK PAIN.
I suggest you read books such as that by Gordon
Waddell "The Back Pain Revolution" (an ex-surgeon who, distressed by the
ineffectiveness of surgery to stem the back-pain tide looked at the epidemiology
of LBP). His assessment (based on researched evidence not the self-important
claims of so many of us therapists) shows that we are failing our patients
profoundly in this area. There is no evidence that our techniques have anything
but short-term effects - we fail to deal with recurrent or persistent back pain
- if you have an 'altenative' method you use that reduces long-term recurrence
in LBP lets hear about it - and lets read the evidence!
Anectdotal evidence that your techniques for
persistent LBP 'really work' just DONT CUT THE MUSTARD. Vague assertions that
you "really don't agree with these dynamic stability ideas" are unimpressive and
unconvincing in the face of (I believe) overwhelming evidence that Dynamic
Stability techniques work - in the hands of competent, skilled
practitioners.
If, as some of you say, you don't believe that
there is any association between LBP and Trb or MTf dysfunction - FINE!
But PLEASE come up with some explanation as to why the published research
has shown strong associations between first-onset back pain and loss of
x-sectional area of Multifidus. Explain why, in a population with LBP TrAb has
such MEASURABLE significant changes in Timing and Quality of contraction. Offer
an alternative explanation as to how 'blinded' practitioners using a pressure
biofeedback unit were able to clearly distinguish between people with a history
of LBP and people who had no such history (despite the fact they had no other
evidence for these individual's LBP history other than their ability or
inability to perform a TrAb contraction).
What I am trying to say to the academics on this
list is fight evidence with evidence, not with personal predjudices and
anectdotal stories.
My feeling Jason is this. I think that some
people's first experience of Dynamic Stability work has been via the health and
fitness industry where silly claims, unsupported by research are being made and
(as Mel rightly says) it is being made into a money making 'fad'. However,
having bought that prejudice to the list I think that it has now been
effectively challenged by plenty of extraordinary evidence that some people have
been previously unaware of - and they are finding it hard to digest this
evidence that contradicts their previously held assumptions. This is what Mel
has previously referred to as 'congnitive dissonance' - the contradication
between what somebody believes to be true (an emotional attachment to a truth)
and what the evidence suggests is true (an intellectual, more 'objective'
truth). I think we are seeing some exapmles of cognitive dissonance on the list
(people find having their emotional 'truths' questioned quite
threatening).
Now this might all seem pretty confrontational and
perhaps it is . All I am asking is that those who should know better 'put up or
shut up' so to speak. I mean it when I say that, on a personal level, I have
considerable respect for any colleague who is willing to enter such a public
arena with their views. However, on a professional level it concerns me that
there is an unwillingnmess to admit that the evidence contradicts one's
previously held beliefs and so (courageously change those beliefs).
This isn't about personal reputation or pride - its
about the future direction of our profession. Either it is going to have the
courage to address the fact that it is failing to address the crippling epidemic
of LBP affecting the Western World (The World Health Organisation points to LBP
along with cardiac problems and AIDS as the most concerning health issues of the
coming decade) and turn towards Evidence Based Medicine and Research that can
direct the profession's efforts towards clinical techniques that are proven to
be effective or it will stay in the 'safe' shadows of personal anectdotal
opinion, unwilling
to intelligently assess the researched evidence, uncomfortable with the
unsettling accusing finger of scientific evidence that asks we constantly
re-address our 'traditional' views about clinical practice we are familiar and
comfortable with.
John Spencer
----- Original Message -----
Sent: Friday, August 16, 2002 11:07
PM
Subject: Re: Movements not Muscles?
John
I went down this road with Mel about 8 months
ago. It won't do you any good. It will only frustrate you
more.
Jason
----- Original Message -----
Sent: Friday, August 16, 2002 6:07
PM
Subject: Movements not Muscles?
John Spencer <[log in to unmask]>
writes:
<< Perhaps if you were more familiar with this
'apparent fact' you would be
aware that the research doesn't just
indicate TrAb activation "in a given
limited situation" but in both upper
and lower limb movements, at varying
speeds, as well as during
trunk perturbation (expected and unexpected),
independent of direction of
movement. >>
*** I have seen many of those studies and each one
has been carried out
according to a certain protocol with specific scope
and limitations, as is
the case with all scientific studies. Their
findings still do not imply
universality under all non-pathological
conditions. Have you read any
studies which have examined the
differences in TrAb involvement during
cocontractive vs ballistic
conditions (for more details of these different
types of movement, see
Basmajian, "Muscles Alive")? For example, please
cite any
references where TrAb monitoring has been carried out under the
complex
ballistic and explosive conditions which are typical in many sports.
Some
of the free standing floor exercises, saltos and manoeuvres in
Olympic
gymnastics or the high jump might be interesting starting
points.
Dr Mel C Siff
Denver, USA
http://groups.yahoo.com/group/Supertraining/