Hello,
there is a significant body of evidence on other exercise having good outcomes in LBP rehab as well.
Cheers,
Anna.
Anna Lee
Principal,
Work Ready Industrial Athlete Centre
Write to me at: [log in to unmask]
Visit me at: www.workready.com.au
Snail mail:
Suite 3, 82 Enmore Road,
Newtown NSW Australia 2042
Australia
Phone: (612) 95197436
Fax: (612) 95197439
Mob: 0412 33 43 98
----- Original Message -----
From: Jason Steffe
To: [log in to unmask]
Sent: Sunday, August 18, 2002 2:52 AM
Subject: Re: Movements not Muscles?
John,
Nice rant! Well put. I agree that the evidence is overwhelming. It's very clear, when you group the evidence (studies) into 3 stages (Normal function, dysfunction after back pain, and rehabilitation outcomes), that the TVA and MF are intimately related to each other and go down the drain with back pain. Retraining these muscles has strongly supported in the literature thus far. I did a ROL academic paper a few months ago in this area and I found the approach to be very solid. No other approach to spinal rehab, that I'm aware of, has as much supporting literature as segmental stabilization does.
The researchers in this area have identified the function, dysfunction and rehabilitation of these muscle groups in well-controlled clinical trials. More work remains to be done such as alternative/better more efficient ways to target the muscle groups, refinements with the PBU, stab of the SIJ, investigations into the deep fibers of the MF vs. the superficial fibers and investigating the cervical musculature.
Jason
----- Original Message -----
From: John Spencer
To: [log in to unmask]
Sent: Saturday, August 17, 2002 8:29 AM
Subject: Re: Movements not Muscles?
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 -----
From: Jason Steffe
To: [log in to unmask]
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 -----
From: [log in to unmask]
To: [log in to unmask]
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/
