----- Original Message -----
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 -----
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/