----- 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/