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PHYSIO  October 2000

PHYSIO October 2000

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Subject:

Re: Psoas & Back pain

From:

"Henry Tsao" <[log in to unmask]>

Reply-To:

[log in to unmask]

Date:

Mon, 09 Oct 2000 11:18:17 GMT

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (172 lines)

Anna,

Thanx for the support and advice. I am open to criticism... I guess with the 
emphasis these days on evidence based treatments, it is difficult to accept 
anything without references, so I don't blame Dr Siff for her comments. I 
have enough time convincing the patients that their back pain is coming from 
a muscle anterior to their back - until they attain the relief!

The problem is what I use at the moment does not have too much research; the 
iliopsoas muscle is a difficult muscle to examine, but I hope in the future, 
there would be more research behind it, espcially with advancement in 
technology. In the mean time, I will continue to keep my mind opened and 
learn as much as I can re: what I use, and about other techniques that I may 
stumble along the way. I will give you and others these 2 references that I 
could find on the iliopsoas complex - hope it gives you more insight into 
what I do:

1. Trikam, R., Dangaria, MD, and Ole Naesh, MD PhD."Changes in 
Cross-Sectional ARea of Psoas Major muscle in Unilateral Sciatica Caused by 
Disc herniation" SPINE Volume 23 Number 8 pp 928-931 1998.

2. Wendy Aspinall, "Clinical implications of Iliopsoas Dysfunction" The 
Journal of Manual & Manipulative Therapy Vol 1. No. 2 pp41-46 1993.

Henry***


>From: "Anna Lee, Principal" <[log in to unmask]>
>To: <[log in to unmask]>
>Subject: Re: Psoas & Back pain
>Date: Thu, 5 Oct 2000 16:11:46 +1000
>
>
>Hello henry,
>
>Keep up the excellent dialogue, don't let mcsiff put you off. The reason we
>have this network is to exchange ideas and discuss!
>
>
>Cheers,
>
>Anna.
>
>
>Anna Lee
>Principal,
>Work Ready -  Industrial Athlete Centre
>Physiotherapist and Occupational Health Consultant
>
>Write to me at [log in to unmask]
>Visit me at www.workready.com.au
>
>Snail mail:
>Suite 3, 82 Enmore Road,
>Newtown  NSW 2042
>Australia
>
>Tel: (02) 9519 7436
>Mob: 0412 33 43 98
>Fax: (02) 9519 7439
>----- Original Message -----
>From: "Henry Tsao" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Wednesday, 4 October 2000 7:56
>Subject: Re: Psoas & Back pain
>
>
>Dr Siff,
>
>That is very interesting that you noted the fact that strengthening vs
>stretching techniques... it would be a great topic for research. The
>exercises I give my patients with back pain are a regime of stretches... 
>the
>strengthening of tight and weak muscles are only done during treatment. The
>muscles that I target in back pain sufferers and allow patients to
>strengthen are the transversus and multifidus... but it has been shown by 
>Dr
>Richardson and Dr Hodges that when the psoas muscle is dysfunctional, the
>transversus and multifidus muscles do not work, and hence becomes weak.
>Therefore, I only teach these strength exercises after a few session of
>releasing the muscles at fault.
>
>Henry***
>
>
> >From: [log in to unmask]
> >Reply-To: [log in to unmask]
> >To: [log in to unmask]
> >Subject: Psoas & Back pain
> >Date: Tue, 3 Oct 2000 00:37:46 EDT
> >
> >On 10/2/00, Henry Tsao<[log in to unmask]> wrote:
> >
> ><< Re: your comments about hypertrophied psoas muscles on MRI, this is
> >where
> >basic theory is important. A hypertrophied muscle does not neccessarily
> >mean
> >that it is tight... a tight muscle can also be weak, which is what a
> >dysfunctional psoas muscle is. Therefore, we not only stretch the psoas
> >muscle, but strengthen the muscle to increase its muscle bulk. I hope 
>this
> >clears up my previous statement. >>
> >
> >***I did not refer to 'tightness' at all in my letter, especially since
> >that
> >term alone can be rather colloquial and vague.  Had I done so, I would 
>have
> >questioned the nature of the alleged 'tightness' on the basis of 
>mechanical
> >vs neural grounds.  I was curious to know why the muscle diameter
> >increased after stretch and spray alone.  As you stated:
> >
> ><<These patients went through a regime of psoas stretch and spray over 
>the
> >next 3 weeks only, and had psoas stretches and psoas ice exercises to do 
>at
> >home. Over the 3 weeks, they re-MRI'ed these people and measured the
> >diameters again. What they found is that there was a significant increase
> >in
> >the psoas and multifidus muscles diameter, and the patients subjectively
> >stated that they were ~80-90% better. >>
> >
> >***As far as I know, the only case of muscle mass and diameter increasing
> >in
> >response to stretching has been in laboratory situations in which birds
> >have
> >had weights hanging from their wings for several weeks at a time.  I was
> >intrigued to know how humans can increase muscle bulk with brief episodes
> >of
> >stretching and spraying.
> >
> >Now you have added that you also had your patients do regular 
>strengthening
> >exercises.  How can you now be so certain now that it was the stretching
> >and
> >spraying alone which resolved the back pain?   In terms of research
> >standards, you cannot deduce that the success which you claimed with
> >"stretch
> >and spray" was thanks to the method which you singled out for praise.  
>Back
> >pain is well known to resolve itself spontaneously or in response to
> >regular
> >strengthening exercises.  As I commented in another letter, if one 
>combines
> >a
> >series of different modalities, then the likelihood of success will often
> >improve, irrespective of the theories suggested.  Have you compared the
> >relative recovery patterns of "stretch and spray" vs strength training
> >subjects?
> >
> >Dr Mel C Siff
> >Denver, USA
> >http://www.egroups.com/group/supertraining
>
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>

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