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PHYSIO  February 2002

PHYSIO February 2002

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Subject:

Re: Transversus Paradox: PP125

From:

John Spencer <[log in to unmask]>

Reply-To:

- for physiotherapists in education and practice <[log in to unmask]>

Date:

Fri, 1 Feb 2002 00:28:05 +0000

Content-Type:

text/plain

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text/plain (210 lines)

Jason

The source was a conference I attended a couple of years ago where Paul
Hodges (at Brisbane) mentioned this. There was no publication of this as
it was emerging data but Paul seemed to think that as TVA responds
independently of direction of movement it wasn't surprising that it had
a different source of control.

I am sure if you could find his e-mail at Brisbane he could  source
this info for you.

In message <000c01c1a91c$418ca7c0$200bc3d1@jason>, Jason Steffe
<[log in to unmask]> writes
>    John,
>
>    Would you mind citing the reference about the PET scan and TVA
>    activation patterns?  I'd like to get my hands on it.
>
>    Thank you.
>
>    Jason Steffe, PT, MS, MTC
>    Physiotherapy Associates
>    1901 Phoenix Blvd, Suite 205
>    College Park, GA. 30349
>    Ph: 770-907-1023
>    Fax:770-907-5608
>>       ----- Original Message -----
>>       From: John Spencer
>>       To: [log in to unmask]
>>       Sent: Tuesday, January 29, 2002 1:28 PM
>>       Subject: Re: Transversus Paradox: PP125
>
>>       M.Siff:
>
>>       >TRANSVERSUS ABDOMINIS ACTION
>>       >
>>       >Here is a quick puzzle and paradox  -  is the role of
>>       transversus
>>       abdominis (TVA) as supremely important as some individuals have
>>       been
>>       suggesting?  After all, the body is extremely efficient at
>>       recruiting
>>       different systems and processes if one of the important systems
>>       involved
>>       in a given action is injured, ill-adapted, fatigued or otherwise
>>       compromised in its ability to offer its optimal contribution.
>>       Not only
>>       does this happen in the muscular system, but MRIs show that this
>>       plasticity of function even happens in the brain.
>>       >
>>       >Those who work clinically often will notice how many patients
>>       with
>>       physical differences or dysfunctions "compensate" by using
>>       different
>>       muscles or patterns to carry out a given task without any
>>       apparent ill-
>>       effects. One example close to home -- my paraplegic wife who is
>>       paralysed from thoracic level T3 is able to carry out tasks that
>>       nobody
>>       should be able to do with that level of injury, but she often
>>       does and
>>       does so without injury.
>>       >
>>       >So much has been written recently about how essential
>>       transversus
>>       abdominis is to trunk stabilisation and mobility, but has anyone
>>       ever
>>       undertaken studies to show that people who may not be able to
>>       activate
>>       it very effectively may compensate very effectively by using
>>       other
>>       patterns of muscle activation and use?  Is there really any
>>       convincing
>>       proof that "less than optimal" TVA activation definitely results
>>       in
>>       significantly less efficient and more dangerous trunk action in
>>       all
>>       daily activities?
>>       >
>
>>       John writes:
>
>>       Certainly clinically we see that people with apparently poor TVA
>>       activation compensate using other less appropriate muscles to
>>       try and
>>       stabilise the lumbar spine. It is often these muscles (eg hams,
>>       hip
>>       flexors) that become initially symptomatic as they eventually
>>       fail to
>>       compensate for a role they are not well adapted to  carry out.
>
>>       In fact the 'model' that the TVA research is based on is that of
>>       a
>>       tripartite system (originally created by Panjabi) whereby
>>       stability of
>>       the lumbar spine relies upon 'passive' structures (eg discs and
>>       bony
>>       structures), 'active' structures and overall central nervous
>>       system
>>       control.
>
>>       So, for instance, if one structure fails (eg a disc becomes
>>       unstable) it
>>       may be that the body compensates by developing bony osteophytes
>>       to try
>>       and re-assert some 'passive' control. Of course all this
>>       compensation is
>>       subconscious.
>
>>       So yes, as you say, the body does compensate. However, clearly
>>       the
>>       ability to  compensate is limited and at the point that the body
>>       fails
>>       to compensate adequately we see symptoms. There are clearly many
>>       people
>>       out in the real  world who have 'bulging' discs or considerable
>>       OA on
>>       x-ray who have no symptoms and others who, with the same
>>       pathologies are
>>       riddled with symptoms. So compensation certainly occurs but when
>>       it
>>       fails  it may be that 'conscious' intervention to activate the
>>       TVA helps
>>       to bring the body back to a less symptomatic state.
>
>
>>       M.Siff:
>
>>       >Studies of actions other than trunk stability have shown that
>>       the same
>>       >muscles do not necessarily become involved or become involved
>>       to the
>>       same extent or in the same pattern in different people or in the
>>       same
>>       person at different times (e.g., there was an article in the
>>       Scientific
>>       American within the last 2 years which used fMRI - functional
>>       MRI to
>>       demonstrate this).  If this happens with other movements, why
>>       should
>>       actions involving TVA be any different?
>
>
>>       John writes:
>
>>       Interestingly, Dr Paul Hodges recently commented on research
>>       using a PET
>>       scanner and studying TVA activation showed that the normal areas
>>       of the
>>       motor cortex that were active with skeletal muscle activity were
>>       not
>>       associated with TVA activity which was an early indication that
>>       the TVA
>>       may be under distinct motor control from other muscle  groups.
>
>>       The research also indicates that whilst muscles such as
>>       hamstrings,
>>       glutes and rectus abdominus were activated in terms of both
>>       TIMING and
>>       DEGREE of contraction DEPENDENT UPON DIRECTION OF MOVEMENT,
>>       TVA's timing
>>       and degree of contraction was the same INDEPENDENT OF DIRECTION
>>       OF
>>       MOVEMENT. SO, yes, there is evidence that might suggest actions
>>       involving the TVA could  be different to other muscles.
>
>>       That individuals display muscle recruitment patterns unique to
>>       each
>>       individual is undoubted... it does not contradict TVA theory.
>
>
>>       Mel writes:
>>       Is there any genuine proof, other than the current conjecture,
>>       that TVA contributions to trunk action is not as predictable and
>>       deterministic as is being claimed by some therapists?   Does it
>>       really
>>       matter all that much if it sometimes does not contribute as it
>>       "should"
>>       during human movement and its decrease in function is
>>       compensated for by
>>       other muscle actions?  Are there any references which help to
>>       resolve
>>       this paradox?
>
>>       John writes:
>
>>       I think clearly that 'some therapists' out there are making
>>       insupportable claims in respect of TVA but that doesn't negate
>>       the
>>       convincing research that indicates this is a very exciting and
>>       promising
>>       area of study. No-one conversant with the evidence would  deny
>>       your
>>       assertion that the body will compensate for dysfunctional
>>       systems but
>>       equally it is clear that the body fails to compensate adequately
>>       in all
>>       cases hence the need for therapeutic intervention, (including
>>       TVA
>>       activation)
>>       >
>>       >Dr Mel C Siff
>>       >Denver, USA
>>       >http://groups.yahoo.com/group/Supertraining/
>
>>       --
>>       John Spencer

--
John Spencer

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