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PHYSIO  August 2002

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Subject:

Re: A Question of Posture

From:

John Spencer <[log in to unmask]>

Reply-To:

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

Date:

Mon, 12 Aug 2002 15:51:04 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (99 lines)

> Barret writes -

> John,
>
> I never said that the chiropractors ever did anything with stabilization.
> Would you care to point out where I did?


John writes -

Well, sorry to persist with this point but you said : "While I appreciate
your effort to restate Sahrmann's theory it doesn't appear to me that it is
anything different than as previously described; a rehashing of chiropractic
dogma".

So you can see my point: If Sahrmann's theory is one of stabilisation and
you say that it is a "rehashing of chiropractic dogma" then  surely you are
saying that Sahrmann is saying nothing new - ergo chiropractors had already
developed a theory (and practice) of dynamic stabilisation.

My argument is that (contrary to your opinion), the theory of dynamic
stabilisation is completely alien to the field of chiropractic and the fact
that you feel that one is just a rehashing of the other reflects a
misunderstanding of the theory Sahrmann relies on (hence my attempt to
explain the theory more fully).

I rather suspect that you have misinterpreted the article you refer to and
see Sahrmann as referring to 'positional' faults that can be passively
corrected rather than 'instability' dysfunction which are addressed actively
through dynamic stability work.



Barrett writes -

To my knowledge their (chirpractor's) focus has always been on vertebral
*position* and its supposed effect on nervous
tissue.

John writes -

Well, that kind of proves my point. You are right, Chiropractic models rely
on analysis of a vertebral position. The dynamic stability model DOES NOT.

I suggest a reading of "Therapeutic Exercise for Spinal Stabilisation in Low
Back Pain".  (Richardson, Jull, Hodges and Hides, 2000). Here you will see
that the dynamic stability model has been developed precisely because the
'positional' and manipulative models of manual therapists have failed to
address the problems of low back pain. To associate to two theories, one as
a rehashing of the other, is a complete misreading as they are enormously
different in terms of the models (and methods) they use.



Barrett writes -

As I've said, Sahrmann has thrown in the pathologic, unstable nature of
spondylolithesis into this mix and it doesn't belong here.

John writes -

Actually, spondylolisthesis is the example 'par excellence' of
intervertebral instability. What more obvious example of a pathology can you
think of which demonstrates intersegmental instability. Why doesn't it fit
here?

I suggest you read O'Sulllivan PB, Twomey L, Allison G 1997 "Evaluation of
specific stabilising exercise in the treatment of chronic low back pain with
radiologic diagnosis of spondylolysis or spondylolisthesis" Spine 22:
2959-2967

This controlled trial of dynamic stability exercises on a classically
'unstable' pathology demonstrates both the effectiveness of the technique
(and to my mind the contrasting ineffectiveness of chiropractic or any
'positional' model).



Barrett writes -

The "core researchers" have *not* been well-received by large portions of
the research and clinical communities. The best resource for this is in the
archives of the "Supertraining" list on Yahoo groups.


John writes -

With respect, the criticisms in these archives are COMPLETELY off the wall.
Most contributors in these archives are totally unaware of even the basic
principles behind stabilisation work. They seem to think that it has
something to do with stopping people falling over! I'm sorry if I sound
disparaging but when people offer criticisms of research you would have
expected them to at least have read the research involved!

I hope you don't feel that my response to your comments on Sahrmann's work
is too vigorous Barrett  as your postings are normally beyond reproach but I
just feel your criticisms are misguided in this case and I feel obliged to
put the case for an area of research which is often misunderstood and
misrepresented.

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