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My original post containing McKenzie’s quote about the “noble but futile” concept of stabilization exercises has generated a number of excellent responses on three separate lists. Several people have pointed out that McKenzie has contradicted himself elsewhere, others agree and still others want him to explain himself further. There has also been some comment about the concept of “spontaneous” nature of contraction and our ability to influence that. There’s no consensus there. Here’s another thought about using stabilization for protection that I came across last week:

In Jonathan Miller's classic "The Body in Question" (Random House 1978) the author, an English physician and playwright, speaks of protective mechanisms in the animal world: "Creatures which have a large repertoire of protective mechanisms are much more favorable placed than those who rely on permanent protection." Miller explains that the sturdy shell of the turtle is quite useful, but only occasionally needed and not able to recover from damage or insult. In addition, it limits mobility. "Animals which rely on heavy shields are no match for ones which have invested in nimbleness, intelligence and ingenuity."

I often feel that therapy has therapy forgotten this, not really noticed it, or simply mistaken strong muscles for sufficiently effective protection. How often are patients taught to "armor" themselves against insult with endless repetitions against resistance while a little thoughtful learning designed to improve upon and healthfully alter nervous response is ignored? Too often, in my experience, though there are several adequate programs out there that incorporate this. Such care doesn’t always fit into the gymnasiums that have replaced the clinical environment of years ago. (I was going to say “of my youth” but that made me feel older still)

I understand that we need both strength and coordination for efficient protection, and it appears that many who work carefully with backache know this well. Of course, it doesn’t take much for the term “core stabilization” to mean little more than mindless (albeit intricate) repetitions against resistance. We’d do well to remain vigilant of that, and it’s not hard to see who has remained so.

Barrett L. Dorko, P.T.
"The Clinician's Manual" <http://barrettdorko.com>
Also at <http://rehabedge.com>
And <http://prorehabonline.com>
And <http://physicaltherapist.com>
And <http://rehabmax.com>