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Dear Barrett,

I agree. I feel a paper can often be produced to validate any given line of argument. As untrendy as it seems I would like to see more recognition of empirical, clinical experience and practice findings over the scientific, evidence based academia . Both are equally flewed in their picture of the world yet the later appears to have gained precedence. Remember science was/is born out of clinical practice and academics in manual therapy would not exist without manual therapy.

Warm Regards Kevin   
    -----Original Message-----
    From: Barrett Dorko <[log in to unmask]>
    To: [log in to unmask] <[log in to unmask]>
    Cc: [log in to unmask] <[log in to unmask]>
    Date: 08 March 1999 11:28
    Subject: Re: MUSCLE WEAKNESS?
    
    
    
    
    Dear Mel,
    
    I claim no ability to see into the futire under ordinary circumstances, but I'd be willing to bet that somebody is going to respond to this post with the time honored, "Oh yeah? Well I tell my patients with bad posture to get busy and exercise and they feel alot (sic) better the next time I see them. I'll keep doing this as long as it works for the good of my patients. I'm sure that research will one day prove I'm right."
    
    I just thought I'd say it first so we could get past it.
    
    Thanks for taking the time to look at the literature.
    
    Barrett L. Dorko P.T.
    <http://qin.com/dorko>
    
    
    
    
    At 11:56 PM 3/7/99 , you wrote:
    >The following few articles give us some interesting information on common
    >beliefs that exist about strengthening certain muscles in order to improve
    >stability of certain joints and enhance performance.  The first one makes the
    >revolutionary conclusion that trunk and pelvic posture do not have any
    >significant effect on abdominal strength.
    >
    >The second reference concludes controversially that shoulder retraction
    >exercises do not have a significant effect on shoulder posture.
    >
    >Clearly, there is a great deal that needs to be re-examined in what is being
    >said about abdominal, shoulder and trunk stabilisation.
    >
    >-----------------------------------------
    >
    >1.  Walker ML, Rothstein JM, Finucane SD, Lamb RL   Relationships between
    >lumbar lordosis, pelvic tilt, and abdominal muscle performance.   Phys Ther
    >1987 Apr;67(4):512-6 
    >
    >The results indicate that lumbar lordosis, pelvic tilt, and abdominal muscle
    >function during normal standing are not related. This study demonstrates the
    >need for a re-examination of clinical practices based on assumed relationships
    >of abdominal muscle performance, pelvic tilt, and lordosis. 
    >
    >-----------------------------------------------------
    >
    >2.   DiVeta J, Walker ML, Skibinski B    Relationship between performance of
    >selected scapular muscles and scapular abduction in standing subjects.    Phys
    >Ther 1990 Aug;70(8):470-6
    >
    >Results indicate that no relationship exists between the position of the
    >scapula in standing subjects and the muscular force produced by the middle
    >trapezius and pectoralis minor muscles. Clinical practices based on an assumed
    >relationship between these variables (eg, the practice of using middle
    >trapezius muscle strengthening exercises to correct a forward shoulder
    >position) should be reexamined in light of these findings. 
    >
    >------------------------------------------
    >An article showing that not only 'rotator cuff' issues are important in
    >shoulder rehabilitation:
    >
    >3.  Palmerud G, Sporrong H, Herberts P, Kadefors R  Consequences of trapezius
    >relaxation on the distribution of shoulder muscle forces: an electromyographic
    >study.   J Electromyogr Kinesiol 1998 Jun;8(3):185-93 
    >
    >This study was focused on the ability to reduce voluntarily the muscle
    >activity in the descending part of the trapezius muscle  without changing the
    >arm position or hand load, and its consequences on the distribution of
    >shoulder muscle forces. 
    > The anterior part of the deltoid and the medial part of the serratus anterior
    >also intensified their activity. The influence on the levator scapulae was,
    >contrary to simulation results and to empirical knowledge, a decrease of the
    >muscle activity. It is suggested that attention is given to the rhomboids and
    >the transverse part of the trapezius when muscle activity is reduced in the
    >descending part of the trapezius, for instance in biofeedback-based therapy.
    >In conclusion, the study showed that reducing the trapezius activity caused a
    >redistribution of muscle forces in the shoulder. 
    >------------------------------------------------
    >More on the role of muscles other than the rotator cuff in shoulder integrity:
    >
    >4.  Arwert HJ, de Groot J, Van Woensel WW, Rozing PM    Electromyography of
    >shoulder muscles in relation to force direction.  J Shoulder Elbow Surg 1997
    >Jul-Aug;6(4):360-70 
    >
    >In a static force task the electromyographic level of 14 shoulder muscles
    >including 3 rotator cuff muscles was related to force direction. The principal
    >force direction of maximal electromyography was identified for every muscle.
    >The deltoid was active in a force direction that could be understood from its
    >anatomy. The trapezius and serratus were mainly involved in stabilizing the
    >scapula in upward and outward force directions. Large multiarticular muscles
    >such as the pectoralis and the latissimus were active in downward and forward
    >forces. The rotator cuff seems to have a specific role in stabilizing the
    >glenohumeral joint.
    >--------------------------------------
    >
    >Here is a reference that shows that paralysis of one of the rotator cuff
    >muscles does not prevent full glenohumeral abduction, suggesting that weakness
    >or even paralysis of certain rotator cuff muscles may not have the dire
    >consequences usually aimed at some rotator cuff weakness. 
    >
    >5.  McMahon PJ, Debski RE, Thompson WO, Warner JJ, Fu FH, Woo SL   Shoulder
    >muscle forces and tendon excursions during glenohumeral abduction in the
    >scapular plane.  J Shoulder Elbow Surg 1995 May-Jun;4(3):199-208 
    >
    > A larger contribution of force from the supraspinatus was required near the
    >beginning of motion, whereas the middle deltoid was more important near the
    >end of glenohumeral abduction in the scapular plane. Tendon excursion for the
    >middle
    >deltoid  and supraspinatus  were proportionately larger than those for the
    >subscapularis and infraspinatus. Simulated supraspinatus paralysis does not
    >change normal joint kinematics and does not prevent full glenohumeral
    >abduction. 
    >---------------------------------------
    >
    >Dr Mel C Siff
    >Denver, USA
    >[log in to unmask]
    >