The Useless Core Strengthening

[bernard]

Hi All,

The core strengthning seems to be a huge part of daily practice of many PTs.
Here is two papers showing another point of view:

Electromyographic functional analysis of the lumbar spinal muscles (http://www.somasimple.com/forums/showthread.php?t=2300)

It is certainly possible to show evidently that the protocol of CS is not really good and perhaps brings more problems than it helps?

[bernard]

Core exercises: Beyond your average abs routine
From MayoClinic.com (http://www.mayoclinic.com/)
Special to CNN.com
Did you know that your core is where all movement in your body originates? Core exercises are an important part of overall fitness training that, except for the occasional sit-up or crunch, are often neglected.
To get your core muscles in better shape, it's important to understand what your body's core is and how you can strengthen it.
Understanding your coreYour body's core — the area around your trunk and pelvis — is where your center of gravity is located. A strong core gives you:

Increased protection and "bracing" for your back
Controlled movement
A more stable center of gravity
A more stable platform for sports movements When you have good core stability, the muscles in your pelvis, lower back, hips and abdomen work in harmony. They provide support to your spine for just about any activity.
A weak core can make you susceptible to poor posture, lower back pain and muscle injuries. Strong core muscles provide the brace of support needed to help prevent such pain and injury.
Strengthening your coreCore strengthening requires the regular and proper exercise of your body's 29 core muscles. Basic exercises that will enhance your core fitness include the:

Bridge
Abdominal crunch or sit-up
Plank
Quadruped A fun alternative to your basic core strengthening regimen is to learn exercises that use a fitness ball. Balancing on these oversized, inflated balls requires that you focus on using your core muscles for support.
Getting the most from your workoutIt's important to do your core exercises at least three times a week. For optimal results, remember to:

Choose exercises that work your core muscles simultaneously. Rather than isolate each muscle group in your trunk, the best exercises for your core are those that get muscles working together at the same time.
Focus on quality of movement rather than quantity. You'll gradually build up to a greater number of repetitions. When starting out, take it slow and learn how to properly perform each exercise with optimal technique.
Breathe steadily and slowly. Breathe freely while doing each of the exercises in your core strengthening workout. Your instinct may be to hold your breath during an exercise, but it's better to continue breathing.
Take a break when you need one. When your muscles get tired, stop and change exercises. And, if you work your core muscles to fatigue during an exercise session, wait at least a day between workouts to allow the muscles to recover.
Get help from a trained professional. Body position and alignment are crucial when performing core strengthening exercises. When you begin, it's a good idea to have a fitness trainer or physical therapist help you perfect your technique. Keep in mind that strengthening workouts — even core strengthening — are just one part of a complete fitness program. Include aerobic exercise and flexibility training to round out your regimen.
October 06, 2005



Here is an example.

[Diane]

I wish they would name all 29 "core muscles" mentioned. Which ones are they talking about? I thought transAb was the big target most of the time. Now I'm confused.

[Barrett Dorko]

Me too.

Not being any sort of expert on this issue, which of course doesn't keep me from not liking it, what can I say now given this information about the use of core strengthening for backache?

I must say that I almost always hear therapists say they "believe" in strengthening the core. I'm wondering why they emphasize "belief" so commonly when talking about this.

[bernard]

Diane,

29, is yet a weird number since I thought we were "symetrical" in this area?
I put the subject since it is controversial. Many SomaSimplers are not really for but many PTs are doing it, every day because they learnt it.

It is a gold standard but it is, IMHO, a meme to forget.

[Diane]

Oy, another big memeplex to deconstruct. :rolleyes:
People claim that rolling patients around backwards over a big ball "strengthens" something.. I secretly think that what it does is;

1. provides the brain with novel stimuli (i.e. use muscle in this challenge or you'll fall on the floor);
2. l-e-n-g-t-h-e-n-s out the abs.. (most of the time sedentary people have them shortened while slackened in sitting positions) and makes people neurally glide those incredibly long cutaneous nerve that flow through the ab walls;
3. gets them breathing. That in and of itself has to be a good thing. As long as they don't try to keep their belly wall contracted as they breathe in.

The quadruped position is a nice one for relaxing and lengthening upper and mid sections, both longitudinally and circumferentially.

Stay tuned for thumbnails of trunk musculature and probably some (not especially art-worthy) homemade drawings.

[nari]

Come to think of it....what proof do the CS aficionados have that multifidii, ES and the others are strengthened by high jinx on the ball and therefore strength is the answer??

They might get thicker (the muscles, that is) and function improves...but how do they know that strengthening has anything to do with pain relief?

That's always intrigued me. I guess it is because there was no other possibility to think about x years ago, hence strengthening muscle = pain relief and/or improved functioning. Of course, they could always come back with the response: How do you know it is not? However I think the neurophysiological line holds far better than the bigger-muscle line.

Nari

[Synergy]

...I must say that I almost always hear therapists say they "believe" in strengthening the core. I'm wondering why they emphasize "belief" so commonly when talking about this.

Barrett,

Maybe it has to do with their 'core values'. :shade: (pretty lame...I know)

Diane,

Your first two points are entirely true, however, why can't this be understood by the majority of PTs?

[bernard]

Nari,

The original theory is only biomechanical.

The L5/S1 disc is 5 cm² and "suffers" the loads.
If we enlarge the area for the loading thus constraints will be lowered.
"Bracing" with abdominals is "the" way to enlarge the loading zone.But it is just wrong.
This is the meme to discard.

[nari]

Bernard, I know...but,as Chris stated, why don't others?
Sorry if my rhetorical statements confuse you..they confuse me at times.

Nari

[bernard]

Nari,

The previous meme is seconded by another => muscular strength is able to relieve pain.

It may be true and wrong at the same time.

[Jason Silvernail]

Well, since I prescribe these exercises for lower back patients frequently and since we have a separate "Lumbar Stabilization Class" in our clinic, I suppose I should speak in support of it.

I guess I won't get into the practice of it too much, but will focus on the theory of why it works and the rationale used to prescribe it. Like others here, I don't think strength and pain are related. However, in some situations there can be a rationale for the use of strengthening exercises. Let me explain.

There have been many biomechanical treatises on the function of the spine, both theoretical and in laboratory. Look for names like Panjabi, McGill, Richardson, Hides, and Cholewicki. The theory is that there is excessive mechanical deformation of certain structures of the spine with movement. What structures? Good question, plenty of likely culprits - but I vote for nervous tissue myself which is found everywhere.

Some key points:
-Studies have demonstrated that proper contraction patterns of core muscles increase the stiffness of the spine and decrease the translations at spinal segments.
-Studies have also shown a motor planning deficit in those with lower back pain, as well as atrophy of certain muscles, especially the multifidus, and that that atrophy does not improve on it's own at the 6 month mark.
-Studies have also shown that a specific exercise program not only improves the atrophy (via return of multifidus symmetry as measured by ultrasound) but improves patient-centered outcome measures relative to pain and disability.
- A recent preliminary clinical prediction rule has come up with some interesting ideas. It in, a few key factors were shown to improve the likelihood of improvement with the technique. It has not been validated, as has the CPR for manipulation, so it's strength of evidence is not as high.
- This prelim CPR (in a nod to self-correcting science) actually showed that people who had the most "fear avoidance" behavior, were more likely to do better with the treatment. Implying a cortex involvement, far from biomechanics.

I have used this mode of care for many years, and I have some personal theories about it myself, which I'll share because I can. :)
I think, as Diane alludes to, that there is a VERY strong cognitive-behavioral aspect to this treatment. It gets people in pain exercising and moving in a safe, supportive environment that focuses on function. It gets them to activate and challenge muscles in an area that is painful and they are concerned about. It also reconnects their brain to the painful area, and restores some motor control and brain activity there, and I don't need to convince anyone here that that's important.

I think that this mode of care fits well into neurophysiologic theory in that the thrust of the idea is to reduce repetitive mechanical deformation across sensitized tissues, restore brain control, engage in functional movement/activity, and place the patient in control of symptoms and in control of pain. It's disadvantages are that the exercises are fairly choreographed (though they are individualized to the person's patterns of painful movement and positions) and they do not encourage freedom of movement/ideomotor movement.

Though if you ask most therapists why it works, they will give you a strict biomechanical answer, most thoughtful therapists (including leading investigators on lower back pain) believe, as I do, that there is a large cognitive-behavioral component to the treatment.

This is not mindless bouncing about on balls and pulling in the tummy. The exercises are targeted to the patients complaints, and the patient is taught to move the spine on their own and find a comfortable position from which to begin each exercise.

I have attached the preliminary CPR paper on this modality, as well as the information sheet I give to patients when we begin, which gives a good explanation of what patients are taught.

What does everyone think?
J

[bernard]

Jason,

I made a pdf version of your Word document.
Some readers haven't the microsoft program.

[Barrett Dorko]

Jason,

Great reply.

It seems to me that if Feldenkrais were alive he'd agree with you 100%, and I never found anything said by Feldenkrais disagreeable. Unfortunately, those who follow his thinking and teach his work have done a terrible job of getting it into the mainstream of movement therapy in our profession. (Not that I've had any success with my own ideas) But I've had many Guild members at my courses, and though they proclaim their interest they are completely silent beyond that. To me, this has been especially disappointing.

Here's where I have difficulty with the stabilization crowd: They seem to think that strengthening alters posture and that posture and pain are related. They go on to assume that pain and strength are related.

As far as I know, none of this has been demonstrated. If I'm wrong, please show me where.

What has been shown is that if people move painlessly with attention and precision and care they can recoordinate their function and, given enough repetition, alter their use for the better for prolonged periods. Feldenkrais was always careful to assign the change to the brain and saw the muscle purely as an agent of/for that change. Stabilization sorts seem to forget that and often speak of the muscle in isolation. Feldenkrais would have hit them over the head with his book.

I have the sense that in the absence of ideomotion more choreography of a special sort is required. Maybe a few moments of ideomotion would replace a much longer period of exercise. I don't know this for sure by any means.

[Jason Silvernail]

Hey, Bernard, thanks!
I don't have the ability to turn Word into PDF, but it certainly is the preferred format. If I send you my entire catalog of self-created exercise and education handouts in word, could you turn them all into pdfs? Just kidding of course. :)

Barrett-
Thanks for your reply. I have to say that I'm not sure it is the posture itself that we are discussing in the stabilization paradigm. It is really less about posture and more about finding a position in which there is less pain (exploring movement to achieve relief- sound familiar?) and contracting muscles to reduce excessive accessory motion at sensitive tissues, reducing the cycle of mechanical deformation.
I will fully admit that the average therapist on the street may not approach stabilization the way that I do, but it is the way I was taught in the Army and the way the investigators of the treatment teach it. Certainly there is a subset of people who sort of mindlessly pass out "core strength" exercises in a rather haphazard way, but I believe they are in the minority.

And I completely agree that posture, strength, and pain are not related. However, we can all agree that movement and position is related to pain when there is mechanical pain due to abnormal neurodynamic or excessive mechanical stress on sensitized tissues. And that's really the heart of core stabilization.

Thoughtful therapists see differences in the terminology, but many people use them interchangeably. I contend there's a huge difference.

Core Stabilization: learning to maintain a comfortable position when outside forces are involved. The spine itself is held still in the comfortable position. Example: keeping you lower back in a certain position when lifting something heavy. I do this all the time for lower back patients.

Core Strengthening: moving your spine against a load for the purpose of increasing strength of the trunk muscles. Example: a situp or crunch exercise. I rarely if ever do this for patients in pain, since strength isn't related to pain.

I think if in the thread that Bernard defines "core strengthening" the way that I have, I completely agree that it's useless in managing pain. Other than perhaps a cognitive-behavior component, which of course would be better aimed at something functional in life, it has no role.

J

[bernard]

could you turn them all into pdfs? Just kidding of course. :)

No problem but there is a free way =>

http://www.somasimple.com/forums/showthread.php?t=1243

Open Office opens words docs and is able to convert them to pdfs.

[bernard]

Back to heart of the core,

Jason,

You're speaking of stiffness as a protective tool.


A stiff element transmits integrally the forces applied.
An elastic and curved one, absorbs a great part of the loading.
The core model is shaking.

[Barrett Dorko]

Jason,

We disagree on only one thing: that therapists who pass out "core strength" exercises haphazardly are in the minority. I get around, and this sort of approach to practice for backache is common enough to be considered the norm.

It's "the elephant in the room" though, and most of our colleagues would prefer I not mention its presence.

If I look a little bulky in Orlando it's because I've decided to wear a wet suit beneath my other one. And those aren't just size 43 clown shoes - they're flippers. Now, if I only knew how to swim...

[Jason Silvernail]

Well, Barrett, perhaps you're right about the quality of "average" care provided. I sort of pride myself on providing quality care, and am in the presence of what I consider to be a very competent group of therapists (in the US Army). Perhaps I just have an elevated idea of what standard of practice is.
On the swimming thing- have you considered water wings? They would round out your outfit quite well, I think...

Bernard-
I guess i'm speaking of stiffness as reduced chronic motion and mechanical deformation of sensitive tissues. If the forces are distributed to other local tissues that are not mechanically sensitive, then the paradigm holds rather well.
Thanks for the OpenOffice site...I'll have to check that out. If it's as easy as it seems, I will be able to say SomaSimple has been of great help to me in more ways than in my practice!

J

[bernard]

If the forces are distributed to other local tissues that are not mechanically sensitive, then the paradigm holds rather well.

If! But are they?
IMHO, they are not. We are using muscles to make the back stiffer but there is also a compressive force created by this activity. Added to the load, it will create a quicker approach the "limits"?

ps: I'm using daily Open Office since... 2004. All the "custom" pdfs are made with it.

[nari]

Jason

I liked your summary of CS information for patients. Useful and concise.

How would we know what tissues are not mechanically sensitive to loading?

The real difference here is that many, many PTs (I agree with Barrett) use CS as means to strengthen 'core' musculature and redistribute load. I think they still operate on the pain/posture/strength meme. You, on the other hand, are coming from the CNS/PNS angle. It's the premise that makes the essential difference - nobody denies that CS is useful, particularly if patients enjoy the routines. It's just like the manipulation premise......and probably zillions of other PT "tools".

Nari

[Jason Silvernail]

I think you're right about that, Nari. It is all about how we approach it. I think a good core stability program can be enormously beneficial in the right patient population, but mindless series of strength exercises are clearly a waste of time.

I guess, in the last two years reading all of you at RE and now here, I have become decidedly more neuro/cortex-centric in my approach to patients. Now I see most all PT treatments in terms of neurophysiology. There are some pathological problems that I approach biomechanically, but most PPP are not, so this approach works well.

What was it someone here said, all the tools, they are all cortex anyway...
:)
J

[BB]

Here is an article that I post only because it does show some correlation with pain and posture, when it is also correlated with a tendency toward certain movement patterns. This gives credibility toward perfect posture being a relative term.

J Orthop Sports Phys Ther. (http://javascript%3Cb%3E%3C/b%3E:AL_get%28this,%20%27jour%27,%20%27J%20Orthop%20Sports%20Phys%20Ther.%2 7%29;) 2004 Sep;34(9):524-34. Related Articles, (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=15493520) Links (http://javascript%3Cb%3E%3C/b%3E:PopUpMenu2_Set%28Menu15493520%29;)
Differences in measurements of lumbar curvature related to gender and low back pain.

Norton BJ (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Norton+BJ%22%5BAuthor%5D), Sahrmann SA (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Sahrmann+SA%22%5BAuthor%5D), Van Dillen FL (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Van+Dillen+FL%22%5BAuthor%5D).

Washington University School of Medicine, Program in Physical Therapy, St Louis, MO 63108, USA. nortonb@wustl.edu

STUDY DESIGN: Cross-sectional. OBJECTIVES: To test the assumption that postural alignment and gender have a bearing on the specific type of low back pain (LBP) a person manifests. BACKGROUND: Measurements of static sagittal lumbar curvature are used by clinicians in the management of patients with LBP, but no investigator has reported differences in curvature related to specific categories of LBP. METHODS AND MEASURES: We used a computer-interfaced, 3-D, electromechanical digitizer to derive curvature angles for the region of the spine between T12-L1 and S2. Trained clinicians examined the subjects and determined their LBP diagnoses. We used t tests to examine differences in curvature between women and men, those with and those without LBP, and those in 4 different categories of LBP. We used chi2 to examine the relationship between gender and LBP category. RESULTS: Lumbar curvature angle (lordosis) was 13.2 degrees larger for women than for men (t = 6.74; P<.01). There was no difference in lumbar curvature between people with undifferentiated LBP and people without LBP. There were differences in lumbar curvature between people in various categories of LBP, for example, subjects in the lumbar-rotation-with-extension category had 8.4 degrees more lumbar curvature than subjects in the lumbar-rotation-with-flexion category (t = 2.16; P<.05). Based on the frequency distributions, there was a significant relationship between gender and LBP category (chi2 = 10.19; P<.01). CONCLUSIONS: Measurements of lumbar curvature should be expected to differ between men and women and may be related to different types of low back pain.

PMID: 15493520 [PubMed - indexed for MEDLINE]

I have used an approach toward this style of exercise very similar to Jason's description, and today I read something in one of Feldenkrais' books that I think fits into this conversation of stability exercises and also of posture.
He speaks of healthy posture and movement being effortless, and without resistance.
Let's say that a person stands in lordosis, pain with extension activities, etc. We could teach them to better recruit the flexors and maintain a less extended position, and this would very likely reduce their pain. However, this position would be attained by balance between 2 over recruiting muscle groups, like 2 elephants sitting on a see-saw. We are, in essence, treating one compensation with another.
Feldenkrais speaks of reducing the resistance, thus making the movement or position effortless. So, if this same person could be taught to reach the neutral spine, healthy posture, by reducing the resistance of the extensors, less, if any, effort of the flexors would be required.
Upon looking at these two different scenarios the person may appear the same, but one is effortless, the other working his butt off to stay neutral. So, I think our approach toward finding that painfree posture is correct, but we may also want to achieve it effortlessly. Then the conditioning becomes more of engraining the movement pattern and less of gaining strength and endurance to sustain this incredible effort.

Cory

[BB]

For those of you who may have given up on my last post once you got to the name "sahrmann," please be sure to read the bottom "non-sahrmann" comments.:angel:

Cory

[bernard]

Cory, your analysis is just fine. Feldenkrais as many eastern approaches are interested by the lowest energy expenditure. This is far from our occidental strengthening.

nobody denies that CS is useful
Hmmm, I do because it is bio-mechanically improbable, physically impossible and maintains the patient conditions.

[bernard]

Hi All,

I propose two little tests:

1/ bending forward around 30/45°
Try it without fear and just let it go in an effortless manner.
Try it with the CS principle with the "muscular brace".What is the more comfortable?

2/ Take a flexion bent position around 40°
Put a hand on your abs and the other on the paraspinals musculature.
Contract your abs without moving and relax. 2/3 times.What is your conclusion?

[nari]

Bernard

You're shooting me down in flames again, but that's OK.;)

Sure it maintains a tenseness and may lead to problems later in life - but for many it feels good, however deluded the reasons may be. That alone is a sufficient reason for it to be taught. It's strictly for the young and young at heart, but if that placebo effect works strongly - why not!!??

I tried your 2 tests.
#1 without CS was clearly more comfortable, which makes sense.
#2 I couldn't detect any difference between abs contracted and not. (And I have a fairly significant TA control - I've always had it)
Both circumstances felt quite OK.
What did I miss this time?

Nari

[bernard]

And I have a fairly significant TA control - I've always had it

That's perhaps the problem but Newton said that an action carries ever a reaction.

If you contract your abs, normally something happens in your back.
You take first the bent position then put hands in place and then contract abs without moving. :lightbulb

[Diane]

BB, just want to say that I like how you think. :)
>We are, in essence, treating one compensation with another.

Exactly. You can't help the nervous system if you are trying to fix a "postural fault" by tightening up another muscle. The whole point of therapy should be to loosen the whole system or any regional part of the whole system, regardless of how big or small, enough in EVERY direction (front, back, sides, circumferential, top and bottom, spherically) that the anti-gravity mechanism can function freely without restriction, no effort.
How? Any way you can...

Sorry for butting in. Back to ab testing. :)

[christophb]

Feldenkrais wrote that it is important to distinguish posture from position. Most of my patients come in stating they have poor "posture" and need core strengthening to maintain that. Posture is ever-changing and I think Feldenkrais took it to mean the ability to move in and out of positions effortlessly. (much like Cory just stated). I think it takes some critical thinking and willingness to give up old ways of thinking to move through a Sahrmann article and come to the conclusion Cory did. Our clinic has the new Sahrmann book and just glancing through it make you anxious about having all sorts of "movement disorders" that need correction:). To stay out of coercion mode I look at core ex as playgrounds for people to explore options to current habitual movements. I let them decide what feels good or not.

Chris

[nari]

I had thought Sahrmann, in her new book, was acknowledging the CNS..oh well.

Chris, that is how I see the endless parades of CS 'classes' - as long as coercion is kept out of it, people would find it both useful and fun.

Perhaps PTs could abandon the "I will correct your posture for you" thinking; and instead invite pts to find their most comfortable positioning. That would take some shifting in thought.
One of the many things I found contradictory about clinical practice is this:

Patient: (who has poor posture) When I straighten up it hurts.
PT: Keep practising until it stops hurting..

Patient: (with a painful back) When I do this, it hurts.
PT: Then stop doing it. (then teaches CS to pt)

Does anyone else find this ludicrous? Yet it continually happens...

Nari

[Diane]

From http://www.artofperformance.co.uk/, sent in by Ian. Go to the link, click on articles, click on "core stability, pure stupidity?":

Core stability, pure stupidity?

okay, I admit its an inflammatory title but I feel its an issue that needs debating and it probably got your attention. Its become a term used increasingly in rehabilitation, remedial exercise and even sports training. But what is meant by it and does anyone know if it is really desirable and beneficial? I also worry that these exercises, originally devised for people with spinal injuries, are widely used by athletes with no pathology!

I wrote the following article in 2001 which had quite an impact, even resulting in abusive correspondence from several quarters - needless to say they were not scientific in nature!

- - - - -

In 1989 the International Union of Physiological Sciences Conference debated the head-neck sensory motor systems as a factor in movement and balance. As a result, over one hundred papers were written on the subject in the following three years. In the editor’s preface to the publications Berthoz wrote: -

The need for a thorough analysis of all aspects of head movement control is all the more important because head movements are a core element of orienting behaviour involving a number of interactive sensory and motor systems.

It is therefore difficult to explain and justify the current popularity of exercises used by many therapists to promote what is known as ‘core stability’. These exercises were devised in response to the perceived problem of poor support. The patient is encouraged to concentrate on using specific muscles to stabilise the core to support an area known to have a weakness. The problem with this action is that it is contrary to the function of the nervous system.

Gerald Gottlieb, a respected scientist working in the field of motor control stresses that one of the functions of our central nervous system is to minimize muscle stress. This, he argued, is why we should not override this directive by concentrating on individual muscle activation during activity. Are we in danger of over doing it when we try to control the actions of specific muscles? Remember this is physiologically impossible anyway! Whilst the nervous system is in favour of minimising stress to help maintain free joint movement and reduce pressure on the internal organs, we are consciously doing the opposite. Following on the back of this paper sports scientist Dr Mel Siff writes: -

… how can one prescribe specific set ways of recruiting muscles in any complex natural movement if research now shows that these highly deterministic patterns of muscle action are not characteristic of human movement?

and
Research into motor control has never shown that training of individual muscle actions enhances skilled complex motor activities. The maxim of "the body knows of movements, not muscles" is constantly reiterated to emphasise this fundamental point. The learning of the motor skills required to execute a given sporting movement are acquired by regular practice of the movement itself, not by teaching isolated joint or muscle actions that are believed to play some contributory role in the sporting movement.

We should not attempt to directly control muscle recruitment for movement or exercise, it should be the thought of an act that initiates our total muscle response and the subsequent movement that determines ongoing involvement. When the managing director decides to sweep the factory floor instead of staying in the boardroom making the big decisions, he interferes with the operation of the whole organisation.

If our innate balance mechanisms are allowed to perform their function unimpeded there is no need to consciously engage muscle or strengthen the middle of the structure independently. In the absence of interference, the reflexes responding to gravity will help to ensure optimum balance and movement.

Mulder and Hulstyn’s research published over twenty years ago ('Sensory feedback therapy and theoretical knowledge of motor control and learning'. Am J Phys Med 63:226-244, 1984.) stated
"Normal movement does not consist of isolated actions that are cortically controlled. Rather it is a sequence of synergic movement patterns that are functionally related. Besides initiating muscle activation, which produces the movement, synergies also serve to maintain equilibrium. Therefore, another goal of treatment may be to improve dynamic postural and movement synergies available, decreasing the tendency for excessive and prolonged recruitment of muscle activity to stabilise posture during movement. Thus, muscle re-education sequences should NOT be performed in isolated movements. Instead they should be incorporated immediately into functional, goal-oriented tasks".

More recently Stuart McGill Ph.D (Physiology) published a paper stating
[i]"The task of daily living is not compromised by insufficient strength but rather insufficient endurance. After an injury it has been demonstrated that the motor system loses its fitness, and abnormal relationships of muscle activity occur. Endurance training is emerging to be far more important in stabilizing the spine than strength. Strong abdominal muscles do not provide the preventive or therapeutic benefit that was thought. Sit ups, with knees bent or even abdominal crunches have not demonstrated any real benefit for the low back. Further, pelvic tilts may actually make the low back worse. There is little support for low back flexibility to improve back health and reduce the risk of future back trouble. Research is demonstrating that endurance has a much greater preventive value than strength. In fact, emphasis on endurance should precede specific strengthening exercise in a gradual exercise program. Increasing evidence supports endurance exercise in both reducing the incidence of low back injury and as treatment. This would include such daily activities as walking, cycling, swimming or repetitive low demand exercise to specific muscles. Co-operative muscle activity is a necessary prerequisite to obtain the desired endurance. That co-operative muscle activity is dependent on proper joint mechanical motion as is proper joint motion dependent on co-operative muscle activity."

also

…spinal stability is achieved with very low levels of abdominal co-contraction, focusing on a single muscle is misguided, and that "sucking in" the TVA in fact compromises, not improves, spinal stability. ( my bold text )

So perhaps a misunderstanding of the problem has led to a short-term remedy. A number of therapists are starting to question the thinking behind core stabilisation techniques as to date there is no convincing clinical evidence to prove their effectiveness. Because it may appear to achieve a result and ‘feel’ good it is not surprising to find the core stabilisation theory featuring in numerous popular exercise philosophies. Again Dr Siff writes: -

At the very outset, we have to dispel the belief that it is possible to focus on 'core stability' on its own. Unless one's entire body is off the ground or is immersed in water, the idea of stabilising the core separate from other parts of the body is sheer nonsense, since the ability of the core in all sports in which one is in touch with a static or moving surface depends strongly on peripheral stability (the limbs). If one is carrying out some movement such as lifting weights, doing aerobics, running, jumping or playing some ground-based sport, the body stabilises as a whole, with interacting contributions from the periphery and the core….. The world of core stabilisation currently remains far too heavily based in marketing and belief than in valid science.

The actions encouraged to promote core stability may feel like they are strengthening the centre of our body. In the absence of ‘valid science’, they appear to protect the spine because it must make sense to support the body from the centre. But the theory ignores the role that limbs play in maintaining stability and the overall controlling influence of the balance and righting reflexes. The few disciplines that do recognise the importance of the head, neck and back relationship resort to what they know best to ‘improve’ it - exercising the muscles of the neck! The exercises designed to achieve this have the effect of increasing interference in an area that requires none. Alexander’s method to promote correct use of the primary control (the relationship between the head, neck and back) is not about right position or strength of the neck and shoulder muscles. In reality the only thing we can directly do in relation to the righting reflexes is to unknowingly interfere with their function. Anthropologist, Raymond Dart, wrote:

The prime factor about human body movement is that it entails the co-operation or integration of both conscious and unconscious mechanisms, i.e. the ‘will’ and the ‘reflex’.

To achieve the level of integration necessary for optimum movement we need to prevent the conditions likely to impede this co-operation. If the amount of effort applied to a task is excessive, the resulting muscle activity is likely to interfere with the reflex by reducing sensitivity. Activation of the reflex could either be delayed or even totally restricted. When the reflex is finally activated, movement is limited due to the reduced capacity of a shortened muscle to contract further or its inability to lengthen when required.

Alexander stressed that if we stop doing the wrong things the right things take care of themselves. If we learn to stop stiffening the neck, the head will ‘find’ its own balance and bring about the most appropriate muscle tone for the current situation to facilitate our innate righting reflexes. As we do not know what the optimum tone should be for each muscle it is not something we should try to achieve. Activities performed with minimal interference with our balance mechanisms will ensure the most appropriate muscle response. Good quality movement promotes the right type of conditioning and removes the need for additional ‘specialist’ exercises.
So how do we attain good movement in order to get into shape? First we need to establish what it is we have been doing to get out of shape, and then we have to learn to stop doing it before we attempt anything else.

- - - - -

I have included below a reply from Stuart McGill PhD (Physiology) Dept of Kinesiology, University of Waterloo, Canada in response to my question regarding core stabilisation techniques. He has published over one hundred papers in this area.

"There is a problem - there are too many therapists promoting stability exercises who do not know what it is, how to measure it, and how to achieve it. Strength has nothing to do with it. Each patient must be properly evaluated to determine the deficit - poor motor patterns or otherwise. I give courses on this and therapists are surprised as to how much is involved- certainly much more than the journals will allow when we publish data based studies. I know the Alexander Technique and in many cases the stable motor patterns are established."

Nice robust piece.:lightbulb

[Diane]

I've been glancing through the third edition of Grieve's Modern Manual Therapy: The Vertebral Column, from 2004.

In another thread I talked about how much more streamlined it has become.. aparently the first edition, which I do not have, was over 900 pages! Also, this edition has a lot more in it about the nervous system.

I thought I would bring this little section forward. (I found it interesting in that it sort of supports one of my own pet theories, that the epaxial muscles are more primitive/ under less "conscious" control than hypaxial trunk muscles and/or later-evolved limb muscles... they don't distinguish among various trunk muscles here though.)

From page 125, in a chapter called "Motor Control of the Trunk":
Controller
It is beyond the scope of this chapter to provide a detailed description of the organization of the control system. However, several important issues require consideration. Firstly, trunk muscles receive inputs from various parts of the CNS including corticospinal inputs (Plssman & Gandevia 1989), which to some extent, unlike the limb muscles, course the spinal cord bilaterally or send collaterals to both sides (Kuypers 1981, Mori et al 1995). However, it is generally considered that there is more significant control of the trunk muscles by the brain stem and spinal structures (Kuypers 1981), for example the vestibulospinal and reticulospinal systems. This is consistent with the relatively small size of the representation on the motor and sensory homunculi. The following section will consider the mechanisms of control of the trunk muscles from a behavioral perspective, that is, consideration of the organization of muscle recruitment rather than the consideration of the specific neural structure and events involved in their production.
Bold mine.
Could it be that the ortho people are starting to carefully venture slightly away from mesoderm over into neuro land? ;)

[Nick]

Jason wrote, "It's disadvantages are that the exercises are fairly choreographed (though they are individualized to the person's patterns of painful movement and positions) and they do not encourage freedom of movement/ideomotor movement."

To me, this is the crux of the matter. Not only do they not encourage freedom of movement, they actively discourage it. The spine is meant to move and the attempts to stiffen it for support are way over-emphasized in my opinion. McGill seems to believe that the spine should never flex. The whole notion of stability leads to the fearful belief in instability and the adoption of abnormal movement patterns. If flexion hurts and I avoid flexion, I am likely to hurt less; however, I am also going to become more restricted into that range and more fearful of performing it. Understanding potential mechanical deformation of the neural tissue requires thinking beyond that potentially imposed by abnormal accessory joint motion or disc bulges.


Ian's article includes the following quote from Mel Siff:
"Research into motor control has never shown that training of individual muscle actions enhances skilled complex motor activities. The maxim of "the body knows of movements, not muscles" is constantly reiterated to emphasise this fundamental point. The learning of the motor skills required to execute a given sporting movement are acquired by regular practice of the movement itself, not by teaching isolated joint or muscle actions that are believed to play some contributory role in the sporting movement."

Agreed - in one sense. This points to the need to differentiate between physical conditioning and skill conditioning (big implications for the discipline of work hardening here). Skill conditioning is very specific. However, contrary to the apparent opinion of many on this board (whose thinking I greatly respect on most issues) physical conditioning through building strength also has many, many benefits. While this may not be directly related to pain, it is still relevant to physiotherapy. Even though neurophysiology is paramount and even if pain is the primary issue we are concerned with treating, the benefits of training the muscular system should not be overlooked IMO. Sarcopenia is a huge problem and, though its effects may take longer to manifest, it will lead to major functional deficits and likely contribute to discomfort. There is value to strength.

Further, McGill's work seems to make to great a delineation between strength and endurance. These are not independent variables and, surely one way to increase muscular endurance is to physically train the musculature.

I want to be clear that strengthening is not my chosen method for treating pain (even though there are some studies that support it - I agree that this falls mostly into cognitive-behavioural changes). However, I think it is the only rational means for treating a number of conditions related to loss of muscle mass that begins at the age of physical maturity. I know every one here focusses on pain and nothing has had more influence on my professional growth than what I have learned from all of you.

Nick

[nari]

Nick

It has always seemed odd that in rehabilitation of the TBI or stroke patient, careful attention is paid to "functional" movements and not exercises for strength. The latter are often applied once the functional improvement has occurred. Admittedly, there is recognition that exercises do not improve strength where brain function is affected.
Yet, faced with a person with an intact brain who has lost ROM and function, has pain and reduced quality of life, the immediate response is often to stretch and strengthen through choregraphed movements. There is rarely an attempt to restore function with neurorehab thinking. I can't base this on studies as I have not found any that compare natural and choreographed movements.
It is this separation between musculoskeletal and neural "conditions" that bothers most of us, and which tends to sway us into neurothought.

However, I agree that with debilitation and inactivity, a general strengthening program is useful. I would also argue that physiotherapists are not the only ones who can do this program; and sending such a patient off to classes run by fitness trainers and the like, leaves us time to treat the tricky dysfunctional patients.

Nari

[Nick]

Good points, Nari. And I agree. Except that fitness trainers usually do not have the knowledge of special conditions that a PT has and, therefore, would have more difficulty developing a program appropriate for special populations, including a program that would not aggravate someone's pain. I think there is a large role for PTs here as well.

Nick

[Barrett Dorko]

Another great post Nick.

And Nari's right; we're necessary when orthopedic problems go bad, as in when they become neurologic problems. Of course, when this happens strengthening procedures take a back seat to our efforts toward recoordination and perceptual problems.

If we're going to handle these patients, maybe we should handle them as Bobath would have.

[nari]

Nick

I was thinking of just debilitated and inactive people being sent off to fitness instructors et al - not those with concomitant pain. They should remain with us, until their pain has largely resolved. An exception might be the person who has not responded to physio intervention or our education and may benefit from group dynamics/structured activity.

Nari

[Diane]

Articles Ian sent to be put here:

Kavcic N, Grenier S, McGill SM. Determining the stabilizing role of individual torso muscles during rehabilitation exercises. Spine. 2004 Jun 1;29(11):1254-65.



University of Waterloo, Faculty of Applied Health Sciences, Waterloo, Ontario, Canada.

STUDY DESIGN: A systematic biomechanical analysis involving an artificial perturbation applied to individual lumbar muscles in order to assess their potential stabilizing role. OBJECTIVES: To identify which torso muscles stabilize the spine during different loading conditions and to identify possible mechanisms of function. SUMMARY OF BACKGROUND DATA.: Stabilization exercises are thought to train muscle patterns that ensure spine stability; however, little quantification and no consensus exists as to which muscles contribute to stability. METHODS: Spine kinematics, external forces, and 14 channels of torso electromyography were recorded for seven stabilization exercises in order to capture the individual motor control strategies adopted by different people. Data were input into a detailed model of the lumbar spine to quantify spine joint forces and stability. The EMG signal for a particular muscle was replaced either unilaterally or bilaterally by a sinusoid, and the resultant change in the stability index was quantified. RESULTS: A direction-dependent-stabilizing role was noticed in the larger, multisegmental muscles, whereas a specific subtle efficiency to generate stability was observed for the smaller, intersegmental spinal muscles. CONCLUSIONS: No single muscle dominated in the enhancement of spine stability, and their individual roles were continuously changing across tasks. Clinically, if the goal is to train for stability, enhancing motor patterns that incorporate many muscles rather than targeting just a few is justifiable.




Effects of different levels of torso coactivation on trunk muscular and kinematic responses to posteriorly applied sudden loads. Clin Biomech (Bristol, Avon). 2006 Jun;21(5):443-55. Epub 2006 Jan 27.

Vera-Garcia FJ, Brown SH, Gray JR, McGill SM.

Faculty of Applied Health Sciences, Spine Biomechanics Laboratory, Department of Kinesiology, University of Waterloo, 200 University Ave W., Waterloo, ON, Canada N2L 3G1.

BACKGROUND: Studies examining rapid spine loading have documented the influence of steady-state trunk preloads, and the resulting levels of trunk muscle preactivation, on the control of spine stability. However, the effects of different levels of muscle coactivation, and resulting spine loads, on the response to a perturbation of the externally unloaded trunk are unclear. METHODS: Fourteen male subjects coactivated the abdominal muscles at four different levels (approximately 0%, 10%, 20% and 30% of the maximal voluntary contraction) monitored by an electromyography biofeedback system while semi-seated in a neutral lumbar spine position. They were loaded posteriorly in two directions (0 degrees and 30 degrees from the sagittal plane) and with two different loads (6.80 and 9.07 kg). Force perturbation, spine displacement and electromyography activity were measured, and torso compression and stability were modeled. FINDINGS: Abdominal coactivation significantly increased spine stability and reduced the movement of the lumbar spine after perturbation, but at the cost of increasing spinal compression. Preactivation also reduced the frequency and magnitude, and delayed the onset of muscle reactions, mainly for the back muscles and the internal oblique. The higher magnitude load and the load applied in an oblique direction both showed more potentially hazardous effects on the trunk. INTERPRETATION: Torso coactivation increases spinal stiffness and stability and reduces the necessity for sophisticated muscle responses to perturbation. Although further investigation is needed, it appears there is an asymptotic function between coactivation and both stiffness and stability. There also appears to be more hazard when buttressing twisting components of a sudden load compared to sagittal components. Patients with trunk instability and intolerance to spine compression may benefit from low to moderate levels of coactivation.

Brown SH, Vera-Garcia FJ, McGill SM. Effects of abdominal muscle coactivation on the externally preloaded trunk: variations in motor control and its effect on spine stability. Spine. 2006 Jun 1;31(13):E387-93.



From the Spine Biomechanics Laboratory, Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.

STUDY DESIGN.: A repeated measures biomechanical analysis of the effects of abdominal bracing in preparation for a quick release of the loaded trunk. OBJECTIVES.: To quantify the ability of individuals to abdominally brace the externally loaded trunk, and assess their success in achieving and enhancing appropriate spine stability. SUMMARY OF BACKGROUND DATA.: Spine stability requires trunk muscle coactivation, which demands motor control skill that differs across people and situations. The quick release protocol may offer insight into the motor control scheme and subsequent effect on spine stability. METHODS.: There were 10 individuals who sat, torso upright, in an apparatus designed to foster a neutral spine position. They were instructed to support a posteriorly directed load to the trunk in either their naturally chosen manner, or by activating the abdominal muscles to 10%, 20%, or 30% of maximum ability. The externally applied load was then quickly released, thereby unloading the participant. Muscle pre-activation patterns, spine stability, and kinematic measures of trunk stiffness were quantified. RESULTS.: Participants were able to stabilize their spine effectively by supporting the load in a naturally selected manner. Conscious, voluntary overdriving of this natural pattern often resulted in unbalanced muscular activation schemes and corresponding decreases in stability levels. CONCLUSIONS.: Individuals in an externally loaded state appear to select a natural muscular activation pattern appropriate to maintain spine stability sufficiently. Conscious adjustments in individual muscles around this natural level may actually decrease the stability margin of safety.

[nari]

Most interesting conclusions; especially in the light of the manip/realtime US imaging thread on RE that has just begun.

Perhaps these papers could be referred to in that discussion?

Nari

[Jon Newman]

Hi Nari,

This window of opportunity business makes it sound like manipulation doesn't have any lasting effect--so better start 'strengthening as pain management' before they start hurting again. Neither of the above makes much sense to me and I don't see how US imaging adds much. Although taking pictures of disks seemed like a good idea when the technology came around so I guess I can see the attraction.

That said, I'm at least glad there is an effort underway to begin strengthening after someone hurts less if strengthening is deemed necessary.

[nari]

jon,

I agree with your sentiments but did not express them as openly as you did.
I suspect sending the above papers would not go down too well...

To me, it is the pervasive meme that one can see pain which holds therapists in its grip. It is a bothersome one.

Nari

[Jon Newman]

It's bothersome? Are you going for the understatement of the year? It seemed like so many in that conversation have contributed so much and come so far with an appreciation for the neurobiology of pain and all of a sudden it's "quick! let's spend our research dollars on taking a picture".

[nari]

jon,

As a person who enjoys a bit of sarcasm, you should appreciate that an understatement can convey a strong emotion...;)

Nari

[Jon Newman]

Author: Brown, Stephen H. M. MHK; Vera-Garcia, Francisco J. PhD; McGill, Stuart M. PhD

Title: Effects of Abdominal Muscle Coactivation on the Externally Preloaded Trunk: Variations in Motor Control and Its Effect on Spine Stability.

SourceSpine. 31(13):E387-E393, June 1, 2006.

AbstractStudy Design. A repeated measures biomechanical analysis of the effects of abdominal bracing in preparation for a quick release of the loaded trunk.

Objectives. To quantify the ability of individuals to abdominally brace the externally loaded trunk, and assess their success in achieving and enhancing appropriate spine stability.

Summary of Background Data. Spine stability requires trunk muscle coactivation, which demands motor control skill that differs across people and situations. The quick release protocol may offer insight into the motor control scheme and subsequent effect on spine stability.

Methods. There were 10 individuals who sat, torso upright, in an apparatus designed to foster a neutral spine position. They were instructed to support a posteriorly directed load to the trunk in either their naturally chosen manner, or by activating the abdominal muscles to 10%, 20%, or 30% of maximum ability. The externally applied load was then quickly released, thereby unloading the participant. Muscle pre-activation patterns, spine stability, and kinematic measures of trunk stiffness were quantified.

Results. Participants were able to stabilize their spine effectively by supporting the load in a naturally selected manner. Conscious, voluntary overdriving of this natural pattern often resulted in unbalanced muscular activation schemes and corresponding decreases in stability levels.

Conclusions. Individuals in an externally loaded state appear to select a natural muscular activation pattern appropriate to maintain spine stability sufficiently. Conscious adjustments in individual muscles around this natural level may actually decrease the stability margin of safety.

Late entry:
Oops. I didn't realize this was already one of the abstracts Ian had posted. Ah well. Hey look kids, there's Big Ben, and there's Parliament.

[nari]

This is a worthy rebuff to core stability buffs.

Somehow, it makes sense. The Qld studies did not seem logical, but maybe that is just my interpretation.

Thanks Ian

Nari

[Diane]

I look forward to reading the whole thing! I see it hasn't even been published quite yet. I look forward to the demolishment of this incredibly tenuous construct (TrA conditioning to "stabilize" spine) that everyone leaped onto as if it were PT salvation or something.

[Randy Dixon]

I'm not sure where this hostility towards core stability comes from. Then again, perhaps I do, I know when legitimate ideas like "functional training" become popular and gimmicky and the real value they had is lost, I get the same feeling.

The TrA activation/stability model is unlikely to go away anytime soon. Why? Because the evidence of its efficacy is growing. I've seen some ideas attributed to this model on this forum that the original researchers didn't make. It's pretty simple, the TrA was shown to be inhibitied in LBP patients, there were also biomechanical changes, the sequence of these three things wasn't known, did the pain cause inhibition, or the inhibition cause mechanical deformation which caused pain or any version of these three.(This may have been resolved since I last studied the research) It was shown that the TrA could be selectively activated, and that this seemed to break the cycle. They didn't suggest that the TrA was the only, or even the most important muscle in stabilizing the spine, or that TrA activation should be consciously performed after the dysfunction was corrected, or that functional activities are not part of "core strengthening" or that things such as perturbation and extremity loading had no value. Basically they found a neuromuscular patterning problem that could be resolved by consciously changing the pattern. I don't know why there is so much resistance to this idea on a neuroscience forum.

[Diane]

Randy, I guess we'll all know more when this paper gets published. I gather it is a balanced deconstruction of the "myth."

I can't speak for everyone, just me, but the issue I always had with it was that it was a meme that got out of control, a runaway meme. Maybe the TrA was not the only muscle that mattered, yet I saw brochures in clinics depicting "hoops" around the lower trunk suggesting that TrA was the only muscle that mattered, and it was from one of Paul Hodges own slides. (I went to hear him speak about it, explain his research. Heard all about pigs and bacon and anal probes.)

There was a real craze on for awhile, but the brochures gradually disappeared, thank goodness.

Basically they found a neuromuscular patterning problem that could be resolved by consciously changing the pattern. I don't know why there is so much resistance to this idea on a neuroscience forum.

My question to you would be, what happens when people let go of their conscious contraction of their TrA as soon as they get distracted? Does the back pain come straight back? Or is it supposed to be gone once they've learned to resolve the neuromuscular patterning problem (if indeed that is even possible..)? If I have back pain, and holding my belly button in against the front of my spine "helps", am I supposed to hold it in the rest of my life? How will my diaphragm, how will my autonomics like that idea?

[nari]

Randy,

I think the runaway Tr/Multifidi/pelvic floor meme is the problem; I don't think anyone denies that contracting TrA doesn't change pain, because it does, during that contraction phase. But a few other bits and pieces are bound to be joining in as well....

The long term management is dodgy.
In the 'old' days, mid 80s, everyone went beserk on pelvic floor retraining (--> 350 times a day) and abdo bracing, to bring out the obliques to provide balance against RA. Eventually, the notion went away, teachers became less fanatical and incorporated the principle into general exercise.
If we think in terms of a few weeks of TrA and/or M activation actually providing that stability long term, then that's fine. But is it true?

Nari

[aléa]

I thought that the goal of this was to re-integrate those muscles in the "body-scheme" ( schéma corporel ). To think that the goal is to have people to always lock their lumbar region is weird. It's true that i see prescriptions like that, but I'm not forced to follow it strictly. To me, working on core stability is more like proprioception.
It's not the idea that is bad, it's its application.

[bernard]

Aléa,

I do not think so anymore. We are mixing automatic muscular activation with planned voluntary exercices that use these muscles. It is the best way to imbalance the system.

[aléa]

we can do the same without planed exercises, with proprioceptions exercises, par exemple sur les ballons de Klein ( Klein's balloons ? :D ), or doing exercises in an upright stance that make the arms move against a resistance => the trunk has to be stabilized.

And could a little bit of "reminding" the existence of those muscles to the mind be bad ? For example, I know that you use a lot of breathing : isn't it a reminder ?

[Randy Dixon]

From what I have read so far, the problem people are having with this idea is the same one I have, they have taken an idea for a specific exercise for a specific purpose and gone haywire with it. I agree that there are those who still teach the "suck in the tummy" or other bracing approach which doesn't have any place in creating normal movement. Most the therapists I know, know better. Also bracing does have its place. If someone is going to deadlift a weight that is equivalent to small horse they had better be "bracing".

[nari]

True TrA contraction does not involve 'sucking' in; it is subtle and felt, rather than seen. Randy, I think this is what you are saying. Those who 'suck' in the belly area are including more obliques and RA. The knack, is to exhale if using TrA to brace for heavy weightlifting.
Possibly, overuse of this movement can lead to a sense of false security,

Nari

[bernard]

If someone is going to deadlift a weight that is equivalent to small horse they had better be "bracing".
Bracing is done automatically. You are just trying to do the job. You do not think to brace but surelery to breath.

[aléa]

It's not always done automatically, it also depends on the position someone take when lifting. Someone cannot brace, although breathing ;), if the lower back is completely bend. But that's ergonomics.

[bernard]

Alea,

You miss the thing. None can lift anything with a bend back.:D
You use your buttock/legs. ;)
here is a fine example =>
http://www.swt.bz/oldswt/exercices/olympic.php

[aléa]

Je pensais que c'était ce que j'avais écrit, j'ai encore quelques petits problèmes d'anglais ;)

[bernard]

Aléa,

Sorry, after reading again your post, it is what you seemed to say.:embarasse

[Randy Dixon]

Ok, your English may not be perfect, but my French is nonexistent. You both lost me, but it looks like the guys lifting are bracing, notice the protruding cheeks on the guy doing the snatch.

Nari,

I used the "suck in the tummy" because that is the way I see it described by those who advocate doing it all the time. This "hollowing" as a way to provide stability doesn't have any place in lifting weights either.

[bernard]

Randy,

Sorry for the French sentence. She was telling me that I misunderstood her position. It was true.:o

Randy,

Lifting such a weight is not light affair.
Look carefully to the pictures and you'll see that in the first one, back is not bend because the man know that he has to pull the bar. The top of the back is in static extension, only transmitting the forces.
When the man begins the snatch, his main goal is done with legs and he has to put the weight over his low back passively, just by moving the body under the bar.
Abs are solicited to stabilize an eventual fall of the bar but it is done very quickly and dynamically with obliquus. It let the Tranversus free to move for breathing.

[Randy Dixon]

Bernard,

I'm not sure what we are discussing. Did you think I was advocating specific TrA activation when lifting weights? I call that "hollowing" and I definitely don't recommend it. What I do recommend, when lifting near maximum, is "bracing" which is done primarily through breath control, almost like a Valsalva maneuver. This is what the guy doing the snatch is doing.

I'm not sure how the back position comments tie into that.

Don't worry about the French, I actually could figure that much out, and besides I have no problems with people using the language they understand best, its my fault if I don't understand it.

[bernard]

Randy,

I think that we are saying the same thing with different words.

I'm against lifting weights with a tight back and TrA contracted. It is the best condition to bring problems.

[Jason Silvernail]

Well, I have a lot more to say on the general core stability topic, but work is a bit crazy at the moment.
I want to post this plan for a RCT, as well as mention that those researchers involved in LBP are really moving away from concepts such as "Stability" and "Strength" and more toward "Motor Control". Just looking at the title of this paper should really help us realize that our researchers are beginning to change the terms of the debate from stabilization to motor control.

I personally believe that it is this motor control, and not some 'stability' construct, that allows movement toward pain relief.
I think that these "stability" exercises work in many cases for the same reasons manipulation works in many cases - it connects the brain to the body and allows ideomotor correction of the relevant mechanical deformation. Don't have much time to go into too much detail right now, but please feel free to post your thoughts on this aspect as you read the paper.
Thanks.
J

[John A. Casler]

Randy,

I think that we are saying the same thing with different words.

I'm against lifting weights with a tight back and TrA contracted. It is the best condition to bring problems.

Hi Bernard, et al,

Please forgive me for jumping into this post so late, but I only today found your listserve/forum.

First, while I lecture/present/workshop on what I have coined. "THE TORSO STABILIZATION MECHANISM", I do not claim to know all there is regarding the subject and look forward to possibly learning and sharing information.

Please do not take my opines as "truth", but only perspective analysis from my awarness, education, and expereince.

On a general level, I would say that I feel many have a large grasp on the processes, structures, and mechanisms that provide a "modulation" of the plasticity of the torso to allow it to create, transmit, and absorb force.

I think were many seem to start stepping out of the boat, is when they try to "generalize".

The TSM (Torso Stabilization Mechanism) is actived in various forms and degrees, during every hour of our "98.6" existance.

But the breath or coverage of this "support system" is applied all the way from spinal support while we sleep, to squatting with 500# on your back.

The Plasticity variance is from "minimal" to maximal, and the difference is LARGE.

Now, along that road, I have seen a few advocate and reject some Muscular Actions.

Of particular interest is the TvA and its role, as well as its particular activation, and why.

I might first suggest that the TvA is "only" a small part of the TSM and is "only" of any serious effect, when it activates "full tension" ability, in concert with the rest of the abdominal complex,

AND....is forced into static/eccentric action via the abdominal contents, being compressed to cause this Maximum Potential via IAP (Intra-Abdominal Pressure)

The reason it is the first to activate, during "minor loadings" or torso stresses, is that it is a "low cost" player, that offers a "non-rigid" support to the Lumbar Spine.

The TvA provides this by:

1) creating a mild compressive force to the abdominal contents. This very light IAP will provide a supportive force to the anterior spine, from the pelvic floor, to the diaphgram.

2) It creates a small rigidity to the lower abdominal wall.

3) It creates a light lateral tensioning to the ThoraColumbar Fascia, introducing both lateral and horizonal stabilities on a fully and instantaneously adjustable level.

But remember, I said the TvA is a "small" bit player, so the above is only to offer functional thought.

And excuse me for jumping arround, but there were comments made about bracing for weight training lifts.

The amount of bracing and stability one might use for lifting a heavy load is usually quite large.

It is "VOLITIONAL", and it well should be. The body IS NOT usually set up for "maximum efforts" with anything but a "guide" reflex. It has not been programmed to naturally respond to un-natural or force maximum loads.

Anyone who attempts, a maximum lift, without volitional activation is living dangerously, is likely to sustain injury, and or will not reach their maximum potential in the action.

The add another point regarding "who" needs learn how to volitionally control the TSM.

Those who suffer pathologies that need the TSM to provide adequate support for either healing, or daily activities without re-injury.

Those without injuries, can rely on reflex, for the right degree of support. Those with exisiting problems, need to participate in the TSM to the degree nessessary to allow healing and provide support.

[bernard]

1) creating a mild compressive force to the abdominal contents. This very light IAP will provide a supportive force to the anterior spine, from the pelvic floor, to the diaphgram.

I can't support this point of view. If you use an anterior force (the resultant force of the activation is anterior), it will automatically adds a load on the spine.

[John A. Casler]

I can't support this point of view. If you use an anterior force (the resultant force of the activation is anterior), it will automatically adds a load on the spine.

Hi Bernard,

Please notice I didn't say "an anterior force". I said the goal is creating IAP.

The actual "pressure force" of IAP is equal in all directions, but will in fact create a "supportive, Hydraulic type pressure". The resultant force "resists" the anterior flexion of the lumbar spine, or if there is a lack of flexion, then is simply supplies anterior support.

Please understand that there are many levels of this support force and various degrees, of activations to move through these activations, which modulate as needed within the current ability of the system.

With this force being created by tensioning the abdominals, the force will look for a means to escape. (the old path of least resistance)

This force can, as I said, resist anterior compression, but moved to the next level by the compressive addition of the diaphgram , it will be actually creating a "decompressive" (internally created version of traction) to the spine.

If you wish to see this type of hydraulics in a simple action, simply take a full tube of toothpaste.

Grab it in the middle and your fingers will be your abs, and you hand the internal lining of the pelvic cavity.

If you squeeze the tube (compressing the contents) this will force the toothpaste "up and down" in the tube, because that is the path of least resistance.

If the tube is new and full, you will likely be able to see that the rigidity of this rather flacid tube becomes quite substantial.

As well it would also be quite supportive compared to the tube without the pressure created by this compression. This is all "simple pressure dynamics".

While many don't fully understand the role if the pneumatic (ITP) and hydraulic (IAP) forces in the torso, they are quite relevant to the TSM and stabilization of the Torso and Spine.

They, as well, are "instantly" modulated and easily controllable, via multiple mechanisms of glottis control and muscular tensions, either volitional or reflexive.

I don't mean to "overstate" the importance of this portion of the TSM. It is simply a player, that sums with the others, as needed.

I might also add that the internal pressure, while being compressed by the abs and diaphgram is also pressing "equally" out against an oblique arrangement of anterior abdominal muscle layers, that "now" are rigid under tension. This forms a highly efficient and well leveraged system of frontal support.

This rigidity, with an already effectively leveraged ribcage (levers from the Thoracic spine) filled with IAP, then forms a very formidable mechanism to control and resist lumbar spinal flexion and loads via a highly developed feedback system.

Again, this is but a portion of the whole system, which "interacts" in a very complex manner in most every positition and action we are involved in.

And finally, the spine is a remarkable piece of engineering, and will, if operating with all its support systems be able to "manage" significant force/loads "IF" it is supported and in effective attitudes.

In fact, some of the mechanisms to to creating effective Torso Stability hinge on actually loading and compressing the discs in a way that actually makes them "less" at risk and more safe, which again might not be immediately evident to those who don't see the disc/vertebra mechanics at work.

[bernard]

Please notice I didn't say "an anterior force". I said the goal is creating IAP.

The actual "pressure force" of IAP is equal in all directions, but will in fact create a "supportive, Hydraulic type pressure". The resultant force "resists" the anterior flexion of the lumbar spine, or if there is a lack of flexion, then is simply supplies anterior support.

John, it is simply not possible. If you increase the internal pressure, you increase the forces in all directions, as you said, and thus, trend to deform the anterior wall => the only solution is then to increase the anterior force and mandatory the posterior (spinal) one. Normally it will bend the chest forward but the spinal muscles will act => increased pressure on discs.

[Randy Dixon]

I am not sure I understand you Bernard but increasing IAP does not have the same effect as contracting the rectus femoris, which is what you seem to be saying. I think you may still be confusing hollowing and bracing. Do a vasalva maneuver, does it cause you to bend forward? If it does then you aren't doing it correctly.

You may be correct that it does increase the forces on the disc but you have to keep two things in mind, (at least), that this is under a heavy load and that it is the axes and planes of the forces in play that is important.

[bernard]

Randy,

just try this static example: Put a hand on the belly and the other one on your back. Contract the TrA and feels what it happens?

The lumbar area contracts => increased pressure on discs. The best way to lift a load without such forces is... to avoid them. :angel:

[John A. Casler]

John, it is simply not possible. If you increase the internal pressure, you increase the forces in all directions, as you said, and thus, trend to deform the anterior wall => the only solution is then to increase the anterior force and mandatory the posterior (spinal) one. Normally it will bend the chest forward but the spinal muscles will act => increased pressure on discs.

Hi Bernard,

Yes, pressure from IAP is forced into the posterior abdominal cavity which is anterior to the disc/spine. This pressure is "distributed" via all the tissue walls and fascia (such as the ThoraColumbar Fascia)

Take a balloon and draw a "dotted line" on it, and then blow it up. Do the lines flow together or grow farther apart? This then is the "action" associated to IAP. It illustrates the pressures ability to support load, reduce anterior pressure, and resist compressive forces.

Now I know your tendency is to say that the line also "flexes". That is so, but this (excuse the pun) doesn't happen in a vacuum. There are other active and passive hard and soft tissues to control this. You cannot take a single Stabilization Process and examine it, without understanding how it works with the whole.

Additionally, it is OK for the spine to "flex" if the load forces are supported.

To advocate not doing this is incorrect. I Strength Train with free weights, and have studied this for over 40 years. I have suffered back injury back in my teens, which plagued me with several yearly visits. While the injured disc has only healed to the point that it can, the weakness is still there, yet with the correct Torso Stabilization techniques, I can use over 400# for repetitions in the Free Barbell Squat.

The TSM is complex, but once you are able to grasp its function and capabilities, and introduce them into your awareness and then into you daily life, your Torso and Spine will function at their highest capability.

[John A. Casler]

Randy,

just try this static example: Put a hand on the belly and the other one on your back. Contract the TrA and feels what it happens?

The lumbar area contracts => increased pressure on discs. The best way to lift a load without such forces is... to avoid them. :angel:

Hi Bernard,

I'm afraid I am going to have to strongly disagree with you and suggest that you may not have trained with loads large enough to fully understand the capabilities of Torso Stabilization Mechanisms.

That "lumbar contraction" you think you are feeling is a little bit more than that.

The TvA flows into the ThoraColumbar Fascia. When the TvA is tensioned, the fascia also tensions, and creates "lateral" stabilizing forces on the Lumbar Spine.

That is a "desired" stabilization action, and even though it is a "lateral" tension, it stabilizes in all directions, as well as beginning to reduce the mobility of the vertebra, which is a modulated stabilization.


Discs, WILL be loaded. It is the most safe and effective management of these loads that is important.

To advocate not implementing these supportive actions will not serve you well.

And please understand, I have entered a thread "on going" and maybe you have encountered theory and rhetoric of some and projected a bit of that into my suggestions.

I can only assume, that once you have assimilated the "complete" system, you will understand its implementation and value.

[Jason Silvernail]

McGill speaks of the "compressive penalty" involved in good trunk stabilization, and I think it might be useful to look at it this way.
I agree with John in that the studies that I have read support his explanation of what happens. We can't have a really stable trunk that can resist large forces without creating compression as part of the deal.

For those people in rehab who are sensitive to compression (best example are those recovering from recent painful disc herniation or lumbar fusion surgery) need to be progressed gently, and mechanisms of the TSM that do not create this compressive penalty (such as TVA motor control work) are started first.
Compression isn't bad. It's absolutely necessary for good stability.

[bernard]

John,

Your last two posts will make my day.
You suppose that I'm a novice with the "ballon" stuff and that is true: Reducing the concept to a ballon is exactly where is the flaw in the theory => You are just seeing and telling us that the walls of the ballon expand but it is well known that the internal pressure augments creating a tension on the walls, themselves.

If you create a tension on the walls (abs) by the internal force/pressure, you have two things that happen:
The belly tries to expand
The tensions of the walls augmentbut you are saying that is is important to limit the belly expansion. Ok, and how is it done? By increasing the stiffness of the anterior wall (the belly) and increasing the stiffness is exactly the same as doing a flexion without moving but the abs were working and if they worked, a counter reaction was automatically created: the lumbar area worked too.

Secondly I must advocate that your point of view is just thwarted by the constant complant of our population:

In 1900 there was 50% of population suffering of LBP.
In 2005 there is just a bit more...;)

If your theory was "good" the epidemy must have had died quickly since the brilliant principles of the ballon was applied. It is just the contrary that happened: I know: Patients do not understand the principles you think good for them. That's true, they do not understand that you are applying theories born in minds of static thinkers. That is not pejorative but they missed the beauty of our spine with its extraordinary flexibility and curvatures.

[bernard]

We can't have a really stable trunk that can resist large forces without creating compression as part of the deal.

Jason,

The "stable" thing is a misconception: We are dynamic creatures and trunk doesn't escape to this "fate".

Just look at the sherpa that is walking and climbing Himalaya. If he applied your principles then the course will end at its start.

[bernard]

John,

Just try this african experience with a tight belly. :angel:

[bernard]

Or just make this easy walking (100kg) over few kilometers.
I'm sure that this unfortunate man doesn't try a second to think about his belly.

[John A. Casler]

John,

Your last two posts will make my day.

Don't tell me you are the French Harry Callahan?



You suppose that I'm a novice with the "ballon" stuff and that is true: Reducing the concept to a ballon is exactly where is the flaw in the theory =>

I might stress this is not theoretical. If there is a flaw, it is my inability to convey the concept and possibly the "large" if not HUGE chunks that sum with this process to create stability.




You are just seeing and telling us that the walls of the ballon expand but it is well known that the internal pressure augments creating a tension on the walls, themselves.

If you create a tension on the walls (abs) by the internal force/pressure, you have two things that happen:

The belly tries to expand
The tensions of the walls augment
but you are saying that is is important to limit the belly expansion. Ok, and how is it done?

I don't recall stating any "specific" importance of limited expansion, other than the fact that "controlled compression", is what creates and modualtes the pressure. The pressure itself is "created" via several mechanisms working together and to varying degrees.

The "key" elements are the diaphgram, and tensioned abdominals, but a few more are listed below:

First one inhales and inflates the lungs and subsequently the rib box. This is done with a rather relaxed abdomen, allowing the abs to distend to accommodate the intrusion from above, by the diaphragm.

Then the glottis is closed trapping the air in the lungs.

The muscles of the ribcage and thorax then compress the ribcage slightly (again with a closed glottis) which creates the ITP.

This compression stiffens and stabilizes the whole upper torso enclosed by the ribs. (Did you ever wonder how those really small discs of the thoracic spine can sustain the heavy loads of 400# plus of Powerlifters?)

The abs are then concurrently tensioned to modulate the needed IAP and create a rather rigid, semi-solid front wall that adds support to the Abdomen/Lumbar Torso. This is easily modulated via all the muscles that cause this compression as well as glottis control allowing reduced or additional IAP.




By increasing the stiffness of the anterior wall (the belly) and increasing the stiffness is exactly the same as doing a flexion without moving but the abs were working and if they worked, a counter reaction was automatically created: the lumbar area worked too.

You may have to explain a bit more about "flexion without moving" since that "to my limited knowledge" is impossible.

Is it possible you are calling the static muscle action of "tensioning", flexion???

However, in any joint where stability is desired, the antagonists statically tension against each other to the degree needed to cause stiffness or stability to the region. The spine is no exception. With the main goal of supporting the anterior disc surface while simultaneously compressing the posterior surface this is a normal and desirable situation.



Secondly I must advocate that your point of view is just thwarted by the constant complant of our population:

In 1900 there was 50% of population suffering of LBP.
In 2005 there is just a bit more...;)

I have no idea why you feel my suggestion is "thwarted" or in any way has something to do with those suffering from LBP.

It took me years to sort this all out, and with such errant paths being taken by the Richardsons, Julls, et all, it has been an interesting journey.



If your theory was "good" the epidemy must have had died quickly since the brilliant principles of the ballon was applied. It is just the contrary that happened: I know: Patients do not understand the principles you think good for them. That's true, they do not understand that you are applying theories born in minds of static thinkers. That is not pejorative but they missed the beauty of our spine with its extraordinary flexibility and curvatures.
__________________
bernard

Again, I haven't seen anyone, with the exception of McGill get it right. I agree that there are a lot of "static" thinkers in the field and that is no doubt an impediment. Even you, who should already know and understand this, as one who is in this area, have trouble understanding. (I accept responsibility via the limitations of this medium)

My comments are based on scientific application and understanding of the processes and structures.

I do have theories, that stem from the evolutionary paths and adaptations which seem to be well thought out but are open to further exploration, but right now they fit, and offer additional support.

[John A. Casler]

Jason,

The "stable" thing is a misconception: We are dynamic creatures and trunk doesn't escape to this "fate".

Just look at the sherpa that is walking and climbing Himalaya. If he applied your principles then the course will end at its start.

Bernard,

It would appear from your examples that you are not fully understanding how this works.

Maybe you could start by explaining what is "supporting the Torso" on the Sherpa, and why he "ISN'T" using the TSM.

To think that he is supporting and lifting these (supposed) loads without "stabilization" forces would stretch the imagination.

Possibly, it is an argument of "degrees" of activation, in which case there is no argument.

[bernard]

Don't tell me you are the French Harry Callahan?

Sorry but my short dynamic gun is called "physics"' and you're dead! :D

[bernard]

John,

Here is my first shot:

The thread is dédicated to a PT method that has nothing to do with exceptional and useless contests that have good chances to bring some body damages.

I do not see patients who lift 400 lbs in their daily activities. I just do not care of such silly things.

I'm talking about men and women who are able to smash down your athletes because they are able to make their jobs over hours, everyday... And you seem unable to understand that it is important, in that case, to forget strength and stiffness and take in place, elegance and placement.

[bernard]

Second shot:

Why the spine presents curvatures?

[bernard]

Take some time for a simple reply.

[bernard]

third shot:
The Nature's lesson (http://www.somasimple.com/forums/showpost.php?p=15814&postcount=69)

http://www.somasimple.com/forums/showpost.php?p=15842&postcount=74

[Randy Dixon]

just try this static example: Put a hand on the belly and the other one on your back. Contract the TrA and feels what it happens?

The lumbar area contracts => increased pressure on discs. The best way to lift a load without such forces is... to avoid them-Bernard

You are confusing Tra contraction with bracing, they are not the same thing, I don't think you are understanding the concept, also yes without a load you increase the load on the discs. Under a load you may also, but you lower the shearing forces.

You seem to think that this irrelevant to the general population since they don't lift extreme weights, but nearly everyone at some point does lift as much as they are able. Those you are arguing with don't seem to be advocating what you seem to think they are advocating. We have not suggested that one walks around bracing continously, or that is even possible and we have not suggested going around concentrating on TrA activation. We all understand that there is a constant shifting between stability and mobility in the spine and that this is normally best left to the organism to adjust. What we do say is that there are times when volitional control is beneficial, such as when lifting a very heavy weight.

[Diane]

I'd be interested in a bit of a rundown of the evolutionary ideas supporting this idea of yours, John.

The whole idea of using abs to brace the back seems a bit weird to me, always has. How is a person supposed to breathe if their abs are tight in order to hold their back "stable"?

The sherpa (great example Bernard) not only has a huge load to carry, he is climbing a hill (!), and therefore using a lot of breath, moving his diaphragm maximally one would imagine (abs relaxed enough to permit abdominal excusion/displacement), and as he climbs his back cannot possibly be behaving statically - it has to be free to adapt (rotate and sidebend, flex and extend, first on one side then the other) as the right leg goes up the hill, then the left, then the right..

I think the extensors do all the work of stabilizing, and when abs are thrown in, this action serves to briefly unload (possibly nociceptive) obliquely fanning nerve roots issuing from the thoracic and lumbar spines through some sort of uncomfortable part of their neural glide range, not to reduce pressure on joints in the spine. At least not functionally, or for more than a couple seconds, or the breathing cycle and all its attendent respiratory physiology would get seriously messed with.

I think trying to assign abs a role in providing stability to spinal joints is to indulge a mesodermal fantasy.

[Diane]

I think it was Susan Mercer (anatomist) who did a study of TrA on a series of cadavers, and learned that they had widely varing anatomy that ranged from a regular muscular TrA, to just a fibrous sheet with no contractile fibres, to a few contractile fibres in odd spots at different levels. Somehow people with no TrA get through life ok, have babies, climb hills.. shucks, even those with diasteses have babies. I just think abs are way overrated, over-obsessed about, over trained, overly contracted for no good reason, that's all. Functionally they are like intercostals without ribs, in fact they derive from the thoracic segments embryologically, helping extend the breathing mechanism, are not meant to support the lumbar spine they happen to live in front of, geographically. What is working the front of the actual spine are quadratus and psoas.

[bernard]

also yes without a load you increase the load on the discs. Under a load you may also, but you lower the shearing forces.

Randy, you think statically there.
The stabilization is just an illusion like you're training a sprained ankle with such a device (photo). There is a constant muscular readjustment that may be viewed as a bracing or a constant activation. This is not the case and the muscles contract and relaxe very quickly because if they do not you will override the stability (Newton law) and if you act voluntarely then you will add a muscular component that is unecessary. The resultant force is just irrelevant.

When you train people to be stiff and brace their bellies you'll have some good chances to aggravate the problems they have and diminish the chances their torsos may move quickly.

I may provide a body snatch example that proves the back extends and the belly expands in the same way during the lift of the load. It is mandatory. :angel:

[bernard]

about this image (http://www.somasimple.com/forums/showpost.php?p=28325&postcount=78) read this

http://indahnesia.com/indonesia/JAWSUL/gunung_ijen.php

The climb out of the crater had been excruciating, with scarcely any reprieve from the fumes or my head, that had felt on the point of erupting itself. Yet the miners I had passed carried more than I weighed on their backs, a feat that seemed impossible.Impossible? No just look at the image and find the solution they found.

Jagged lumps of sulphur—some stuffed and bound into sacks, some heaped to overflowing in plaited baskets—but always in pairs, and always betwixt a slender yoke that flexed in rhythm to the bearers strides.

[Jon Newman]

I'd benefit from some clarification by those advocating for "core strengthening". First, is there something else you'd rather call it than core strengthening?

Second, is the activation of muscles prescriptive or descriptive? That is, does one need to be told to do this or is this a description of what happens when people lift heavy things?

Third, is this "preventative" advice as well as rehabilitative? I'm familiar with people feeling better after being instructed about such things but I'm not familiar with any preventative studies.

Thanks.

[John A. Casler]

Sorry but my short dynamic gun is called "physics"' and you're dead! :D

In order to use physics in Torso Stabilization, you need to be able to apply it through BioMechanics.

Forces and their affect on various structures, as well as how we manage them, is very complex and important.

[John A. Casler]

John,

Here is my first shot:

The thread is dédicated to a PT method that has nothing to do with exceptional and useless contests that have good chances to bring some body damages.

I do not see patients who lift 400 lbs in their daily activities. I just do not care of such silly things.

Hi Bernard,

I only used the Strength Training examples responding to your quote below:

I'm against lifting weights with a tight back and TrA contracted. It is the best condition to bring problems.


Also your picture examples of the Sherpa, and those with large loads on their heads don't exactly look like normal daily activities, to most of us.





I'm talking about men and women who are able to smash down your athletes because they are able to make their jobs over hours, everyday... And you seem unable to understand that it is important, in that case, to forget strength and stiffness and take in place, elegance and placement.

Not sure what "smashing athletes" has to do with anything, but again the failure of this medium precludes good communication.

I have not, and am not stating that any and all activities of the Torso require "maximum" activation of the mechanism (TSM). This mechanism is activated and modulated as needed to fit the dynamic requirements of the structure and force, from flexible and plastic, to rigid and stable.

[John A. Casler]

just try this static example: Put a hand on the belly and the other one on your back. Contract the TrA and feels what it happens?

The lumbar area contracts => increased pressure on discs. The best way to lift a load without such forces is... to avoid them-Bernard

You are confusing Tra contraction with bracing, they are not the same thing, I don't think you are understanding the concept, also yes without a load you increase the load on the discs. Under a load you may also, but you lower the shearing forces.

You seem to think that this irrelevant to the general population since they don't lift extreme weights, but nearly everyone at some point does lift as much as they are able. Those you are arguing with don't seem to be advocating what you seem to think they are advocating. We have not suggested that one walks around bracing continously, or that is even possible and we have not suggested going around concentrating on TrA activation. We all understand that there is a constant shifting between stability and mobility in the spine and that this is normally best left to the organism to adjust. What we do say is that there are times when volitional control is beneficial, such as when lifting a very heavy weight.

Well stated Randy.

Again, the ability to discuss a subject so complex is very difficult

[kongen]

Hi all!

This might be related to this discussion... An article I have collecting dust but will read this time around :)

Anders.

[John A. Casler]

I'd be interested in a bit of a rundown of the evolutionary ideas supporting this idea of yours, John.

Whew!!! I don't have the time to explain the whole concept (takes quite some time in my workshops), but in essence, for millions of years the spine was not "axially" loaded. It was supported between forelegs and hind legs.

Just take a look at the "physics" it had to deal with "suspended" horizontally in that manner.

You will immediately see that gravity itself maintained a compression to the ventral (posterior to us) disc and various flexors, including the abdominals provided a modulated supporting force to keep the torso in position and the load to disc surfaces correct.



The whole idea of using abs to brace the back seems a bit weird to me, always has. How is a person supposed to breathe if their abs are tight in order to hold their back "stable"?

I wish you could attend one of my workshops, and see how simple and understandable it is.

See a lot of PTs and Researchers get hung up on "parts" and local musculature and systems. Loads and forces are applied to the body as a whole.

We need not look exclusively at the spine, but at how it functions within the Torso.

ALL muscular antagonists are arranged to co-contract and supply stability to the joints they service. The spinal flexors and extensors are no different.




The sherpa (great example Bernard) not only has a huge load to carry, he is climbing a hill (!), and therefore using a lot of breath, moving his diaphragm maximally one would imagine (abs relaxed enough to permit abdominal excusion/displacement), and as he climbs his back cannot possibly be behaving statically - it has to be free to adapt (rotate and sidebend, flex and extend, first on one side then the other) as the right leg goes up the hill, then the left, then the right..

Again such is the failure of the medium. The Sherpa (and we have no idea what that load is) most certainly has significant "tension" in the abs. Additionally, your observation that he likely is not tensioning his spinal extensors is also true, since they are likely being adequately compressed via the axially placed load.

Does he have IAP? Of course, since compressing the abs, which he must do to keep the load from causing him to fall backwards, will also create "some" IAP.

I think it is important not to get hung up (again) on a small portion of the TSM, but to recognize the importance of each part of it, and how it functions and contributes to various loads and forces.




I think the extensors do all the work of stabilizing, and when abs are thrown in, this action serves to briefly unload (possibly nociceptive) obliquely fanning nerve roots issuing from the thoracic and lumbar spines through some sort of uncomfortable part of their neural glide range, not to reduce pressure on joints in the spine. At least not functionally, or for more than a couple seconds, or the breathing cycle and all its attendent respiratory physiology would get seriously messed with.

I think trying to assign abs a role in providing stability to spinal joints is to indulge a mesodermal fantasy.
__________________
Diane

Mesodermal Fantasy????

I can assure you this is not a fantasy. I can only wonder as to how you could begin to even question such, but I have no idea as to your level of awareness on the subject.

I can only suggest that you "broaden" your view. In order to completely understand the Biomechanics of how various force loads impact the body. As I stated before, each and every joint that has antagonists, uses them to create stability. The Torso is far more complex than that and has, at its disposal, active and passive tissues, structures and processes that sum to create the Torso Stabilization Mechanism.

And please understand that "extreme" IAP and ITP are only used under the largest loads, and requirements, so there is no need to "hold your breath" constantly.

But if you are athletic at all or have any experience with lifting objects, you will have no doubt experienced the "reflexive" glottis closure, and creations of these pressures without you even thinking about them.

[John A. Casler]

I think it was Susan Mercer (anatomist) who did a study of TrA on a series of cadavers, and learned that they had widely varing anatomy that ranged from a regular muscular TrA, to just a fibrous sheet with no contractile fibres, to a few contractile fibres in odd spots at different levels. Somehow people with no TrA get through life ok, have babies, climb hills.. shucks, even those with diasteses have babies.

Hi Susan,

Please don't misinterpret my suggestion as similar to those who feel the TvA and Multifidus are the "Golden Bullets". (especially those who advocate "sucking in")

Your information is relevant and meaningful. A TvA without the ability to shorten is "still functional" for extreme spinal loading, in that it is most significant for its "transverse" orientation which, along with the other abdominals creates a perfect "containment" for the IAP. And even without tensioning ability, it is still connected to the Thoracolumbar Fascia which when tensioned causes stability to the lumbar spine. The TvA need only have IAP applied to it causing it to distend or bulge (what some might call pushing the abs "OUT") to create this tension and contribution to stability.



I just think abs are way overrated, over-obsessed about, over trained, overly contracted for no good reason, that's all. Functionally they are like intercostals without ribs, in fact they derive from the thoracic segments embryologically, helping extend the breathing mechanism, are not meant to support the lumbar spine they happen to live in front of, geographically. What is working the front of the actual spine are quadratus and psoas.

More good points. They are like "intercostals" without ribs.

Do you understand how the ribs contribute to the stability of the "thoracic" spine???

The abs serve a "soft tissue" function similarly to the lumbar.

Please don't tell me you have never considered "ribs" spinal/torso stabilizers?

[John A. Casler]

I'd benefit from some clarification by those advocating for "core strengthening". First, is there something else you'd rather call it than core strengthening?

I call it "conditioning" of the TSM (Torso Stabilization Mechanism) This includes strengthening, activation (both volitional and reflexive) and flexibility.



Second, is the activation of muscles prescriptive or descriptive? That is, does one need to be told to do this or is this a description of what happens when people lift heavy things?

The TSM is normally a reflexive activation. Training it improves the capacity, however under the most extreme loads, and sometimes in therapy it need be "volitional" until the reflex and mechanism is of sufficient strength and responding well. to proprioceptive cues.




Third, is this "preventative" advice as well as rehabilitative? I'm familiar with people feeling better after being instructed about such things but I'm not familiar with any preventative studies.

Yes, I believe that for the average person, this is a significant "preventative" considering the huge numbers of the population who suffer from the de-conditioning of the TSM.

[John A. Casler]

Hi all!

This might be related to this discussion... An article I have collecting dust but will read this time around :)

Anders.

Hi Anders,

Ah Yes the Psoas. While a primary mover in some actions, it is definitly involved in stabilizing the Lumbar Spine in an antagonist relationship with the abs in others.

Since its force is on the lumbar spine accentuating the lumbardorsal curve, (similar to lumbar extension) its antagonists are the abdominals which then activate against that action.

I am a little "shy" to support papers that quote Richardson and Hodges, since I disagree with much of their direction and conclusions, but there is "some" reasonable information in this paper (which I didn't have time to read in total)

[John A. Casler]

When you train people to be stiff and brace their bellies you'll have some good chances to aggravate the problems they have and diminish the chances their torsos may move quickly.

I may provide a body snatch example that proves the back extends and the belly expands in the same way during the lift of the load. It is mandatory. :angel:

Bernard,

You are totally misunderstanding. Neither I nor any one I have read here, is advocating client/patients be trained to be "stiff".

[Jon Newman]

Hi John,

More questions. Hope that's ok.

Do you have any sources for the preventative aspect?

Do you think if everyone was conditioned as you suggest that the commonality of back problems would significantly diminish?

If the TSM is reflexive why are so many people deconditioned? Are these people areflexive?

[Diane]

John,
In answer to your replies to my latest tw