Announcement

Collapse
No announcement yet.

The Useless Core Strengthening

Collapse
This is a sticky topic.
X
X
  • Filter
  • Time
  • Show
Clear All
new posts

  • Originally posted by pht3k View Post
    a nice exemple of plasticity. Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain. 2008 Aug;131(Pt 8):2161-71. Epub 2008 Jul 18.
    =>
    http://www.somasimple.com/forums/showthread.php?t=6183
    Simplicity is the ultimate sophistication. L VINCI
    We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

    Everything should be made as simple as possible, but not a bit simpler.
    If you can't explain it simply, you don't understand it well enough. Albert Einstein
    bernard

    Comment


    • thanks bernard!
      physiotek.com ------ __@
      Eric aka pht3k ---- _`\<,_
      ----------------- (*)/ (*)

      Comment


      • Thanks Jason! :angel:
        Simplicity is the ultimate sophistication. L VINCI
        We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances. I NEWTON

        Everything should be made as simple as possible, but not a bit simpler.
        If you can't explain it simply, you don't understand it well enough. Albert Einstein
        bernard

        Comment


        • I can't say whether this commentary will fall into the 'useless' category or not, but here is an abstract from Hodges called Transversus abdominis: a different view of the elephant that should add to the discussion. Thanks to anyone who can post a copy in the sounds of silence for us. :angel:
          Eric Matheson, PT

          Comment


          • thanks Eric to let us know about this article; i would like to read it too.
            physiotek.com ------ __@
            Eric aka pht3k ---- _`\<,_
            ----------------- (*)/ (*)

            Comment


            • btw in this same issue from bmj there is a link to lederman 'The Myth of Core Stability' article already stated here...
              http://bjsm.bmj.com/cgi/eletters/42/11/930#3638
              physiotek.com ------ __@
              Eric aka pht3k ---- _`\<,_
              ----------------- (*)/ (*)

              Comment


              • Here's Hodges paper:
                http://www.somasimple.com/forums/sho...4950#post64950
                enjoy
                physiotek.com ------ __@
                Eric aka pht3k ---- _`\<,_
                ----------------- (*)/ (*)

                Comment


                • The latest from Hodges

                  1: J Pain. 2008 Dec;9(12):1169-74.

                  Changes in motor unit firing rate in synergist muscles cannot explain the maintenance of force during constant force painful contractions.

                  Hodges PW, Ervilha UF, Graven-Nielsen T.

                  NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia. p.hodges@uq.edu.au

                  The firing rate of low threshold motor units is decreased in constant force contractions during experimental pain. However, as firing rate is a determinant of force, it is unclear how force is maintained. Increased synergist muscle activity may compensate. This was investigated by evaluation of motor unit firing rate in synergist ankle plantar flexor muscles (triceps surae). Single motor unit action potentials were recorded in medial gastrocnemius and soleus muscles with fine wire electrodes in 10 subjects. Gross muscle activity was estimated from surface electromyographic (EMG) recordings. Bolus injections of 5% hypertonic saline were injected into lateral gastrocnemius to induce pain (low intensity, 0.5 mL; high intensity, 1.5 mL). Subjects gently plantar-flexed the ankle to recruit 1 to 4 motor units and performed 3 20-second contractions to this target before, during, and after pain. Firing rate decreased approximately 12% in synergist heads of triceps surae during pain and recovered after pain. Despite reduced firing rate, root-mean-square surface EMG amplitude did not change. The effect of nociceptor stimulation is not restricted to painful muscles but reduces motor unit firing in synergist muscles. Changes in synergist muscles cannot explain the maintenance of muscle force. Maintenance of surface EMG amplitude suggests recruitment of additional motor units. PERSPECTIVE: This study showed that activity of synergist muscles can be affected by muscle pain. However, the changes in activity of synergist muscles may not compensate for changes in the painful muscle. This finding provides evidence of more widespread effects of pain on muscle control.
                  "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                  Comment


                  • the core

                    Yes, it's been my observation (ha), that when I ask an athlete to do a side bridge with a hx of LBP you can actually see the other muscles around the LB shut down. This can happen even without pain. Maybe some type of irritation occuring. Lends support to the globalists vs. training the TaAb isolationist.

                    Comment


                    • Originally posted by Jason Silvernail View Post
                      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.
                      PS the study for this paper (you posted the 2006 study proposal) seems to have been now completed.

                      Link:

                      http://www.ncbi.nlm.nih.gov/pubmed/19892856

                      Motor Control Exercise for Chronic Low Back Pain: A Randomized Placebo-Controlled Trial

                      Leonardo O.P. Costa, Christopher G. Maher, Jane Latimer, Paul W. Hodges, Robert D. Herbert,Kathryn M. Refshauge, James H. McAuley and Matthew D. Jennings


                      BACKGROUND: The evidence that exercise intervention is effective for treatment of chronic low back pain comes from trials that are not placebo-controlled. OBJECTIVE: The purpose of this study was to investigate the efficacy of motor control exercise for people with chronic low back pain. DESIGN: This was a randomized, placebo-controlled trial.


                      ...

                      RESULTS: The exercise intervention improved activity and patient's global impression of recovery but did not clearly reduce pain at 2 months... Secondary outcomes also favored motor control exercise... CONCLUSIONS: Motor control exercise produced short-term improvements in global impression of recovery and activity, but not pain, for people with chronic low back pain. Most of the effects observed in the short term were maintained at the 6- and 12-month follow-ups.

                      Comment


                      • This is just too funny not to put in this thread: How to Good-bye Depression: If You Constrict Anus 100 Times Everyday. Malarkey? or Effective Way?

                        "
                        Product Description

                        I think constricting anus 100 times and denting navel 100 times in succession everyday is effective to good-bye depression and take back youth. You can do so at a boring meeting or in a subway. I have known 70-year-old man who has practiced it for 20 years. As a result, he has good complexion and has grown 20 years younger. His eyes sparkle. He is full of vigor, happiness and joy. He has neither complained nor born a grudge under any circumstance. Furthermore, he can make love three times in succession without drawing out.

                        In addition, he also can have burned a strong beautiful fire within his abdomen. It can burn out the dirty stickiness of his body, release his immaterial fiber or third attention which has been confined to his stickiness. Then, he can shoot out his immaterial fiber or third attention to an object, concentrate on it and attain happy lucky feeling through the success of concentration.

                        If you don't know concentration which gives you peculiar pleasure, your life looks like a hell.

                        About the Author
                        Hiroyuki Nishigaki, a graduate of Osaka City University in 1963, resides in Japan. He was employed by the Kyodo News Agency until 1976. He is the author of four books in Japanese, including How to Attain Silent Knowledge, and the author of one book in English Rejuvenation and Unveiled Hidden Phenix.
                        Sounds like a lot of sticky concepts to me..
                        Maybe he'll grab core stab ex and save them from oblivion..
                        The comment section has some funny bits too.
                        Diane
                        www.dermoneuromodulation.com
                        SensibleSolutionsPhysiotherapy
                        HumanAntiGravitySuit blog
                        Neurotonics PT Teamblog
                        Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                        Canadian Physiotherapy Association Pain Science Division Facebook page
                        @PainPhysiosCan
                        WCPT PhysiotherapyPainNetwork on Facebook
                        @WCPTPTPN
                        Neuroscience and Pain Science for Manual PTs Facebook page

                        @dfjpt
                        SomaSimple on Facebook
                        @somasimple

                        "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                        “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                        “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                        "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                        "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                        Comment


                        • Fabulous deconstruction of core stab training by noigroup on facebook.

                          "TRANSVERSUS ABDOMINUS UNDER INTERNATIONAL ATTACK

                          In a recent magazine section of Australia's widely read national newspaper, 'The Weekend Australian' (August 21-22) the validity and usefulness of core stability training was strongly challenged and in particular, the rapid international shift of the research from the physiology laboratories to personal trainers, pilates and gym instructors was criticized (Bee P, Core promises, The Weekend Australian Magazine Aug 21-22, 2010). As is well known, during the last decade, Paul Hodges' team based at the University of Queensland has provided data showing that activation of transverse abdominus was inhibited in groups with back pain and that training offered protection from further injury. As The Weekend Australian says "it wasn’t a clear link and the evidence wasn’t conclusive."

                          The article included quotes from a number of overseas experts, such as Thomas Nesser (US), Stuart McGill (Canada), Peter Gladwell from the UK and Eyal Lederman (UK), author of the article "The myth of core stability", all supporting the notion that initial research claims were overinflated by the exercise industry. There were no Australian responses to the article, but perhaps it wasn't solicited. It's good to see this challenge and appropriate that it is in the lay literature.


                          KNOWLEDGE IN THE WRONG HANDS

                          I have always had some trouble with the idea of core stability and could never get past the fact that the body core is actually the aorta. I am no fan of specific exercises… it's all too biomedical for me, nor am I a fan of the still widely held notion that pain is related to the "instability" detected by many core stability practitioners. This is one of the concepts which prevents acceptance of central sensitisation. However, I am in awe of the experimental process, vigour and output at the University of Queensland, unmatched in physiotherapy anywhere in the world.

                          There is nothing much wrong with the research findings – it's how they have been used by some physiotherapy teachers and the research industry to the point of almost cult like acceptance. There is always a problem with knowledge. Carl Sagan in "The Demon Haunted World" expressed great foreboding about "awesome technological powers in the hands of the few and when those representing the public interest have difficulty grasping the issues or are unable to knowledgeably question those in authority". This statement is also related to health, for example, self medication where people repeatedly take potent pain killers and the bastardisation of the transverses abdominus research by the exercise industries and some educators.


                          THE DODO IN REHABILITATION

                          The specific muscle activation movement will be up for many and stronger challenges in the future, but we do this to ourselves in the world of rehabilitation. The "dodo effect", (Rosenwieg 1936) is well known in psychology circles. It basically says that therapeutic orientation does not matter as all orientations work, as long as the single factor of faith that it will work is held by patient and therapist. Those who can remember their reading of 'Alice in Wonderland' may remember the dodo handing out prizes after a race where distance and time were not measured and saying "everyone has won and all must have prizes." In the physically based rehabilitation world in addition to the more established professions of physiotherapy, chiropractic, occupational therapy and osteopathy there are subgroups and groups based on technique (eg. massage therapists, acupuncturists), geography (eg. Australian and Norwegian approaches), singular tissues (eg. focus on isolated muscles, craniosacral, disc lovers) and people's names (eg. Feldenkrais, Maitland, Mulligan). Everyone must be getting a prize or these various groups would have evaporated. The core stability movement is currently one of these groups.


                          A CORE CANNOT STAND ALONE

                          But is it faith or a little more than faith? Or has something additional been isolated by each group. I'd like to think so. Core stability may well provide something special for a particular group in a particular circumstance and this will need clever research to show, but it is clearly not something to be done at the exclusion of other exercises or strategies. It, as well as the other groups desperately need integration into biopsychosocial assessment and management strategies for effectiveness , expansion and to encourage rational debate on its place. The divergent approaches listed above may well converge when this happens and common factors in the approaches are established.

                          Big picture neuroscience is the basic science essence of biopsychosocialism. We will try our best to present this view at the second 'Neurodynamics and Neuromatrix conference' in Adelaide 2012." 
                          www.noi2012.com
                          Diane
                          www.dermoneuromodulation.com
                          SensibleSolutionsPhysiotherapy
                          HumanAntiGravitySuit blog
                          Neurotonics PT Teamblog
                          Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                          Canadian Physiotherapy Association Pain Science Division Facebook page
                          @PainPhysiosCan
                          WCPT PhysiotherapyPainNetwork on Facebook
                          @WCPTPTPN
                          Neuroscience and Pain Science for Manual PTs Facebook page

                          @dfjpt
                          SomaSimple on Facebook
                          @somasimple

                          "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                          “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                          “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                          "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                          "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                          Comment


                          • At last.

                            Shouldn't this article be printed out and sent personally to the millions who've been hoodwinked?
                            Barrett L. Dorko

                            Comment


                            • Yes. The information should be sent to every PT department. I'm sure it would irritate some.

                              I like to look at the "core stability" genre as a motor control approach. My personal experience; I get episodic low back pain a couple times a year. I'm an avid weightlifter, work out four times a week. If some therapist told me my low back pain was due to core weakness, I would laugh in their face. Based on what I have learned, in my own experience of pain, that mechanical deformation of neural tissue occurs in my lumbar spine. I utilize my knowledge of movement and exercise; and guess what, it has always abated after one week.

                              So, with that said, why would I give my patients with low back pain "core strengthening", when I didn't need it to get well?

                              Chris Hansen, PT

                              Comment


                              • Answer: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

                                I didn't handle you in class but wonder about your resting posture and whether or not you self-correct (ideomotion) yet.
                                Barrett L. Dorko

                                Comment

                                Working...
                                X