Please be aware that the following information is based on my interpretation of each lecture and therefore, may be subject to “lost in translation”.

Please click here for Part 1

Please click here for Part 2

.

.

‘Clinical Update: Emerging trends in exercise management of spinal pain’

~ Paul Hodges & Stuart McGill

This lecture was the meat and potatoes of the symposium. Dr. Hodges was the main presenter and often asked Dr. McGill to provide some practical insight into some of his interventions for low back pain. While they both stressed that they were likely very similar in their approach to spinal care, it was evident from this talk that the divergence is still glaring. In fact, even the miracle blade could not cut the tension in the air although both were very professional in their “debate”.

Here are my notes:

Basic principles:

• Dynamic control far exceeds static control
• The system as a whole is what’s important, not a single muscle
• The biopsychosocial framework must be considered during intervention
• The assessment is highly important
• The principles are drawn from multiple approaches in training

5 basic but key components to DYNAMIC CONTROL:

• Posture
• Movement
• Underactivity (tends to involve local structures)
• Overactivity (tends to be global structures)
• Evaluation of both provocative and relieving factors

Treatment Goals:

• Postural correction
• Movement correction
• Muscle Activation Optimization

Posture:

Dr. McGill gave an example of the importance of posture and its relationship with our breathing. Feel free to perform a self-assessment in the various positions

• Regular sitting – normal breath
• Slouched – breath goes directly to mid-chest level
• Military position (shoulder retraction, thoracic extension) – breath goes down to base of lungs
• Rotate and list to one side – one lung becomes compromised and breath is taken up by contralateral lung

Movement:

Dr. McGill also provided us with a movement correction example

• Upright stance and muscle activity
• A forward posture (slouched or neck protraction) vs neutral spine
• Bottom line: change posture during movement may change activity of lumbar musculature (i.e. extensors)
• For those of you who have his newest DVD, he also demonstrates this example there.

*All three (posture, movement, muscle activation optimization) are important but we as clinicians have to figure out which of these is our priority in treatment.

“STATIC STABILITY DOES NOT EQUAL FUNCTION”

Interplay between dynamic and stiffness:

• This is a continuum
• Depends on the load (high load requires high stiffness)
• Depends on the movement (greater movement requires greater dynamic control)
• Depends on the predictability (low predictability requires high stiffness)
• We need to find the right balance!

“Change in motor control is about looking at the whole system not the parts.”

Common features of motor control strategies:

Dr. McGill on posture correction:

• First try to achieve elastic equilibrium
  • First start with a position of least load / stress concentration
• Then try to modulate that with pain
  • Can be standing
  • Can be seated
  • This seated example touched upon correct posture. Rather than actively extending the thoracic spine (which increases extensor muscle activity), tilting the pelvis anteriorly is preferred

Preservation of feedback control may be via taping:

• I found this to be quite interesting in light of the various taping techniques currently on utilized in the rehabilitation and sport medicine settings
• Taping may also be used for modifying muscle activation strategies

“NEUTRAL SPINE IS NOT STATIC!”

• It needs to be variable…and within the functional range

“The gluteus maximus is a (free) knee extensor!”

• When standing, active contraction of this muscle passively extends the knee
• “Spread the floor and use the hips”
• This is advantageous as it unloads the quadriceps muscle

Activating the HIGH glutes & glute med:

• Needs core stiffness
• Externally rotate hips
• This may be done actively and reactively (minibands around the knees and around the feet)

Activating LOW glutes:

• Only achieved in a deep squat position

Posture and Movement is about load:

• How does pain change with the addition and removal of load?
• McGill  – “tolerance is a function of posture and movement”

McGill on Bracing:

• Become a dimmer switch not a light bulb
• Its all about tuning!

Hodges: There’s a difference between just making a muscle active (Transversus Abdominis) vs an optimal way of using the muscle:

• It’s not enough just to activate the muscle…you have to learn how to use it!

Hodges:

“There is no doubt that Stu and I have differing positions on the role of the deep muscles in the clinical approach but I think it is good that we have different ideas because all individuals patients are different.”

“The Transversus Abdominis is not the most important thing in low back pain but our data show that it is the most consistent deficit in low back pain presentation. Therefore it is important to address this muscle as part of the comprehensive package of treating low back pain.”

“Improving the activation of the deep muscles may decrease the over activity of the global/superficial muscles.”

Dr. McGill on the Transversus Abdominis:

• He understands that the TrA is important. His problem is that there are so many other important aspects to low back pain patients.
• …and far too often the patients that he sees are “paralyzed” by the concept of a dysfunctional TrA. They are always asking, “is my TrA working?”, “why isn’t my TrA working?”
• This is why he subscribes to the method of external focus for motor learning by Gabrielle Wulf.

Dr. Hodges:

• Counters that there is data to show that simply an internal focus to “wake the muscle up” is ok. As long as there are subsequently more functional goals to focus on

*In my opinion, It’s an apples vs oranges debate!

“Train movement control, posture and muscle activity during rehabilitation”

• If they flex the spine while bending forward then train them not to flex the spine while bending forward.
• Its that simple!

Dr. McGill:

“Fix the biggest things first to get them out of pain…THEN fine tune!

• This was his rebuttal to the TrA and MF controversy. He states that he has never encountered a patient where the TrA deficit was the most significant dysfunction

Dr. Hodges’ strategy of multifidus activation:

• Can you turn it on?
• What else happens when you turn it on?
• Do you have control over the strategies?
• Most important and effective strategy is to use imagery.

“There’s something about attention to detail that’s driving changes in neuroplasticity”

Dr. McGill:

• States that his athletes cannot individually activate muscles medial to lateral but they can superiorly and inferiorly
• BUT THE MENTAL FOCUS WAS IDEAL!!!

Dr. Hodges:

“Delays are significant in a motor system.”

• This deficit is NOT the dysfunction but only a window of opportunity to look into the system.

.

As mentioned earlier, this turned out to be an interesting and enlightening high tension academic debate but both experts argue that it would be most valuable to have a patient on hand to both assess to really truly get an idea of how each think. They agreed that this would truly provide valuable insight into the magnitude of their agreement/disagreement.  Out of all of this, they state that there is mostly convergence between the two and that it may be the last (5%)…i.e. their specific methods…that may be different.

“Divergence is healthy. Because if not, what would drive research?”

*The purpose of everything is the individualized goals of each patient. That’s it!

Related posts:

1. 2010 Spine Control Symposium Recap: Part 2 A recap of the presentations put forth by Paul Hodges...
2. 2010 Spine Control Symposium Recap: Part 1 A recap of the presentations put forth by Peter Reeves...
3. 2010 Spinal Control Symposium – Toronto McGill, Moseley, Hodges, Reeves...

Related posts brought to you by Yet Another Related Posts Plugin.

Please be aware that the following information is based on my interpretation of each lecture and therefore, may be subject to “lost in translation”.

Note: Please click here for Part 1

It must be stated that each of the two esteemed researchers prefaced their talks with addressing the fact that misconceptions often occur when one is asked to speak about a specific facet of their research. Both of them stated that the oft-requested material is simply a part of the big picture and as a result, labeling and misinterpretation typically occurs.

.

‘Motor control changes in spinal pain: effects, mechanisms and efficacy of interventions’ ~ Paul Hodges

Adaptation & Rehabilitation: How does motor control change in the presence of pain?

Some common myths explained (in red):

The Transversus Abdominis and Multifidus are NOT the most important muscles for spine control

• However, he states that they do make a contribution and that this is often modified in the presence of low back pain.
• His rationale for addressing the importance of specific musculature is compromised control (of the system) in the presence of weakness or inhibition.
• Note: he was adamant in stating that rehabilitation does not stop here…that training these muscles should not be the sole target of lumbar rehabilitation

With respect to the debate surrounding the delay of motor activity with arm movement:

• He states that this delay is not necessarily a dysfunction in and of itself -> but simply is a “window” to look into the system.

Motor control training is NOT just about training the Transversus Abdominis

• The aim should be placed on addressing postures, movement patterns and muscle activation patterns
• A consideration of the deep musculature is simply one aspect of motor control

People should NOT be encouraged to isolate the Transversus Abdominis and Multifidus in function

• The aim should be to change their activation patterns while introducing them into function…in addition to the correction of posture, movement, and muscle activation (if necessary).

The need to isolate deep muscle activity in rehabilitation

• Some of the reasons presented pertained to organizational changes within the brain, the relationship between motor activity improvement and clinical improvement, and the applicability for the identification of individuals who may respond to motor control rehabilitation
• This was one area where he stood his ground

Some explanations as to why motor activity decreases during pain:

• Reflex inhibition
  • Change in excitability of the motor neuron (descending motor pathway) secondary to injury
• Change in organization of the motor cortex
  • In the presence of low back pain, he reported that the cortical area of TrA representation is shifted posterolaterally
  • Interestingly, individuals with the biggest temporal delays in motor activity have the largest shift in displacement (note: this does not necessarily imply causation).

Motor control isn’t always about giving people more…it may also be about taking things away

• Some people have OVERactivity!!!!
• That often individuals with low back pain have increased muscle stiffness and subsequently, poor control.

So does an increase in muscle activity during pain allow us to adapt? Yes!

Is this adaptation about protection of the injured part? Yes – the high threshold strategy

• But is this a good thing or a bad thing? Does that alter motor control?

Hmm…

Adaptation ALSO occurs in the presence of a “threat” of pain

• The “threat” of nociception caused alterations in motor activity
• Therefore nociception is actually not necessary

Adaptation may be good in the short term…but it may be detrimental in the long term

• In the short term, adaptation facilitates alteration in stresses and loads placed on the body. i.e increased trunk stiffness for spine stability
• BUT…too much secondary stiffness may perpetuate back pain due to increased compression forces
• Thus, variability is necessary to adapt to change in conditions/environment…

We have to match the system to the demands of the task!

.

"...and in this corner"

.

“Opinions on the links between back pain and motor control: The disconnect between clinical practice and research” ~ Stuart McGill

A WHOLE BUNCH OF OPINIONS (in red)

As mentioned earlier, Stu prefaced his lecture by stating that clinical groups develop preconceived notions of different researchers due to the requests they receive to speak about a specific component about their research.

• He is always asked to talk about stabilization strategies and therefore never gets a chance to talk about anything more than what they ask for
• He hazards a guess that there is actually about 95% convergence between himself, Hodges, and the various researchers within the field!

Notice the space in between…its actually larger than each of these two think!

• Lately he asks questions not on what causes pain but what takes pain away

“Its at the concentrations of stress where the tissues break down.”

“It is extremely important to ask if your patients have good days and bad days.”

• If so, you know you’re going to be successful – so find out what creates the good days!

“People get painful backs because of the way they move”

• We must assess Postures, Motions, and Loads to find out (within each variable) what
  • Causes pain
  • Takes pain away
  • Prevention and treatment therefore, can be summed up as “don’t do what hurts you!”

Postural dominance:

• Flexion (cyclists), extension (gymnasts), lateral flexion/rotation (cricket bowlers), etc
• Neutral spine is imperative to minimize shear loads
  • At spine neutral, the longissimus muscle is at 45 deg and therefore,  able to buttresses this shear
  • With spinal flexion, the longissimus is at 10 deg and therefore, unable to buttress this shear

Movement screening:

“Just because they can (perform an ideal movement upon screening), it doesn’t mean they will!”

• Movement screening may show you what they can do (i.e. deep squat) but it doesn’t necessarily show you what they will do….with the various tasks they have to perform throughout the day.
• Therefore, provocative testing must also be performed!

On using the term  chronic non-specific low back pain:

“Wouldn’t it be funny if we lumped all leg pain into “leg pain” and did a research study to determine the efficacy of various treatment approaches for “leg pain” (chiropractic care vs physical therapy vs massage therapy)”

• Note: In general, I, myself think researchers may be missing the boat on this argument altogether. That is, researching the efficacy of various treatment modalities on CNSLBP…especially since more evidence is pointing toward a weaker relationship between pain and tissue disruption/dysfunction the greater the chronicity of pain

“Muscles of the torso are fundamentally different than those of the limbs”

• Limb/extremity muscles – generate motion
• Torso muscles – stop motion
  • No such thing as agonist and antagonist in the spine. They all work together.

“The rectus abdominis, with its transverse tendons, is designed to create short range stiffness – otherwise God would have given us a hamstring!”

Quadratus Lumborum vs Gluteus Medius for lumbopelvic stability in the frontal plane:

• During the unilateral suitcase carry – McGill argues that the QL eccentrically contracts to hold the pelvis up during the swing phase as opposed to the current widespread belief that the gluteus medius is the primary stabilizer of femoral adduction during the stance phase

On the problem with performing a physical exam/assessment on a patient in jeans:

• Whether you ask them to perform a quadruped rock or straight leg raise, jeans tend to lock the hips and force the spine to move in greater ranges of motion than normal

Internal vs External Focus for Skill Transfer:

• Gabrielle Wulf: suggests that external focus in motor learning more effectively facilitates performance
• E.g. Pelvic Floor control
  • Rather than asking a patient to contract and relax their pelvic floor, he suggests one should focus on farting and preventing a fart

Insert random quote here:

“Pavel will kick you in the feet randomly and put you on your back before you even know it.”

On the Transversus Abdominis:

“Most clinicians would be more successful ignoring this muscle”

• His rationale was that stiffness and stability in the spine comes from a corset action – synergistic action between all core musculature
• That the TrA can simply be “tuned” up by raising ones voice

“I would be so bold to argue that Gluteal problems are much more dominant as a whole than the TVA”

• Karel Lewitt – push navel down and out to facilitate intraabdominal pressure. Stop drawing navel in!

On creating deep oblique training:

• Lay on one’s back with hips and knees flexed
• Breath with normal tidal volume – go to full tidal expiration – then KEEP FORCING AIR OUT

.

There you have it. A recap of the lectures presented by arguably the two most prominent leading researchers in the field of spine control. I apologize for withholding personal opinion from this summary, but I felt that doing so would provide everyone with an unbiased narrative of their lectures. Tune in tomorrow for Part 3 of the 2010 Spine Control Symposium Recap as Professors McGill and Hodges “join forces” to provide a clinical update on the emerging trends in exercise management of spinal pain.

Related posts:

1. 2010 Spine Control Symposium Recap: Part 1 A recap of the presentations put forth by Peter Reeves...
2. 2010 Spinal Control Symposium – Toronto McGill, Moseley, Hodges, Reeves...
3. Motor Learning and Neuroplasticity in Rehabiliation Summarizing the benefits of motor-skill training in musculoskeletal rehabilitation....

Related posts brought to you by Yet Another Related Posts Plugin.

Please be aware that the following information is based on my interpretation of each lecture and therefore, may be subject to “lost in translation”.

.

“Spinal Stability: The six blind men and the elephant” ~ Peter Reeves

A Reductionist vs Systems approach to management

• Interaction of the various systems is extremely important
• It is normally difficult to target the actual cause of LBP, especially in the presence of multiple findings
  • Systems approach allows you to look into the interactions between the various findings
• He uses the popular parable, “Six blind men and the elephant” to demonstrate that focusing on just one sign or symptom of low back pain is analogous to taking a reductionist approach.

• When trying to determine if something is stable, all one has to do is apply a small perturbation and observe the response
  • Systems that are in a low energy configuration are going to be stable
  • For further explanation, please see my previous post titled “Variability for Stability“
• Feedback control is probably the most important aspect of dynamic stability and this corresponds to both positive and negative feedback.
  • For stability, we always have negative feedback control
  • But there’s more than one pathway for feedback control (voluntary and reflex)
    • Note: Unfortunately, the presence of pain and dysfunction will result in delays within the reflex pathways
• Reeves demonstrated a stick balancing example to explain feedback control for stability. He introduced this concept in a recent letter to the editor in the European Spine Journal. Essentially there are two main necessities for feedback mechanisms for stability:
  • The need for tracking – we need to know the position of the mass that we are concerned with.
  • The need to know the velocity of the mass’ movement
  • Lacking this results in an impairment in feedback control, and subsequently greater effort and / or displacement.
  • Note: impairments in feedback control are generally less significant during slow movement
• The future of his research and the heart of systems science lies in the modeling and its manipulation in the search for answers. His goal is to see how the system, aka the plant and the controller (see my “Variability for Stability” post), responds to different types of perturbations (not just one type of perturbation)

• The definition of “stability” is content dependent
  • Therefore he uses the concept of “risk of injury” instead.
  • He’s less concerned with the definition of stability and more concerned with how stability is achieved

.

“Motor Control Changes and Back Pain: Chicken, Egg, neither or both?” ~ Lorimer Moseley

Central themes (in red)

“pain and spinal control abnormalities result from implicitly evaluated needs of the organism.”

• His focus was not on the relationship between spine control and back pain but on why people with back pain actually have pain.
• (Stu McGill taking notes as always)
• Aside from humans, even the most basic biological organisms (i.e. unicellular organisms) will repel away from threat…its all about protection!

Pain vs Nociception

• Pain – unpleasant conscious sensory and emotional experiences
• The purpose of pain is protection

• The purpose of nociception is to facilitate those protective devices that humans possess

Quote:

It is “seductive” to conclude that recorded activity in c fibers and a-delta fibers will result in pain.

• Role of the thalamus is to relay and prioritize information – “what is important for the brain to know RIGHT NOW?”
• The brain is modulating nociception all the time (we have about 600 neurons descending from periaqueductal gray to modulate one ascending nociceptive neuron).
• The relationship between nociception and pain is a variable one.

• Vision is purely a sensory experience and the brain modifies it.

Pain and the Brain

• Pain is an output of the brain into consciousness
• “What is the most appropriate conscious output here?”

“trunk muscle activity results from the implicitly perceived demands on the trunk.”

• Inducing experimental pain changes motor imagery performance

“we really don’t know whether motor control changes BECAUSE of pain”

– it’s a chicken and egg argument.

Considerations pertaining to the concept of nociception and protective motor control changes:

• Is it NECESSARY?
• Is it SUFFICIENT?
• *his answer was it is sufficient but it may not be necessary

Considerations pertaining to the concept of pain and protective motor control changes:

• Is it NECESSARY?
• Is it SUFFICIENT?
• *he quoted a previous paper by Hodges that stated “recurrent back pain patients in whom motor control changes are observed are often pain-free at the time of testing.

Motor control as an output of the brain to the muscles:

• The brain often asks “what are the demands on my trunk?” based on the current state, position, mobility, and vulnerability of the spine.
• Therefore, the brain can impart non-volitional motor control changes!!!

Pain as an output of the brain to the muscles:

• The brain often asks “how dangerous is this (nociceptive information) really?“
• Therefore, the brain will determine the need and presence of pain

So consequently, the brain asking itself “How Dangerous is this REALLY?” is in his view, what determines back pain.

…tune in tomorrow for Part 2 of the 2010 Spine Control Symposium Recap. You won’t want to miss the great McGill and Hodges “debate”!

Related posts:

1. 2010 Spinal Control Symposium – Toronto McGill, Moseley, Hodges, Reeves...
2. Thinking About Thoughts Cognitive aspects of treatment of lumbopelvic pain. From the upcoming...
3. Core Stability: Is it all a myth? The Journal of Bodywork & Movement Therapies recently published an...

Related posts brought to you by Yet Another Related Posts Plugin.

He’s already written two great posts that pertain to low back pain and rehabilitation and I am sure there will be many more to come. For those of you who are too busy treating patients to stay abreast on the current research, he effectively provides user-friendly (aka therapist-friendly) posts to guide your therapeutic management.

Go ahead and check out his site, I guarantee it will get you thinking and maybe, force you to examine your own clinical thought processes.

www.craigliebenson.com

Check it!

Related posts:

1. Dr. Stuart McGill in Toronto A recent publication by Dr. McGill and an upcoming course...
2. Motor Learning and Neuroplasticity in Rehabiliation Summarizing the benefits of motor-skill training in musculoskeletal rehabilitation....
3. Scientific Foundations and Principles of Practice in Musculoskeletal Rehabilitation Scientific Foundations and Principles of Practice in Musculoskeletal Rehabilitation is...

Related posts brought to you by Yet Another Related Posts Plugin.

It seems as though the greater the variability in the “system”, the greater the stability. Peter Reeves of Michigan State University uses a “plant and controller” analogy to describe this in great detail. He likens plant to the spine and its interbertebral joints and musculature. The controller, conversely, includes the reflexive and voluntary pathways that travel through the spinal cord.

When considering the system as a whole, that is the plant and the controller, the greater the stiffness, the less likelihood of dysplacement of that system…therefore, stability!

Unfortunately, however, a stiffer system does not always equate to optimal performance.

Consider the example of walking on a log.

Our system (the plant and the controller) may be better off as one that is open and available to react and respond to the dynamic and changing environment. Reeves doesn’t believe that a system that displays greater stiffness is ideal in this situation. He suggests the possession of greater variablity is ideal…motor control, if you will.

Unfortunately, this system may fail in the presence of LBP. That is, when feedback control is altered. However, we must fear not. A “bottom up” approach that incorporates some form of manual therapy may be the intervention of choice for our patients.

Back to stiffness.

Don’t get me wrong. I do think stiffness is important. However, it may just be an intermediate step. Consider a maximum effort deadlift. Consider the player receiving a body check in ice hockey. Here, system stiffness would be valuable for stability sake. Please remember that one goal in rehabilitation is to have the motor control system subconsciously learn more stable patterns (thanks Dr. Liebenson).

So perhaps Pr. Stuart McGill’s research on rate of contraction/relaxation (pulse) may allow “stiffness” to play a larger role in the dynamic environment. The only downside is that this often seems to be voluntary and does not necessarily include the reactive component of neuromuscular control (edit: the “bottoms up” kettlebell exercises do).

Enter Gray Cook…

Photo source

Related posts:

1. 2010 Spinal Control Symposium – Toronto McGill, Moseley, Hodges, Reeves...
2. Core Stability: Is it all a myth? The Journal of Bodywork & Movement Therapies recently published an...

Related posts brought to you by Yet Another Related Posts Plugin.

Part 2: The research behind the technique

Part 3: What is P.A.I.L’s™ and how is it used in this system?

Part 4: Assessment techniques, and how the system sets itself apart

For more information on Functional Range Release and any of Dr. Spina’s other seminars, please visit Functional Anatomic Palpations Systems.

Related posts:

1. Dr. Richards on Biomechanics & Stretching A lecture by one of my university professors and mentors...
2. When, Not What! Making better informed decisions...
3. Assess and Correct: A Review On Friday, I finally received my DVD copy of Assess...

Related posts brought to you by Yet Another Related Posts Plugin.

Suffering from a lower body injury, this female athlete had been undergoing therapy for quite some time. Having exhausted the list of differential diagnoses, it was not until the head therapist, Ed Ratz, discovered the potential cause of her dysfunctions.

A navel ring? Really? How so?

Kathie Harvie, an athletic therapist and osteopath from the University of Windsor investigated this topic several years ago and states:

The piercing constitutes a scar, and a scar is a robber of mobility. The scar adheses the superficalis fascia (Scarpa’s) of the abdomen – which links up with the inguinal canal, and once you hit the inguinal you can go anywhere all levels of fascia congregate there…so my image is the bike wheel or the flag pole with lots of streamers..the virgin belly button is a floating anchor, the adulterated belly button is not so floating..as a floater it serves as a reference point, accomdating its connections..mainly the pelvis (right and left medial umbilical ligaments and the mean umbilical ligament)..when it is not so floating, it does not accomodate. Back to the wheel…pelvic and thoracic diaphragm are the tires, the falx and the 3 umbilical ligaments to the pelvis are spokes and the belly button is the axis…and…since it is common to have infections with belly button piercings…so that adds to the adhesiveness concept.

Interesting, huh? So in the event that you’re having some difficulty searching for answers on a particular patient, be sure to check the missing “link“.

Related posts:

1. Minimizing Hip & Groin Injuries Considerations for minimizing hip and groin injuries in activity and...
2. Concise Guide To Sports Injuries Another feature of this blog will be book reviews that...
3. Dr. Richards on Biomechanics & Stretching A lecture by one of my university professors and mentors...

Related posts brought to you by Yet Another Related Posts Plugin.

Recently I have been on a quest to enhance my understanding about pain and dysfunction and through my endeavours, have come to a “roadblock ” regarding the concept of MOVEMENT. In particular, the relationship between pain, movement and intent.

As an individual who makes a living from helping to improve one’s pain and dysfunction, I have recently been asking myself, what is the true importance of movement?

To demonstrate my thought processes, I have included thoughts from three well respected physical therapists below.

Diane Jacobs writes:

A big implication in PT is that muscles are to blame for pain. Another implication is that somehow imparting motor control will help mop up pain …. movement of any kind will help “prevent” pain, an assertion I think can be supported by the idea of neurodynamics. But motor control? Why get that fancy about it? I don’t think it can prevent pain any better than simply more of regular movement would.

So, why do we think/why are we being asked to believe that we can train individual muscles? It makes no sense. Not from a nervous system standpoint. And let’s face it – without a nervous system a human organism is a motionless cadaver. So I give that system priority over anything anatomic/structural/mesodermal. Muscles are just the puppet strings, not the puppeteer. I want to interact with the puppeteer when I treat, and I don’t mean only cognitive control over movement. I mean, ways to change behaviour patterns that may be contributing factors, and try to directly approach/affect the sensory cortex through handling its outer sensor array – skin, and physically drag about (slightly) various neural structures embedded from below into skin. Learning about cutaneous nerves, their names and locations, shifting the mental focal length up, closer to the surface, helps reframe a lot of this stuff automatically.

So…. coming back to the point about multifidus, seems to me the brain tries to figure out ways to use movement, get the movement goal accomplished, without using the same muscle the same way twice in a row. Why would you not want to frame the multifidus issue (apparent weakness) as a defense (which would mean that it’s just inhibited, probably by pain), rather than as a defect (i.e., a target for some kind of intervention)?

Kyle Kiesel writes:

The response by the CNS to increase muscle activation to the outer core muscles in the presence of pain is known has a High Threshold Strategy (HTS). Increased activation of the outer core musculature is, of course, normal for the system to manage a high load task, but in response to a painful episode or a dysfunctional inner core, it is a compensatory strategy…

The inner core receives ongoing subconscious input from the CNS, which automatically maintains respiration, activates the pelvic floor for continence and segmental stabilization, and activates the TrA and LM for segmental stabilization in anticipation of a spinal perturbation. This is a highly automated, delicate functioning system…

Gray Cook writes:

The first thing you always need to consider is movement. If movement quality is not above a minimum standard, then this is the first problem you need to deal with.

Personally, I have gone well beyond the concept of training muscles. I understand that we have to employ movement. However, when it comes to the utilization of movement as a prophylactic and rehabilitative approach for pain and dysfunction, my personal preference would be to strive to achieve movement that is of ideal quality and not simply compensatory.

So my (vague) question for the masses is:

When it comes to pain and dysfunction, does quality of movement really matter?

Related posts:

1. Common Movement Dysfunctions What to look for when screening and assessing the moving...
2. Zygapophyseal Joint Pain Patterns: Part 1B (Cervical Spine) A study testing the reliability of their pain charts by...
3. Core Stability: Is it all a myth? The Journal of Bodywork & Movement Therapies recently published an...

Related posts brought to you by Yet Another Related Posts Plugin.

August 28, 2010

8:00am – 8:30am Check-in and registration

8:30am – 8:45am Welcome and Introduction – Professor Paul Hodges

8:45am – 9:35am Professor Stu McGill

• Opinions on the links between back pain and motor control: The disconnect between clinical practice and research

9:35am– 10:25am Dr. Lorimer Moseley

• Talk title TBC

10:25am – 10:40am Morning Coffee Break

10:40am – 11:30am Professor Paul Hodges

• Motor control changes in spinal pain: effects mechanisms and efficacy of interventions.

11:30am – 12:20pm Associate Professor Peter N. Reeves

• Spine Stability: the six blind men and the elephant

12:20pm – 1:00pm Lunch

1:00pm – 2:00pm Clinical Update – Professor Paul Hodges

• Emerging trends in exercise management of spinal pain

2:00pm – 2:30pm Symposium Update

• Panel discussion on areas of convergence and divergence

2:30pm – 3:00pm Question and answer session.

3:00pm Symposium Close

Register here

Related posts:

1. Dr. Stuart McGill in Toronto A recent publication by Dr. McGill and an upcoming course...
2. Thinking About Thoughts Cognitive aspects of treatment of lumbopelvic pain. From the upcoming...
3. Dr. Richards on Biomechanics & Stretching A lecture by one of my university professors and mentors...

Related posts brought to you by Yet Another Related Posts Plugin.

Diagnosis:

Interpretation: Inadequate assessment.

Comment away!

Photo source

Related posts:

1. Zygapophyseal Joint Pain Patterns: Part 1B (Cervical Spine) A study testing the reliability of their pain charts by...
2. Pain, Movement, and Intent Is there a relationship?...
3. Its Not Always Bursitis: Greater Trochanter Pain Syndrome The use of “Trochanteric Bursitis” as a diagnosis for lateral...

Related posts brought to you by Yet Another Related Posts Plugin.

Related posts:

1. Scientific Foundations and Principles of Practice in Musculoskeletal Rehabilitation Scientific Foundations and Principles of Practice in Musculoskeletal Rehabilitation is...
2. Low Back Disorders An oldie, but a goodie. A review of McGill's 1st...

Related posts brought to you by Yet Another Related Posts Plugin.

Related posts:

1. Optimum Body Mechanics A brief summary of maximizing Optimum Body Mechanics in activity...
2. Dr. Stuart McGill in Toronto A recent publication by Dr. McGill and an upcoming course...
3. Negative Effects of Static Stretching Negated? It goes without saying that the “commonly” held belief about...

Related posts brought to you by Yet Another Related Posts Plugin.