Study Title: Cryotherapy to Treat Persistent Muscle Weakness After Joint Injury

Authors: C. Kuenze & J.M. Hart

Journal: The Physician and Sportsmedicine

Date: October, 2010

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Summary:

• This paper reviewed the potential beneficial effect of cryotherapy on a common clinical entity beyond that of pain or inflammation…muscle weakness. While muscle weakness following joint injury may be a product of a multitude of factors upstream of simple reflex inibition mechanisms, “arthrogenic muscle inhibition” caused by structural damage and / or effusion may nonetheless persist throughout post-injury rehabilitation and recover. Of particular concern is the potential for high-threshold or compensatory muscle activity when specific muscles being exercised are unable to fully activate. The authors of this paper reviewed several studies looking at the approach of cryotherapy on AMI. From the limited existing literature available, it was revealed that pre-rehabilitative cryotherapy may have a transient, disinhibitory efect on muscle recruitment ability. That while the mechanism of such intervention has still yet to be ascertained with certainty, the application of 20-30 minutes of “cryotherapy prior to therapeutic exercise (may) provide a method for clinicians to open the motoneuron pool prior to exercise to maximize effectiveness.”

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Kuenze, C. & Hart, J.M. (2010). Cryotherapy to treat muscle weakness after joint injury. The Physician and Sportsmedicine, 3 (38), 38-42.

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“Just because they can move well, doesn’t mean they will.”

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But does that mean you shouldn't?

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In the last 4 months, I have had the privilege of seeing Dr. Stuart McGill speak twice on low back health and performance. On both occasions he stated the above quote with respect to screening movement. My interpretation on said quote is that:

• Screening movement may show you what they CAN do (i.e. deep squat) but it does not necessarily show you what they WILL do….

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...with the various tasks athletes perform on an everyday basis.

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And I agree.

But if an athlete has requisite mobility and stability yet still does not move well, I believe that is more of a coaching problem rather than a “screening” problem. You simply cannot expect the screening system to do the work for you.

For example, if an athlete is showing approximately 45 degrees when actively lifting his or her leg off a table, would it not be prudent to improve this finding? It is naive to think that inadequate ranges of motion do not correlate with possible risk of injury.

This is why we have goniometers in orthopaedics in the first place.

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Just ask fellow Edmontonian, Dr. David Magee

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Now I am not suggesting that you must only strive for full mobility and flexibility. Because once we achieve our desired range, we must lock it in. We must lock it in with the most challenging and relevant exercise the athlete can do well. Use whichever progression along the exercise continuum for that particular joint complex and respective movement plane you wish. Just make sure you create meaningful changes for the individual. And call it whatever you want: Motor learning. Neuroplasticity. Whatever,

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Screening systems are not be-alls, end-alls. They simply provide baseline measures. We must not forget that there are many other aspects of fitness to consider. It is known that fatigue, both aerobic and neuromuscular, plays a role in injury risk and therefore should be at the top of our list of priorities. Without question, an athlete who screens well but posseses poor aerobic capacity will be at more risk of injury in the third period. Of course the screen will not be sensitive to this. But we must not fault the screening system. We must look at our testing protocols…or lack thereof.

Perhaps it might be wise to perform the screen under fatigued states?

Perhaps.

But if an athlete screens well yet continues to perform athletic movements with suboptimal form, perhaps the finger should be pointed elsewhere.

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Even if you are in close vicinity to a mirror.

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Muscle Imbalances Revealed

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I have already posted information pertaining to those presentations by Eric Beard and Bill Hartman, so if you have missed those, feel free to check them out here.

As a clinician, I really get excited when I see strength coaches who frequently stress the importance of safe and effective approaches to low back and core training. Mike is one example as evidence by some of these articles:

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Understanding Your Abs I

Understanding Your Abs II

Spinal Stupidity

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In this current presentation however, he talks about the hip and the pelvis.

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The Hip and Pelvis with Mike Robertson

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Mike covers three key points in this webinar and discusses his opinions of why:

• The hip and pelvis are the functional centrepiece of our body,
• The hip and pelvis are intimately linked, and
• The hips need everything from mobility and stability to motor control and strength

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Most of us are aware that the hips are possible culprits in knee, low back, lower leg, and upper body injuries and dysfunctions (*click here for an article recently published by a friend and colleague), therefore, it is our role as diagnosticians to be able to identify whether or not they are involved in each individual presentation.

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Assessments

Some of the assessments covered in this webinar include:

• Hip rotation (note: most people simply look at quadriceps and/or hamstring length)
• Front plank (note: Stu McGill also uses the v-sit for flexor endurance)
• Leg lowering
• Squat
• Lunge

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Mike very frequently stresses the importance of mobility, motor control, strength, stability, endurance and symmetry…however…he recognizes that athletes are different and that asymmetries while functional, should certainly be kept in check.

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Training Principles

*Some of the training principles he employs were shared:

• The importance of the continuum between rehab and performance (*shameless plug: feel free to come and see my talk about this in hawaii)
• The importance of seeing where each individual starts in the continuum and then progressing accordingly
• The importance of the continuum between isolated training and integrated training. What the individual needs depends on where they fall in the continuum.

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When working with his clients, Mike also mentions that he typically follows a 3 phase progression:

• McGill phase (planks, side planks, birddogs)
• Corrective phase (chop/lift, split-stance push/pulls)
• Dynamic stabilization phase (push-ups, split-squats, offset loading)

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Some final notes I picked up from this webinar:

• Mike likes to use pushups as a stabilization exercise rather than an upper body exercise. Note that the best way to get the Rectus to fire 100% is via a pushup walk-out.
• Proper hip mobility (i.e. flexion) leads to great hip separation. This dissociation is important!
• Importance of loading once you’ve achieved your corrective objectives (to facilitate neuroelasticity and hopefully neuroplasticity).

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What a fascinating joint complex. But complex it is, and hats off to Mike Reinold, Eric Cressey, Dale Buchberger, Michael Chivers, and others who really have a true appreciation for understanding the role of this region in human movement and athletic performance.

Another one of those individuals who truly understands the shoulder is Eric Beard. A corrective exercise specialist and manual therapist, Eric was one of Rick Kaselj’s team of experts in Muscle Imbalances Revealed.

Muscle Imbalances Revealed

I recently provided a summary of Bill Hartman’s lecture on Mobility and Muscle Imbalances which can be found here. This post, however, will focus on Eric’s lecture. So sit back and enjoy!

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Secrets and Staples of Training the Athletic Shoulder with Eric Beard

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• If you have yet to listen to one of Eric talks, you are missing out on such an entertaining and engaging speaker. It was really my pleasure to “sit in on his presentation”. Often times you will encounter boring, monotone speakers that have you constantly asking yourself (or the computer) “when do we get to the good stuff”? With Eric, this doesn’t happen. He provides relevant and important information that ultimately results in seamless transitions from one slide to the next. His passion for the shoulder certainly does not go unnoticed.

• Eric begins the lecture with a brief epidemiological literature review to provide the rationale for corrective exercise (CEx) for the shoulder. That is, the importance of using prudent strategies to minimize or prevent unwanted sequelae (i.e. secondary to impingement). He goes on to outline some everyday causes of shoulder impairment and states,

"Our bodies are NOT designed to wear man-satchels!"

• He also provides a thorough review of the anatomical structures of the shoulder, the implications of abnormal biomechanics to specific tissues, as well as some typical mechanisms of injury and tissue failure of this complex joint complex.

The shoulder is a complex joint complex!

• He then proceeds to cover some important assessments and tests for the shoulder that fitness professionals can utilize in “healthy” populations to direct one’s corrective exercise strategies. *note: I’ve been known to frown upon shotgun approaches to corrective strategies since corrective exercise should be…well…CORRECTIVE. In my opinion, giving everyone the same thing is not only lazy, but also time-wasting.

• As a health care practitioner (LMT), Eric also shares some important precautions and clinical tidbits that many fitness professionals may not be aware of when prescribing self-care strategies such as self-myofascial release. Some important information that everyone should know!

• All in all, Eric does an excellent job with this lecture. If I may suggest: when watching this presentation it is important to not focus on the slides but on his dialogue as he provides a wealth of information. This is not dissimilar to sitting in on a Gray Cook or Stu McGill lecture…you need to put the pen down and JUST LISTEN. You’ll likely have to watch this presentation multiple times, first with the eyes closed to just listen to the wealth of information he provides and second with the eyes open to appreciate the beauty of the slide show that he complements his dialogue with.

For more information on this educational resource, please visit Muscle Imbalances Revealed.

Because even the fist pump deserves optimal mechanics!

*Please note that the above link is an affiliate link but one that I highly recommend.

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One such risk factor may be the presence of muscle imbalances.

In a nutshell, muscle imbalances develop between muscles that have a tendency to develop tightness and other muscles which are prone to inhibition (according to Janda). However, there is more to simply stretching out your hip flexors and strengthening your hip extensors.

Fortunately, Rick Kaselj put together an awesome line up to create an educational resource for athletes, fitness professionals, and clinicians that details some of the specific and practical information that individuals should be aware of when addressing these muscle imbalances.

Muscle Imbalances Revealed

I had the privilege of studying these presentations in video format and wanted to share some of my thoughts with you. Normally I would “review” such educational resources but rather than doing so, I figured it would be more practical to pass on some of the things I learned. Since this resource was quite comprehensive, rather than outlining the entire set in one post, I thought I would provide my thoughts in a series.

First up:

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Mobility & Muscle Imbalances with Bill Hartman

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With all the hubbub surrounding corrective exercise these days, it is important that we obtain our knowledge from credible sources. Bill Hartman is one of those individuals and I am thankful to have had the opportunity to learn from his presentation. Here are some of the things I took away:

• Everyone should be doing mobility exercises. We simply should use different methods and intensities depending on the individual we are working with. Bill reminds us that we should not use a cookie cutter approach when programming. We must be specific. This might be “training 101″ but laziness is quite rampant in the fields.

• Often you will utilize seated and quadruped exercises to improve thoracic extension in your clients. Unfortunately, some of these exercises may cause or irritate shoulder impingement (see Chi’s comment this post). Thankfully, Bill provided a nice modification for placing the shoulders in external rotation to minimize subacromial impingement when performing these exercises.

• Bill also provided a short little piece looking at hip immobility versus lumbopelvic-hip dysfunction. He suggests the importance of performing a modified ober’s test together with the modified thomas test when assessing one’s lumbopelvic-hip complex.

• Money moves. We’re all looking for money moves. Bill provides a couple of techniques for active hip mobilization (i.e. coupled adduction and active hip internal rotation). If you’ve seen Assess and Correct, you may be familiar with these.

• Bill also reminds us that the position of the acetabulum position may block hip mobility. Therefore, it would be wise to first assess this position not dissimilar to how Stu McGill scours the hip prior to squatting.

• Bill suggests the importance of simultaneous anterior compartment strengthening when performing dorsiflexion mobilization exercises of the ankle.

• The “key point” of his presentation was that we must adapt to the client. That, for example, some individuals may require active mobilization techniques while others require passive techniques such as manual therapy.

Adapt baby, adapt!

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*FYI, Rick Kaselj has just updated this educational resource to include new presentations on the lower extremity, fascia and barefoot running:

• Muscle Imbalance Exercises for the Lower Extremity
• Fascia, Exercise & Muscle Imbalances
• Naked Running

For more information on this educational resource, please visit Muscle Imbalances Revealed.

*Please note that the above link is an affiliate link but one that I highly recommend.

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YOU!

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You see, the way people think, affect the way people feel. And the way you interact with your patients, may affect the way your patients think.

As you may or may not know, chronic pain is a disease in and of itself and is, by and large, rarely a reflection of diseased or injured tissue. In a musculoskeletal sense, injured tissues generally take weeks, maybe months, to fully recover and the normal healing process typically dictates proper plan of management. But for the most part, a proper plan of management must respect the stages of “healing”.

Let me ask you this…

• In the acute phase, do you chase the pain and perpetuate? Or do you medicate and manipulate and EDUCATE?

• In the subacute phase, do you over-perform passive care and still chase the pain? Or do you provide self-care exercise and EXPLAIN?

• In the chronic phase, do you coddle the patient while you search for the magic cure? Or do you interact with the patient, expose in a graded fashion and REASSURE?

So in the event that you are unsure as to what I mean by the above, may I kindly suggest that you grab a snack and watch this video from one of my lectures in the University of Alberta’s Certificate in Pain Management program through the Faculty of Rehabilitation Medicine.

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Press play to watch the video

*Please note that I am not advocating medication and manipulation for all acute patients, this was simply an example.

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“At what age should you start developing movement patterns for the purposes of injury prevention?”

In my opinion, this was a significant question in light of the fact that there as been ongoing discussion on several forums as to what minimum age would be most appropriate for the application of the Functional Movement Screen.

Since many of the athletes I work with fall within the 12 to 21 year old age range, it seems only appropriate that I address this question. Here are some tidbits of information that may assist in clarification:

Childhood ranges from 6 to 9 years of age and is marked by significant physical changes that in general, exhibit a linear growth. Development is typically somewhat predictable.

Adolescence, in contrast, ranges from 10 to 16 years of age and is marked by dramatic and rapid physical changes.

When considering the appropriate minimum age, it is also important to understand the differences between growth and maturation.

• Growth: actual changes in size occurring over a period of time
• Maturation: progress towards biological maturity (timing and rate of maturation generally varies between and within individuals).

Adolescent growth spurts generally occur between 13 and 15 years of age in males and between 11 and 13 years of age in females, while the age of maximal rate of growth (aka peak height velocity) generally occurs approximately 1 to 2 years following the commencement of sexual maturation. These variables may indeed influence motor learning and control.

In general, young children lack the motor skills required to adequately run, jump, and throw. With growth and maturation of the neurological and musculoskeletal systems, so do the development of these skills. The adult forms of these skills are generally acquired between 6 and 10 years of age and while the nervous system reaches 90% of its adult size by the age of 6 and full maturation by puberty, ultimate skill development depends highly on practice and training.

Gender differences do occur with motor performance with boys generally outperforming girls in run, jump, and throw performance. Further, males generally demonstrate continual improvement until early adulthood while improvement in females often slow by age 14…likely a result of proven decreases in levels of physical activity. It should be noted however, that in general, females tend to perform better than males on fine motor tasks.

Through an examination of the Long Term Athletic Development stages from the Canadian Sport for Life resource, it is apparent that the Learn to Train stage (Boys 9 – 12, Girls 8 – 11) is the stage at which adolescents should be developing and refining all movement skills, since the brain is capable of highly refined skill performance.

Interestingly, those who may be classified as “late developers” actually have an advantage since this learn to train stage is actually lengthened in this population.

During my graduate education experience, I had the privilege of working closely with Joe Baker, Phd of York University who’s primary focus and interests lie in optimal human development. When asking his opinion of this topic, his response was:

“…‘lack of consensus’ is a good way to describe most of the recommendations regarding training and rehab issues with youth and adolescent athletes. It’s clear that there are significant and persistent problems with this population but no real consistency in the recommended approach to deal with them. The immature motor system is part of the explanation but it also relates to the motor system’s interaction with the still developing cognitive and physiological systems. Adolescent athletes are at a stage of development that is almost constantly in flux making a ‘one size fits all’ approach very difficult…Unfortunately, I’m not sure of any rehab recommendations for this population.”

So in consideration of the above information, my recommendations would be as follows:

• Movement pattern development for the purpose of injury prevention may be implemented at the ages corresponding to early adolescence

• Functional Movement Screening for the purpose of identification of injury risk may be implemented at a similar age, HOWEVER, it is my opinion that the development and refinement of general movement skills take priority over the screen itself.

• Focus should be on the fundamental of motor development until mid to late adolescents – at least that’s what our research would suggest for most late maturation sports. (a recommendation from Dr. Baker)

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The following information was derived primarily from the text, “Scientific Foundations and Principles of Practice in Musculoskeletal Rehabilitation” by Magee et al as well as the Canadian Sport for Life website.

For more information on youth development please visit the International Youth Fitness Association and Canadian Sport for Life.

Photo source

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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

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‘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.

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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!

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

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“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

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“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”!

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A new released article from Dr McGill :

click here

See Below for details on his upcoming course:

Building the Ultimate back: from Rehabilitation to Performance

November 20 and 21, 2010 in Toronto

• 4 hours – Building the foundation
• 2 hours – Interpreting patient presentation
• 1 Hour – Preventing Back Disorders
• 4.5 hours – Rehabilitation Exercise
• 4.5 hours – Training for performance

This 16 hour lecture / workshop weekend with Dr. McGill will be located at  the Westin Harbour Castle, 1 Harbour Square, Toronto. I am also thinking of hosting a social this weekend so if you are attending please let me know.

For more information on Dr. McGill visit www.backfitpro.com

Visit  www.msk-plus.ca/Courses.htm for more information and online registration, or email info@msk-plus.ca for more details.

See you there!

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• The data from this study came from two sources (firefighters and kinesiology students).

• The main objective of this study was to assess the relationship between the V-sit test and the plank test for torso flexion endurance.

• The pearson correlation was r=0.34 (low correlation) as well as the r-squared value. It almost seems obvious that these two wouldn’t correlate well as they are two totally different positions.

I think the main reason McGill did this study was because people were using the PLANK test in place of the V-SIT to test flexion endurance (which has plenty of data correlating poor endurance times with low back disorders).

• The moral of the story is to use the V-sit when doing your tests for flexion endurance.

• He also cautioned against “training the test” due to the high compressive loads.

I do not have an image of the V-Sit test but can send you a copy of the full article if you would like. Just reply below with your email and I’ll shoot it over.

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