On Saturday, August 28, 2010, I had the privilege of attending the spine control symposium put forth by the University of Queensland's Centre of Clinical Research Excellence in Spinal Pain, Injury & Health. This was a must symposium for all professionals in the rehabilitation injury who manage low back pain and with the constant growth and debate pertaining to the research in this field, I am truly thankful for such an opportunity to expand my knowledge. As such, I also believe that it is my responsibility to relay that information onto my colleagues and will make an attempt to do so below.
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
With respect to the debate surrounding the delay of motor activity with arm movement:
Motor control training is NOT just about training the Transversus Abdominis
People should NOT be encouraged to isolate the Transversus Abdominis and Multifidus in function
The need to isolate deep muscle activity in rehabilitation
Some explanations as to why motor activity decreases during pain:
Motor control isn’t always about giving people more…it may also be about taking things away
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
Adaptation ALSO occurs in the presence of a “threat” of pain
Adaptation may be good in the short term…but it may be detrimental in the long term
We have to match the system to the demands of the task!
"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.
"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."
“People get painful backs because of the way they move”
"Just because they can (perform an ideal movement upon screening), it doesn’t mean they will!"
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)"
“Muscles of the torso are fundamentally different than those of the limbs”
"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:
On the problem with performing a physical exam/assessment on a patient in jeans:
Internal vs External Focus for Skill Transfer:
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”
“I would be so bold to argue that Gluteal problems are much more dominant as a whole than the TVA”
On creating deep oblique training:
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.