The transversus abdominus

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 criticised (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 connot 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.

Last month’s notes on treating the rellies

Wow! Treating the rellies is definitely a common chord and we got piles of stories. Thanks to everybody who wrote in with their own, but particularly to Alyssa of Australia who can struggle to help rellies with their pelvic floor issues.

I have a complete phobia of treating friends and family. This may partially stem from the fact that I mainly do pelvic floor rehabilitation, and when someone starts telling me about their weak bladder and how they need to see me I break out into a cold sweat thinking “do they realise what is going to be involved when they come to see me? It ain’t no regular treatment couch!!”…

Congratulations Alyssa, we will send you an Explain Pain Combo for your brilliance!

Legendary instructor of the month
Laurie Urban is one of Winnipeg’s great assets. He has a handful of diplomas, a tidy bachelor and is currently completing his MSc. Rehabilitation where he is looking at the possibility of using the Slump Test as a screening test for neuropathic pain.

Laurie is a Co-Director at the Sports Physiotherapy Centre in the Pan Am Clinic and lecturer at the University of Manitoba, both in Winnipeg.

The cuddly Canuck is an accredited instructor and Chief Examiner within the Orthopaedic Division of the Canadian Physiotherapy Association. He is a Fellow of the Canadian Academy of Manipulative Physiotherapists and is currently on the planning committee for the upcoming IFOMPT conference being held in Quebec City in the fall of 2012.

Laurie has published articles on the Straight-Leg-Raising-Test in The Journal of Orthopaedic and Sports Physical Therapy and in Greg Grieve’s Modern manual Therapy of the Vertebral Column. When they’re not guzzling gallons of maple syrup, together with Sam Steinfeld, he teaches all NOI courses in Canada.

Laurie next instructs:
Mobilisation of the Nervous System 23 – 24 October Regina, Canada. Enquire here

 

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One Response to “The transversus abdominus”

  1. Memory lane Mondays – The transverses abdominus | noijam Says:

    […] wrote a noinote on the rapid uptake but inherent issues of another motor control paradigm; that of the transverses abdominus and ‘core stability’ that links in nicely here and is worth a little stroll down memory […]

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