The Useless Core Strengthening

[nari]

John,

Assuming it is desirable for the body to be in 'good' maintenance, then it is assumed that people do not need to lift weights or engage in heavy workouts.
If this were so ,then the population would be somewhat disabled to a much higher level.
So core strengthening does what? Satisfy a need for exercising? That's fine. Does it act as a preventative? There is some indication it can lower the incidence of spinal problems. Does it 'cure' LBP? I haven't noticed evidence of this - the juries seem indecisive on this.
If we are talking about belief systems where people work core musculature like crazy and feel great; then it may have value. Endorphins are useful. But I have come across many folk who go to Pilates / core classes because they feel they should as opposed to want to; and it doesn't seem to alter their aches and pains much.
I guess my point is: strengthening 'normal' musculature can be very enjoyable and beneficial for some in the cardiovascular sense, anyway. As long as it is clear that strengthening a weakness is not really related to pain issues....
As for the sherpa issue, their brains have probably worked out the optimal posturing after generations of slogging up and down mountains....without much thought from their conscious brains.

Nari

[John A. Casler]

Originally Posted by John A. Casler

I might also suggest that a Sherpa might be interested in certain elements of understanding the TSM and what he might do to "improve his capability" and or reduce his injury potential.

Originally Posted by Bernard

Clearly, no. He has the best solution that I know and you are still unable to decipher his "curves' mystery".

Interesting that you know the mindset of the world's Sherpa.

If you wish to discuss spinal curvature please explain your "mystery" which is obviously only a mystery to you, and we can explore the elements and forces you wish to dance around.

Originally Posted by John A. Casler

I can only assume you are certainly not saying that Sherpa do not develop injuries specific to their activities.

Originally Posted by Bernard

There is a fate in each job. Sherpas do not escape to this problem. I never said they have no problem but certainly far less than us. If they have had our LBP percentage the Sherpa community will be as common as our. It is not the case!

I would suggest that while this may be true, you have no evidence of this and it is pure speculation based on general observation, and assumption that their daily physical activity may help "condition and strengthen" their Torso Stabilization Mechanism.

Originally Posted by John A. Casler

And you didn't set "any trap".

Originally Posted by Bernard

Really?

Yes, really

Originally Posted by John A. Casler

I chose to ignore your curvature question

Originally Posted by Bernard

Many readers will think you fell in because a "LBP" solution cannot be constructed without these basic biomechanicals facts.

As of this moment, you haven't suggested any pertinent biomechanical "FACTS" that are not included in the TSM which I advocate. Instead you find amusement in "traps" that are a mystery because you don't disclose what elements of them you wish to assert.

We might be better served if you assume less of a gamesman type posture, and simply state your points.

Originally Posted by John A. Casler

Additionally since it seems your "concern" is disc compression

Originally Posted by Bernard

It is not my concern at all. What is the fact that make you think this?

Hmmmm,,, Let me see,

YOU WROTE:

Normally it will bend the chest forward but the spinal muscles will act => increased pressure on discs.

The lumbar area contracts => increased pressure on discs. The best way to lift a load without such forces is... to avoid them.

I trust I haven't misquoted or taken out of context, since at least two other list members commented on your "compressive" concerns.

Originally Posted by John A. Casler

As well, I am waiting to hear what caused your LBP and if you suffered disc damage and to what extent. Since you claim you have "rehabbed" or "ended" the pain with your "discoveries", I would be interested in your therapy.

Originally Posted by Bernard

I had a hard fall when I was doing the national service (in stairs with a 80kg load). There was/is a disc protrusion/herniation and I suffered of intermitent paresis since this date. I suffered until I discovered the NOI group and its neuronuts. I understood that pain is not ever linked to a RX image. I stopped to have a quasi-constant pain when I read Feldenkrais/Hanna/Butler/Shacklock... and understood that we were told wrongly that our body was badly in an upright posture and our spine "weak" designed.

Sorry to hear of that, since while there is "some" healing, the disc will always be weak to "exposed" compression to the anterior disc surfaces.

The Postural suggestions of Feldenkrais et al; can certainly reduce the exposure and effective and efficient postures and positions are part of the TSM.

I have incorporated a couple training and conditioning components to produce mild, effective, and supported, cyclic compression and decompression of the disc in a safe therapeutic manner, in an attempt to increase nutrient flow (which is highly limited by virtually no blood supply)

Originally Posted by Bernard

So actually, I have pain 2/10 some minutes/year because an injury may bring sequels.
Additionally I never, never tell a patient to strength their abs. I forgot it and give in place some painfree walking duty or Tai-Chi moves.

Sequels? Doesn't sound to me like you have "ended" your problem, but only improved your conditioning and awareness slightly.

In truth, your disc is "in waiting" and is subject to "ANY" position of stress where the anterior surface is compressed and the posterior is "open", as in Lumbar spinal flexion.

Additional bad news is total repair is not possible, so continued awareness as to your bodies positions is crucial to reducing anterior compression and posterior opening.

Creating support to the anterior torso via the combinations of IAP and activation of the abs will reduce the compressive forces, and maintaining tension of the spinal extenders will keep the "opening" from occurring, as well as compressing the posterior disc body which:

1) cups the posterior disc surface in the concave surface of the vertebrae, making it much stronger to the internal pressures of the nucleus pulposus, which are looking for escape by pushing through the annular wall at the weakness you have already injured

2) compressed the "exposed" portion making it tougher/denser to resist the internal hydraulic disc pressure also.

If there is a shining light, it is that at your age, the disc height is now reducing, and this in itself helps limit the injury to exposure.

Your reluctance to suggest your patients condition their abdominals properly is likely based in not being exposed to "effective", and not damaging exercises.

You are, (my assumption) correct in NOT giving exercises that could make the problem worse, as some do when they prescribe "the wrong type" of ab exercises.

[bernard]

Originally Posted by John A. Casler

you have no evidence of this and it is pure speculation based on general observation

That's true but does my observation is not logical?

Originally Posted by Bernard

Normally it will bend the chest forward but the spinal muscles will act => increased pressure on discs.

The lumbar area contracts => increased pressure on discs. The best way to lift a load without such forces is... to avoid them.

I assume and there is good references saying that anterior loading increases problems. That is all I wanted too say (perhaps too quickly).

Originally Posted by John A. Casler

Sequels? Doesn't sound to me like you have "ended" your problem.

I accept that an injury brings sequels and little problems. I have to cope with. Structural problems are the only things where there is no total solution. I do not think you make miracles eitheir.

BTW, I'm totally able to bend forward and extend my back without fear and pain. I do not use abs for that.

Originally Posted by John A. Casler

If there is a shining light, it is that at your age, the disc height is now reducing, and this in itself helps limit the injury to exposure.

I feel in a great condition and more supple than ever. I'm able to carry heavy loads only if my body tells me I'm able to do it.

Originally Posted by John A. Casler

]Creating support to the anterior torso via the combinations of IAP and activation of the abs will reduce the compressive forces, and maintaining tension of the spinal extenders will keep the "opening" from occurring, as well as compressing the posterior disc body which:

Please take a sheet and make a drawing of the forces: It will point out that you're on a wrong issue.

[EricM]

John,
I understand your argument as to why you believe a strong and conditioned torso may be important, however, like Randy I think, I'm still not sure just what the heck it is that you do to "condition and strengthen the torso," that is so fundamentally different than what anyone else has ever done?

Perhaps you've already stated it somewhere above, but what is it about the Aussies work that you disagree with?

Can you ever know when someone is strong and conditioned enough?

Eric

[John A. Casler]

Originally Posted by Bernard

Another silly question from a stupid PT: Is there a single example (in Nature and primates) showing a strong abdominal musculature? Just curious.

Hi Benard,

Not a silly question, but probably not relevant either.

The association you are trying to make, is not going to demonstrate significant enlightenment.

Except for primates, which don't have the "curvature" you are interested in, the rest of nature is primarily quadrupedal (with a few exceptions like Kangaroos and birds for example) and the spinal support and TSM operates primarily horizontally rather than vertically. Even in primates, vertical spinal loading is seldom relevant considering how often it occurs and general locomotion being arms and legs.

However, you might observe that when the attitude of the spine and torso is horizontal rather than vertical, that it is the abdominal musculature that maintains quadrupedal posture, and is subsequently activated at all times during normal locomotion and activity.

So no doubt, the relevance of abdominal strength and conditioning is important to the function of that attitude. As we "rose up" to more bipedal attitudes, we have lost that ab conditioning relevant to having a balanced antagonist to the spinal extenders which now serve as dominant in maintaining posture.


Another point, is that the level of what happens in nature, is likely not going to assist you in rehab or athletic conditioning because all activity in nature exists within the limitations of "everyday" levels of conditioning which offer less "insurance" than supranormal levels afforded by progressive types of conditioning.

If all we needed was the level afforded by everyday activity and the normal lifecycle, you and I would be all together useless and unneeded.

So in effect the practice of therapy and conditioning is man's extension of what happens naturally.

On top of that, what might be considered "strong abdominal musculature"? Strength is relevant to what?

The idea, is to provide the level of conditioning needed to help an injured bodypart reintegrate to full function and reduce the likelihood of re-injury.

In the athletic world the idea is to extend the performance capabilities of the body in an integrated fashion.

[John A. Casler]

Originally Posted by Nari

John,

Assuming it is desirable for the body to be in 'good' maintenance, then it is assumed that people do not need to lift weights or engage in heavy workouts.

Hi Nari,

Lifting weights, or heavy workouts are SAID, (Specific Adaption to Imposed Demand) and relevant only to the degree you wish to "extend" your performance and insurance against injury.

Almost "all" types of physical therapy involve "progressively applied" forces and ROMs to rehabilitate function and reduce reoccurrence, and hopefully help the body repair damaged tissues and process that have been interrupted and deconditioned.

Originally Posted by Nari

If this were so ,then the population would be somewhat disabled to a much higher level.

I'm sure most of us have seen the numbers of 85% of the population has LBP. I would consider that a rather high level.

Originally Posted by Nari

So core strengthening does what? Satisfy a need for exercising? That's fine. Does it act as a preventative? There is some indication it can lower the incidence of spinal problems. Does it 'cure' LBP? I haven't noticed evidence of this - the juries seem indecisive on this.

The reason there is so much conflict, is that there are too many "unaware" chiefs offering rather bad information on core conditioning. That is also why you have not seen "evidence". Look at most any study that "claims" to compare abdominal strengthening versus a control group of "non-strengthened" abs. What exercise(s) do they use to strengthen the abs??

Generally sit ups or crunches. Hello??? Since when do we lift loads or support the spine by "flexing the spine"??

So, no with this type of "understanding and awareness" you will not see improvement, and I am surprised you don't see "injury" caused by such lunacy.

What I suggest "is not" to satisfy a need for exercise. And yes, it does offer a preventative/prophylactic measure simply by extending the performance limits of the tissues via conditioning, as well as the supportive processes.

Originally Posted by Nari

If we are talking about belief systems where people work core musculature like crazy and feel great; then it may have value. Endorphins are useful. But I have come across many folk who go to Pilates / core classes because they feel they should as opposed to want to; and it doesn't seem to alter their aches and pains much.

I am not intimately familiar with the total Pilates system, and Joe was not educated in Anatomy and Biomechanics to the degree necessary to create a system for the torso, but to the extent that he many times used longer chain actions causing various torso loads, it looks like it might be more helpful than ball balancing.

I can not attest to the aches and pains of your associates who practice such.

Originally Posted by Nari

As for the sherpa issue, their brains have probably worked out the optimal posturing after generations of slogging up and down mountains....without much thought from their conscious brains.

The Sherpa are examples of developing the core via load/forces through core. Contrary to what some have been claiming, the Sherpa do condition the TSM via carrying progressively heavier loads and calling on the kinetic chain to activate to meet the load requirements.

This includes various application of the TSM. Some of this is "reflexive" and some is volitional. I am not sure why some feel that the Sherpa are not capable of "learning" and "teaching" various techniques of their tasks. It seems the "assumption" is that they just let all this happen "naturally" with little evidence to that fact.

In fact, I think one of Bernard's links even pointed out the degree of balancing they utilized to improve load handling.

Carrying heavy packs is no different than lifting heavy unstable loads of any kind, and will condition the TSM.

To be sure, these people start young, and progressively implement these loads. They don't just turn 14 and start off carrying 200# packs up a hill. This is simply a prime example how loads can be translated through the torso by conditioning and activating the TSM.

Those who think that the Torso Musculature and Stabilization Processes are not called upon here, need only pick up a heavy pack and hike up the side of a good hill. I have done this hundreds of times. I can assure you the body will respond to the load/force appropriately, and will condition as per the General Adaption Principle.

[John A. Casler]

Originally Posted by John A. Casler

Sequels? Doesn't sound to me like you have "ended" your problem.

Originally Posted by Bernard

I accept that an injury brings sequels and little problems. I have to cope with. Structural problems are the only things where there is no total solution. I do not think you make miracles eitheir.

Bernard, I can only implore you to consider some of what I say, because once you understand it, and develop the awareness to it, you may find fewer to no reoccurrence of your condition.

Is it a miracle cure? Of course not. It is the implementation the system that supports the "injured/damaged" tissue, and helps extend the limits of its safe function.

Originally Posted by Bernard

BTW, I'm totally able to bend forward and extend my back without fear and pain. I do not use abs for that.

Congratulations, but why would you use abs to bend forward?

Originally Posted by John A. Casler

If there is a shining light, it is that at your age, the disc height is now reducing, and this in itself helps limit the injury to exposure.

Originally Posted by Bernard

I feel in a great condition and more supple than ever. I'm able to carry heavy loads only if my body tells me I'm able to do it.

And I assume when you have "sequels" that is your body telling you not to do it? That certainly is not a problem if it fits within your lifestyle.

Originally Posted by John A. Casler

]Creating support to the anterior torso via the combinations of IAP and activation of the abs will reduce the compressive forces, and maintaining tension of the spinal extenders will keep the "opening" from occurring, as well as compressing the posterior disc body which:

Originally Posted by Bernard

Please take a sheet and make a drawing of the forces: It will point out that you're on a wrong issue.

I am sorry you underestimate my level. I would certainly not post that I have a system and knowledge of these things without substantiation.

My Physics, and Biomechanics are well researched, and validated by implementation. This is not "abstract" in any way. It is natural, and how the body functions. I again can only assume that the limitations of the medium have not allowed you to grasp what I have suggested.

I know it is complex. Over time I believe I will be able to eventually offer enough information to accommodate your perception.

[BB]

Hi John,

One distinction that I think should be drawn out is the difference between injury and pain. Each can be present without the other.

While I agree with the SAID principle as a form of graded exposure and performance enhancement, it's ability to prevent pain that is not yet present is a different story.

I think this separation of training for performance and movement to resolve pain needs to be delineated a bit. I'm not saying that whatever movements you use do not have the capacity for improving pain, but I'm not sure any change in pain can be attributed directly to any changes that occur in strength or conditioning.

[John A. Casler]

Originally Posted by Eric

John,
I understand your argument as to why you believe a strong and conditioned torso may be important, however, like Randy I think, I'm still not sure just what the heck it is that you do to "condition and strengthen the torso," that is so fundamentally different than what anyone else has ever done?

Hi Eric,

Actually there are a few out there who have similar approaches. Stuart McGill is certainly in the ballgame.

My focus is adjusted to the needs of the person, but the two key areas are:

1) Developing an awareness of the specific forces that can yield catastrophic damage and how to activate and position yourself to reduce those possibilities.

2) Condition the musculature/fascial tissues, and motor neural efficiency of the Torso muscles that activate during various high load activities producing Stabilization.

I have a several very specific (and unusual) exercises that can only be demonstrated properly in a one on one, or group setting, that lead very quickly to very nice results when coupled with the awareness.

At some point in the near future, I might have video of these, which could also serve the purpose, but do not as of yet.

Originally Posted by Eric

Perhaps you've already stated it somewhere above, but what is it about the Aussies work that you disagree with?

I have HUGE problems with "magic bullet" theories based on local and minor players in the TSM. All the TvA/Multifidus hoopla is beyond strange in a scientific setting. Additionally, the fact that they have explored and researched that path and claim to have "supporting" studies, is enough to turn one against the process.

Most all of it is "fantasy" including the "mysterious inhibition" they trot out that MUST be overcome if one is to have a healthy and reactive spine and torso.

They don't even know how the TvA performs its function from what I have been able to gather.

So do the TvA and Multifidus stabilize the spine? Of course they are "bit" players in a far larger mechanism (TSM) but have little function overall except in the very lowest of force situations.

Originally Posted by Eric

Can you ever know when someone is strong and conditioned enough?

Eric

How can anyone answer that? If you can function well in your daily activities and have a conditioned "cushion" of insurance then I think you will be fine.

What all need understand, is that a single major incident of disc failure can lead to a lifetime of reoccurring and episodic pain and limitation.

However, even after such an occurrence, you can rehab to levels even beyond your previous condition, if you follow the right protocol and develop the awareness necessary to distribute loads and create support forces.

[John A. Casler]

Originally Posted by BB

Hi John,

One distinction that I think should be drawn out is the difference between injury and pain. Each can be present without the other.

While I agree with the SAID principle as a form of graded exposure and performance enhancement, it's ability to prevent pain that is not yet present is a different story.

I think this separation of training for performance and movement to resolve pain needs to be delineated a bit. I'm not saying that whatever movements you use do not have the capacity for improving pain, but I'm not sure any change in pain can be attributed directly to any changes that occur in strength or conditioning.

Hi Cory,

I agree 100%, and my typing ability precludes me being able to provide information for "all" needs and implementations of this.

I don't feel that anyone should ever undertake a program without reasonable diagnostic measures to allow customization of the protocol for first stage and second stage implementation.

The greater part of what I suggest is best left to the post acute stage. Once the pain source is known then the process must be initiated below pain response thresholds.

In general other modalities are likely more effective at causing protrusion recision, and reduction in pain causing elements.

But again, I agree.

[BB]

Hi John,

Developing an awareness of the specific forces that can yield catastrophic damage and how to activate and position yourself to reduce those possibilities.

Be careful of the fear avoidance behaviors this promotes. Reminds me of the McKenzie folks and the way they promote avoidance of movements as well as the alignment folks who think that lack of a certain posture is a sign of impending doom.

What all need understand, is that a single major incident of disc failure can lead to a lifetime of reoccurring and episodic pain and limitation.

Same thing here. The dreaded disc strikes again. I think that the studies indicating 30% of the asymptomatic population is walking around with a disc herniation was already brought up in this thread.

Once the pain source is known then the process must be initiated below pain response thresholds.

This makes me think you are working from a tissue damage equals pain standpoint. A question for you: What pain sources do you think there are?

Also, take a look at this link. It is a discussion on the McKenzie method and fear of movement.

[John A. Casler]

Originally Posted by BB

Hi John,

One distinction that I think should be drawn out is the difference between injury and pain. Each can be present without the other.

This is true. The conditioning/rehab I suggest is only applicable if the pain is caused by "insufficient" conditioning, that can be improved or increased via progressive rehabilitative exercise.

Originally Posted by BB

While I agree with the SAID principle as a form of graded exposure and performance enhancement, it's ability to prevent pain that is not yet present is a different story.

It is quite well known that higher levels of conditioning and awareness can reduce injury, or increase the level of force/trauma that cause it.

Originally Posted by BB

I think this separation of training for performance and movement to resolve pain needs to be delineated a bit. I'm not saying that whatever movements you use do not have the capacity for improving pain, but I'm not sure any change in pain can be attributed directly to any changes that occur in strength or conditioning.

In general, only those that were caused by trauma/force that a higher level of conditioning would have resisted.

[John A. Casler]

Originally Posted by John A. Casler

Developing an awareness of the specific forces that can yield catastrophic damage and how to activate and position yourself to reduce those possibilities.

Originally Posted by BB

Be careful of the fear avoidance behaviors this promotes. Reminds me of the McKenzie folks and the way they promote avoidance of movements as well as the alignment folks who think that lack of a certain posture is a sign of impending doom.

Hi Cory,

That is an interesting point. Does that mean you support loaded anterior disc compression? At some point we all know that some positions and force loadings are risky based on several factors. Not developing or maintaining that awareness may be a bad idea.

Originally Posted by John A. Casler

What all need understand, is that a single major incident of disc failure can lead to a lifetime of reoccurring and episodic pain and limitation.

Originally Posted by BB

Same thing here. The dreaded disc strikes again. I think that the studies indicating 30% of the asymptomatic population is walking around with a disc herniation was already brought up in this thread.

I address this later, but asymptomatic disc damage has little relevance to symptomatic damage. Just because some do not produce pain, it does not eliminate the pain caused by those that do.

Originally Posted by John A. Casler

Once the pain source is known then the process must be initiated below pain response thresholds.

Originally Posted by BB

This makes me think you are working from a tissue damage equals pain standpoint. A question for you: What pain sources do you think there are?

That is correct. The system I suggest is only effective against preventing damage by raising conditioning levels, or reducing reoccurrence by rehabbing and then increasing resistance to the forces that caused the injury.

If the pain is not caused or a result of that then this does not address it.

Originally Posted by BB

Also, take a look at this link. It is a discussion on the McKenzie method and fear of movement.

Thanks for the link. This is what makes "listserve" discussion of such a complex topic difficult, since you cannot address "all" symptoms and conditions.

For example: The link refers to "avoidance of bending". I can still recall the day after years (and I mean over 30 years) of avoiding bending over, that I was able to simply bend over to allow my chest to touch my upper thighs. The shear power of regaining that ability was very empowering.

That said, the "awareness" that I am speaking of, is of performing that same action under loaded conditions or while in the acute stage of injury when pain is present.

So the my suggestion still stands, and I may be luckier than someone who has no symptoms, since lacking the experience of having felt the difference between symptomatic and asymptomatic can provide you with the awareness to discern the difference.

To not recognize, that we have a wide range of forces to deal with, as well as conditioning levels can be dangerous.

Earlier, I mentioned that I have a herniated disc. I also mentioned that with awareness to activation of the TSM I have performed 500# free weight squats for reps, without fear.

In fact, strangely enough, there is an extremely "dangerous" looking exercise called the Bent Over Barbell Row, where you bend over where your Torso is parallel to the floor, and lift a heavy barbell to your waist/lower ribcage and lower it. This body position is similar to the degree of bend needed to tie my shoes (actually since I stand on 6" wooden blocks it is a deeper bend)

With the proper activation of the TSM, and strict adherence to the bodies positions, I have used over 240# for 30 reps and over 315# for 5 reps. My point is not to show how "strong" I am, but to demonstrate that with a well conditioned TSM and
awareness, the spine and its discs (even those with some degree of trauma based pathology) can safely deal with HUGE loads.

Yet, if I bend over "without" maintaining adequate TSM activation, to tie my shoes, I can easily herniate that disc in a heartbeat. Those with disc related pain "must" take this into their awareness and if they are to resist reoccurrence, they must realize this weakness, and activate the protection of the system.

The disc does recede and heal slightly, but it will likely always be the "weak link" to reoccurrence.

The observation of pain free disc pathology is irrelevant in support of developing an awareness of one's limits.

Most of the disc damage without pain, that I am aware of, is not, in the Lumbar Spine, but more in the cervical and thoracic discs. Obviously if pain is not present from the disc damage it would likely cause few problems for normal activity, except possibly limitations in mobility.

So I would suggest the therapist/clinician, err on the safe side, and be "conservative" with spinal flexion to symptomatic client/patients.

Presenting information like that link to the "uninformed", (read those without the experience to recognize when, and when not, to restrict) could be quite dangerous.

Disc pathology is a serious, and quality of life threatening condition. Being cavalier in general, because of some article by Louis Gifford (whom I have never heard of) who thinks the restriction causes "unneeded" disability is risky.

If you read the above regarding my Weightlifting. I would be equally irresponsible to try to help patients do the same.

The training system is designed to strengthen the support and stabilizing mechanisms, so that full function and ROM "can" be achieved, but to discount that there need be awareness to unequal disc loads or torques (bending and twisting) is looking for trouble.

I might suggest that it is not that we advocate different goals, but more that we "view" them from a different perspective.

[Jon Newman]

Hi John,

This is true. The conditioning/rehab I suggest is only applicable if the pain is caused by "insufficient" conditioning, that can be improved or increased via progressive rehabilitative exercise.

How do you determine that the painful person before you is one that is painful due to lack of conditioning?

With the proper activation of the TSM, and strict adherence to the bodies positions, I have used over 240# for 30 reps and over 315# for 5 reps. My point is not to show how "strong" I am, but to demonstrate that with a well conditioned TSM and awareness, the spine and its discs (even those with some degree of trauma based pathology) can safely deal with HUGE loads.

Here the goal seems to be to handle huge loads rather than decrease pain. And I don't see how you lifting huge loads isn't demonstrating how strong you are. For me, the opportunity cost of lifting huge loads is too high. I don't need to lift huge loads and my ability to do so over the course of a lifetime is limited by biology. In fact, lifting huge loads anytime is an added risk but sometimes the return is worth it. I'm defining huge loads as something that you need to spend life hours conditioning yourself to be able to do it at all.

Those who do need to lift huge loads for their jobs would be interesting to study to see what they are doing and how they are doing it. It would be particularly interesting to perform a longitudinal study of a variety of measures to see what predicts a "significant" pain experience and what changes after such an experience.

Some of that data has been collected I'm sure. Maybe we could post some of that info here.

[John A. Casler]

Originally Posted by John A Casler

This is true. The conditioning/rehab I suggest is only applicable if the pain is caused by "insufficient" conditioning, that can be improved or increased via progressive rehabilitative exercise.

Originally Posted by Jon Newman

How do you determine that the painful person before you is one that is painful due to lack of conditioning?

Hi Jon,

I am not generally the "first" person someone sees regarding their back problem, and the majority of my work is focused on consulting, seminars and workshops. Frankly, I have only encountered a couple of cases where the pain was due to a neurological pathology, and not an injury, or deconditioning of the system.

Originally Posted by John A Casler

With the proper activation of the TSM, and strict adherence to the bodies positions, I have used over 240# for 30 reps and over 315# for 5 reps. My point is not to show how "strong" I am, but to demonstrate that with a well conditioned TSM and awareness, the spine and its discs (even those with some degree of trauma based pathology) can safely deal with HUGE loads.

Originally Posted by Jon Newman

Here the goal seems to be to handle huge loads rather than decrease pain. And I don't see how you lifting huge loads isn't demonstrating how strong you are. For me, the opportunity cost of lifting huge loads is too high. I don't need to lift huge loads and my ability to do so over the course of a lifetime is limited by biology. In fact, lifting huge loads anytime is an added risk but sometimes the return is worth it. I'm defining huge loads as something that you need to spend life hours conditioning yourself to be able to do it at all.

Please re-read what I said:

My point is not to show how "strong" I am, but to demonstrate that with a well conditioned TSM and
awareness, the spine and its discs (even those with some degree of trauma based pathology) can safely deal with HUGE loads.

Yet, if I bend over "without" maintaining adequate TSM activation, to tie my shoes, I can easily herniate that disc in a heartbeat. Those with disc related pain "must" take this into their awareness and if they are to resist reoccurrence, they must realize this weakness, and activate the protection of the system.


If you read the above regarding my Weightlifting. I would be equally irresponsible to try to help patients do the same.

My point was NOT that one needs to be super strong, but that there are TWO elements to consider, that must work together:

1) An adequately conditioned TSM
2) An awareness of the postures and positions that maintain equilibrium and stability

My example of handling a HUGE weight correctly, and then suffering an injury from the simple act of tying my shoes was a real example, and meant to illustrate that "strengthening and conditioning only" is not sufficient for the best coverage.

The example is to also show that even with disc damage, the biomechanics of properly applying the system can allow normal to extreme activity, with little or no residual effect.

Originally Posted by Jon Newman

Those who do need to lift huge loads for their jobs would be interesting to study to see what they are doing and how they are doing it. It would be particularly interesting to perform a longitudinal study of a variety of measures to see what predicts a "significant" pain experience and what changes after such an experience.

I have found very little, but am "talking" with several of the "delivery" companies, UPS/FEDEX/DHL regarding programs for their drivers, who sit while driving, and then lift packages in various positions.

[Jon Newman]

Hi John,

I re-read your post and I have nothing to change from my previous comments. Lifting huge loads only demonstrates that you can do it rather than you have some sort of injury prevention ability for everyday life that others don't. In fact, you point out that tying one's shoes may be sufficient for an injury to occur with or without conditioning.

I have no reason to think that special awareness of the TSM (a term I'm using just to be consistent and because people here are using it--versus it being a particularly valid and meaningful term in itself) is required to tie one's shoes. I see small children tie their shoes all the time and they'd have no idea what the heck you're talking about. Nor are they particularly conditioned. I understand ballet dancers are wonderfully aware and conditioned but often hurt none the less. What gives?

[anoopbal]

Hi John

Interesting discussion. From what I have read, I think you are, like most others, trying to understand and explain pain from just a biomcehanical perspective. ANd I hope you are talking and trying to treat 'chronic' pain in your clients

Joohn, I know you have read Stuart Mcgill, and he seems to be an expert in low back biomechanics.

Besides Mcgill, have you read anything from David Butler, Lorrimer Moseley, Melzack, or patrick wall ( bcos they are supposed to be experts in pain physiology). If yes, what do you think is wrong with their understanding of chronic pain and treatment of chronic pain? If not, what is your personal opinion about the psychological and neurophysiological factors contributing to pain? Or what makes you think the biomechanics model is ALL we need to know to understand pain?

Anoop

[John A. Casler]

Originally Posted by Jon Newman

Hi John,

I re-read your post and I have nothing to change from my previous comments. Lifting huge loads only demonstrates that you can do it rather than you have some sort of injury prevention ability for everyday life that others don't. In fact, you point out that tying one's shoes may be sufficient for an injury to occur with or without conditioning.

Hi Jon,

I might disagree that "greater strength" teamed with effective "biomechanics" will not yield more insurance.

To understand this we have to realize that the "my" example is of an existing pathology which is "exceptionally" weak in very specific circumstances. For those without the existing injury, improved support of a better conditioned system would seem likely to provide benefit.

Maybe this example might help clarify.

Say you were going to build a Bridge, and while the engineering physics of the structure was the same, you had the option of building it from: 1) Bundled Straw, 2) Wood, 3) Steel.

Obviously straw and wood would be considered the weaker of the materials, but could be used within certain load parameters to good effect. Using Steel may be "overkill", but would likely be the one with the greatest strength overall.

So in our case, we have 1) no conditioning, 2) General Conditioning, 3) Hyperconditioning.

It has to be quite evident, that the conditioned ability to handle large loads "IS" going to yield greater ability.

Also in the case of the structures, and processes, one must certainly see that "conditioning" produces stronger muscles, stronger connective tissue, and stronger bones. Ultimately to submit that there is no difference seems strange, when we know there is a strength difference.

I can only say again, that I certainly am not advocating the need to practice heavy weight training, but the abilities and qualities from such (at appropriate levels)undeniably "strengthen" the TSM.

However your point is well taken, and I would only assume that you are making the point that one needs "adequate" conditioning. You are not advocating that the system be left to "decondition" (are you?).

Originally Posted by Jon Newman

I have no reason to think that special awareness of the TSM (a term I'm using just to be consistent and because people here are using it--versus it being a particularly valid and meaningful term in itself) is required to tie one's shoes. I see small children tie their shoes all the time and they'd have no idea what the heck you're talking about. Nor are they particularly conditioned. I understand ballet dancers are wonderfully aware and conditioned but often hurt none the less. What gives?

My example of "tying ones shoes" coupled with 500# squats, was specific and was to demonstrate that if you already have disc pathology, that very high level stabilization "CAN" be accomplished with awareness, but the two (conditioning and awareness) must be married, and neither has full strength without the other.

In the healthy and young spine, there is little need for concern, (except of general conditioning) unless the prospect of high load forces exists, such as in competitive athletics, or job related stresses.

Regarding Ballet Dancers, I am not aware of their "understanding" the biomechanics of the TSM, and subsequently they subject themselves to high level stress without the 2 part system (they may be physically conditioned).

[John A. Casler]

Originally Posted by anoopbal

Hi John

Interesting discussion. From what I have read, I think you are, like most others, trying to understand and explain pain from just a biomcehanical perspective. ANd I hope you are talking and trying to treat 'chronic' pain in your clients

Joohn, I know you have read Stuart Mcgill, and he seems to be an expert in low back biomechanics.

Besides Mcgill, have you read anything from David Butler, Lorrimer Moseley, Melzack, or patrick wall ( bcos they are supposed to be experts in pain physiology). If yes, what do you think is wrong with their understanding of chronic pain and treatment of chronic pain? If not, what is your personal opinion about the psychological and neurophysiological factors contributing to pain? Or what makes you think the biomechanics model is ALL we need to know to understand pain?

Anoop

Hi Anoop,

I need to be clear that I do not think the "biomechanical" approach is the cure all to all pain.

I hope I have not said anything to make one assume that.

My system is designed to condition and treat the TSM to provide the support and stabilization it is capable of to:

1) Condition the TSM to function at the level needed for individual needs.

2) Condition the TSM to provide support and stabilization to those who have suffered injury that can be improved by such conditioning and support.

The degree of improvement is coupled to the specific type of problem and the degree it can be improved by reducing the stresses of a deconditioned and low level functioning of the TSM system.

[Jon Newman]

I can only say again, that I certainly am not advocating the need to practice heavy weight training, but the abilities and qualities from such (at appropriate levels)undeniably "strengthen" the TSM.

Yes. Everyone agrees that lifting weights makes you stronger. Nothing new here.

However your point is well taken, and I would only assume that you are making the point that one needs "adequate" conditioning. You are not advocating that the system be left to "decondition" (are you?).

No. But I also don't think that it takes specialized training to achieve adequate conditioning for health and most people can do this on their own as they desire.

Your bridge example has no nervous system nor does it have the degrees of freedom of movement of a body nor are you converting muscle to steel. It is an uninteresting analogy.

When you speak of awareness, what are you training people to be aware of?

Which aspect do you think is more important, the awareness training or the conditioning? I already realize you think they are both important so no need to defend that, I'm just wondering if you feel one has more importance than the other.

[Jason Silvernail]

Anoop-
Surely Mr Casler, who it seems has no credentials or academic training in any medical discipline, is not purporting to evaluate and treat any medical problems in his clients? That would seem to be quite a legal and ethical situation, to me.

I think lost in this debate is whether the particular program John is recommending produces better training outcomes or pain reduction than a more standard or "traditional" program - either in performance enhancement or in rehabilitation. It doesn't seem as if there's any evidence one way or another in that way, beyond a biomechanical theory. I think it bears mention that similarly complex biomechanical models (such as the facet alignment theory in manipulative medicine or the disc bulge theory of McKenzie) utterly failed in terms of their ability to adequately explain pain and dysfunction or as a paradigm for training and prevention. While John may indeed have detailed knowledge of a theoretical biomechanical paradigm, it remains to be seen whether such a theory is practically useful - in either training or rehabilitation. To judge by the past history of such systems, this program's future is indeed grim.
John-
On the Richardson/Hodges/Hides and TVA/Multifidus thing - I don't think the primary researchers in this area are talking about this deep subsystem as important for core stability by itself. After reading McGill's work and ideas, the emphasis has shifted from stability to motor control, and that there may be some sort of benefit to training muscular control in people with LBP, rather than strengthening per se. It seems to me that such programs work via a graded exposure and cognitive-behavioral mechanism more so than a biomechanical one, as current research certainly seems to demonstrate. I think by accusing Richardson et al of a belief that they have abandoned when new evidence presented itself, you are demonstrating a lack of awareness of the current research perspectives in rehabilitation. But as I brought up earlier, not having any academic training or credentials in a medical discipline certainly puts you at a disadvantage when it comes to these areas.

Similarly, I know very little about throwing a discus. But then I'm not claiming to have the best discus program around, so I suppose that makes sense.

I appreciate your willingness to share with us, and I agree with your assessment that the electronic world has it's communication limitations.

[anoopbal]

Thanks for the reply.

Since you dint reply my question, I guess you havent read ANY of those authors, And if you havent read those authors, I dont think you know much abt the psychological and neural aspects of pain ( and most of it are recent devolopments in the field of pain).

People here have read both the biomechanical and neural aspects of pain. You are only familiar with just ONE aspect. Hence this big gap in understanding.

I need to be clear that I do not think the "biomechanical" approach is the cure all to all pain.

But from what I read from your posts there is no mention of the "nervous sytem" involvement in pain. As you wrote," My system is designed to condition and treat the TSM ....

If you think there other aspects involved, What do you have in your system which tries to addresses specifically the psychological and neurophysiological aspects of pain besides the TSM? ANd if you are familiar with those aspects, you WILL have ssomething to address those issues.

Anoop

[Jon Newman]

In effort to try to start bringing some research to the table I'll add this. I encourage others to add what they feel is relevant to the conversation.

Authors: Bigos SJ. Battie MC. Fisher LD. Hansson TH. Spengler DM. Nachemson AL.

Title: A prospective evaluation of preemployment screening methods for acute industrial back pain.

Source: Spine. 17(8):922-6, 1992 Aug.

Abstract
Preemployment screening methods have been ineffective in predicting those at risk, and in curbing the impact of back problems in industry. Such methods have centered on individual physical factors (capacities and clinical examination). This study evaluates commonly used physical examination measures and simple historical data for its ability to predict individuals at risk for future back injury reporting in the aircraft industry. In this study, once simple historical information about previous pain treatment was known, information gained from physical factors added no significant predictive value.

[BB]

Hi John,

See this link to an article on disc pathology in asymptomatic individuals.

I recall another study (didn't see it in my brief search tonight) that found 30% lumbar herniations in asymptomatic individuals. Those with extruded disc fragments were the only group that was correlated with LBP consistently.

I recall in McGill's book that he does not advocate doing prone extensions as a result of the forces created. Were a disc herniation, and I'm talking specifically about damage to the disc material, responsible for pain, then why were my patients with this diagnosis able to do the exercise pain free in countless individuals back when I used to use such things?

My point is that tissue damage and pain are 2 separate things. Tissue damage is an orthopaedic issue. It responds to tissue stress in a predictable fashion and when present will likely benefit from the approach for which you advocate.
Pain is a neurological issue. It happens with or without tissue damage. The relevant tissue is the nervous system.

The position and movement avoidance issue is relevant with tissue loading. However, fear of movement creates fear of pain. It creates a mindset which all of us here see way too frequently. My pain is due to my alignment, disc herniation, lack of stability, insert other here. When I hurt I must therefore have damage. Therefore my pain is due to damage. Therefore, I shouldn't move or I'll damage myself further.

This mindset prevents the needed action sequence from occuring.

Louis Gifford is a world wide respected PT in pain management, has produced a series of great books on pain, is in England.

[bernard]

Originally Posted by John A. Casler

the rest of nature is primarily quadrupedal (with a few exceptions like Kangaroos and birds for example) and the spinal support and TSM operates primarily horizontally rather than vertically. Even in primates, vertical spinal loading is seldom relevant considering how often it occurs and general locomotion being arms and legs.

Since man is bipedal your TSM is either irrelevant.

Originally Posted by John A. Casler

However, you might observe that when the attitude of the spine and torso is horizontal rather than vertical, that it is the abdominal musculature that maintains quadrupedal posture, and is subsequently activated at all times during normal locomotion and activity.

Check your glasses, I do not see such stranges facts and certainly not in human population.

Originally Posted by John A. Casler

As we "rose up" to more bipedal attitudes, we have lost that ab conditioning relevant to having a balanced antagonist to the spinal extenders which now serve as dominant in maintaining posture.

Ridiculous, and we have brought some papers and you didn't replied: It becomes a bad habit from your own.
Show me please some proves that are saying we are not, all the time, bipedal.

Originally Posted by John A. Casler

In the athletic world the idea is to extend the performance capabilities of the body in an integrated fashion.

Bullshit, musculature is maintened by artificial training: Every bodybuilder knows that.

So John,
You are continuously avoidind to reply to simple questions and refuse to bring a single drawing showing the superiority of TSM over Nature strategies. Is it so difficult? Yes, if you discard the curves and forget that pressure is not done under special conditions you seems to misunderstand.

[bernard]

Originally Posted by John A. Casler

the rest of nature is primarily quadrupedal (with a few exceptions like Kangaroos and birds for example) and the spinal support and TSM operates primarily horizontally rather than vertically. Even in primates, vertical spinal loading is seldom relevant considering how often it occurs and general locomotion being arms and legs.

Bad news, my cousin Fred (picture) is a primate and walks often on its four limbs. He forgot totally to activate/train the TSM mechanism but I'm perhaps wrong?

[Randy Dixon]

Bernard,

Yes, you are wrong. A gorilla or a human activates the TSM all the time and as long as they move they are conditioning it, this isn't hard to understand. You seem to think that there is something mysterious about this that is being proposed. You also stated that there are no axial forces because of the spine being curved. This makes no sense. You claim then that there are no shear forces affecting the spine. This is ridiculous. You seem to think that John is completely ignorant of the curvature of the spine, if you read the posts where this discussion began, perhaps in another thread, you would see this is where the discussion began. If you wish to be taken seriously in this discussion quit presenting straw man arguments and then going "Aha, got you again!" Comments such as those below do nothing to further the discussion:

Musculature is maintained by artificial training-Bernard

Really? This contradicts every example you have provided and your primary point.


Since man is bipedal your TSM is irrelevant.-Bernard

? I can only assume you misunderstood what was written. The argument presented is that BECAUSE man is bipedal the TSM has become more relevant.

I have presented papers....-Bernard

Prior to Jon's latest post there is nothing to refute from the papers you have presented, nothing there contradicts what John has said.

I have my own questions about what John is proposing, similar to Jon's, Jason and Cory's, however, I think that if you wish to have answers to your questions you need to reread the whole thread, you don't seem to understand the points being made. You're example of the Sherpa is an argument towards what John is suggesting, that training and awareness, whether brought about in the gym or by carrying loads in a practical setting, provides protection from back injury. My own view is that training and awareness provides protection in those situations that are similar to the conditions in which you train, but not necessarily in other situations.

[John A. Casler]

Originally Posted by Anoop

Thanks for the reply.

Since you dint reply my question, I guess you havent read ANY of those authors, And if you havent read those authors, I dont think you know much abt the psychological and neural aspects of pain ( and most of it are recent devolopments in the field of pain).

People here have read both the biomechanical and neural aspects of pain. You are only familiar with just ONE aspect. Hence this big gap in understanding.

Hi Anoop,

I'm sorry, but I thought I did answer you when I said my suggestion has only to do with pain as the result of biomechanical problem. So no I have not read the authors you asked about.

Originally Posted by Anoop

But from what I read from your posts there is no mention of the "nervous system" involvement in pain. As you wrote," My system is designed to condition and treat the TSM ....

If you think there other aspects involved, What do you have in your system which tries to addresses specifically the psychological and neurophysiological aspects of pain besides the TSM? ANd if you are familiar with those aspects, you WILL have ssomething to address those issues.

Considering we have a dual neural system, consisting of sensory and motor aspects, to that degree, yes it would be impossible to "not" involve those elements.

The TSM certainly is "controlled" by volitional and reflexive impulse. It is also responsive to "pain" via facilitation and inhibition mechanism.

But to further address the issue, I would need to know what "nervous system pain" you are interested in, its source, and any other elements, that might distinguish it from impingement, mechanical or chemically irritating pains.

[John A. Casler]

Originally Posted by John Casler

However your point is well taken, and I would only assume that you are making the point that one needs "adequate" conditioning. You are not advocating that the system be left to "decondition" (are you?).

Originally Posted by Jon Newman

No. But I also don't think that it takes specialized training to achieve adequate conditioning for health and most people can do this on their own as they desire.

Being in the therapy/training/exercise world, I find it surprising to not recognize the effectiveness of some protocol over the other.

Originally Posted by Jon Newman

When you speak of awareness, what are you training people to be aware of?

Good question.

It is no secret what a great health problem we have in "Back Pain". While I may not understand the "pulse" of this list, it seems that this thread is about Torso Conditioning. Torso Conditioning is not just making muscles stronger, it is conditioning and maintaining all the structures, processes, muscles, and sensory and motor functions of the torso.

I think we all know that the body has a relatively complex system of proprioception and reflexive response. We also know that the Spine and its elements are also complex. The Torso as a whole is actively functioning any time we are in motion and sometimes even when we are not. There is even much "passive support" that is reduced when the TSM is deconditioned.

Most of this unconscious support activity in the healthy and well conditioned individual, is going on "behind the scenes" without us doing a thing.

However, due to injury, aging, sports, accidents, deconditioning or whatever, we find ourselves facing injury, pain, or weakness.

So the awareness is to that of positioning and postures, that help maintain and support discs and spinal structures, and or create a favorable load distribution to that disc to reduce the chances of injury, or reoccurrence of same.

The awareness is also inclusive of certain processes, of support, such as understanding and knowing how to volitionally create IAP and ITP when lifting heavy objects, or reducing stress to an already injured disc.

The awareness is to proper techniques of bending, lifting, twisting, and any number of normal daily activities that can cause same.

Those truly "in pain" from a protrusion/impingement or other, know that riding in a car, getting in and out of a car, sitting on an airplane cross country, picking their luggage up off a moving conveyor, or even "sleeping" wrong, etc, etc, etc, can cause, or keep them in pain.

If that pain is caused by a deconditioned TSM, coupled with poor posture and lifting technique, then the awareness is to develop the habits of maintaining positions and effective physical attitudes to reduce the exposure to undue stress and damage, or even to reduce the stress to the point to allow "healing" to the degree that healing can take place.

Originally Posted by Jon Newman

Which aspect do you think is more important, the awareness training or the conditioning? I already realize you think they are both important so no need to defend that, I'm just wondering if you feel one has more importance than the other.

I really can't separate them as far as importance, since their effectiveness is derived by their summation. Plus, each and every individual has specific requirements for "their" situation.

[Diane]

I would need to know what "nervous system pain" you are interested in, its source, and any other elements, that might distinguish it from impingement, mechanical or chemically irritating pains.

As far as I know, there is only nervous system pain. It may be fed by a number of inputs, that are nociceptive, but the nervous system is the only system that "hurts."

[John A. Casler]

Originally Posted by BB

I recall another study (didn't see it in my brief search tonight) that found 30% lumbar herniations in asymptomatic individuals. Those with extruded disc fragments were the only group that was correlated with LBP consistently.

Hi Cory,

I haven't disagreed that "painless" disc damage is of any major concern.

Originally Posted by BB

I recall in McGill's book that he does not advocate doing prone extensions as a result of the forces created. Were a disc herniation, and I'm talking specifically about damage to the disc material, responsible for pain, then why were my patients with this diagnosis able to do the exercise pain free in countless individuals back when I used to use such things?

I certainly can't speak to your patient, nor do I have enough information to explain your McGill reference, but I have mentioned other places in this thread that "I" too have disc damage and am able to function beyond most expectations.

Originally Posted by BB

My point is that tissue damage and pain are 2 separate things. Tissue damage is an orthopaedic issue. It responds to tissue stress in a predictable fashion and when present will likely benefit from the approach for which you advocate.
Pain is a neurological issue. It happens with or without tissue damage. The relevant tissue is the nervous system.

I only address "tissue damage" that "causes" pain, if it can be addressed via physical therapy.

I would be interested in just specifically what you feel is causing the "non-tissue damaged" pain.

Originally Posted by BB

The position and movement avoidance issue is relevant with tissue loading. However, fear of movement creates fear of pain. It creates a mindset which all of us here see way too frequently. My pain is due to my alignment, disc herniation, lack of stability, insert other here. When I hurt I must therefore have damage. Therefore my pain is due to damage. Therefore, I shouldn't move or I'll damage myself further.

This mindset prevents the needed action sequence from occuring.

I disagree with what I "think" you are saying and feel it is a "slippery slope" unless you have highly specific diagnostics.

That said, I am interested in how you can diagnose such. I have had pain to the point of passing out, and I can assure you that what I think you are advocating, would have lead to a surgical procedure.

I am also interested in what you term the "needed action sequence". Action for what?

Originally Posted by BB

Louis Gifford is a world wide respected PT in pain management, has produced a series of great books on pain, is in England.

I Googled him and found information on him, but with all due respect, I would asked him the same question.

The evidence of disc damage "without pain" does not have any effect on those who have disc damage "with pain".

The exception would be that you treat, those who have disc damage with pain, the same. Please explain why that is not a potential problem.

[Jon Newman]

Hi John,

If that pain is caused by a deconditioned TSM...

You've said this before also. How do you determine if the person before you in pain is one that is in pain caused by a deconditioned TSM?

[nari]

John,

I have had pain to the point of passing out

I can certainly understand that, but am curious as you what you think, given that you haven't had total weakness along with the pain (correct?), is causing that almost unbearable pain? Do you know for sure you have a sequestered disc/AP? Or a basic prolapse?
People can have severe lumbar pain with no indications of noncompliant discs. Would these people be treated differently by yourself?
Pain is pain, and excluding the obvious tissue damage such as a compound fracture or lacerated liver or Gr2 ankle sprain, (nociceptive), injury is not a prerequisite for pain. Neither is pain an automatic indication for avoiding movement, which Cory has said.

Nari

[Jon Newman]

I'll continue to try to add some studies. I encourage others to also.

Authors: Bo Andersen L. Wedderkopp N. Leboeuf-Yde C.

Title: Association between back pain and physical fitness in adolescents.

Source: Spine. 31(15):1740-4, 2006 Jul 1.

Abstract
STUDY DESIGN: A cross-sectional study of 9413 adolescents. OBJECTIVES: To study the associations between back pain, physical activity, and physical fitness. SUMMARY OF BACKGROUND DATA: A high physical fitness level, and especially muscle endurance in the back muscles, is associated with lower risk of back pain, but little is known about other types of physical fitness and back pain in adolescents. METHODS: A cross-sectional study of 3956 boys and 5457 girls 17 years of age. The associations between self-reported back pain and different types of physical fitness and self-reported physical activity were analyzed in high schoolchildren in Denmark. RESULTS: Back pain was reported by 43% of the girls and 37% of the boys. Back pain was associated with low isometric muscle endurance in the back extensors, and the highest quartile had a lower risk of back pain (odds ratio = 0.71; 95% confidence interval, 0.62-0.82) within the last month. No associations were found to aerobic fitness, functional strength, flexibility, or physical activity level after adjustment for muscle endurance. More girls than boys experienced back pain, and it was more common in taller adolescents. CONCLUSION: Children with high isometric muscle endurance were less likely to report back pain. No other measures of physical fitness or level of self-reported physical activity were linked to back pain reporting

The "isometric strength" finding is consistent with what Biering-Sorensen was reporting in the 80's and the "tallness" issue is also consistent with other evidence . However, it is unsurprising that a population self-reporting back pain also have low isometric muscle endurance.

I wondered to myself while reading this if all those with the ability to produce high isometric strength participated in a specific sort of training. I'll look into the full text to see if that sort of detail is mentioned.

[BB]

I would be interested in just specifically what you feel is causing the "non-tissue damaged" pain.

Well, I'm glad that you are interested. I sure wish more people were. The short answer is a real or percieved threat to the body's integrity causing the perception of pain. The long answer, and I definately recommend reading the long answer, is here.

I have had pain to the point of passing out, and I can assure you that what I think you are advocating, would have lead to a surgical procedure.

If you're assuming that I would push you into a compromising position then you are wrong. What I am advocating is that my explanation for why a position hurts and why a certain position may not be attainable at the time would likely be quite different from yours. The reasons for the difference are within the gifford article.

I am also interested in what you term the "needed action sequence". Action for what?

Patrick Wall's 3 stages of pain resolution. 1) withdraw from stimulus 2) protective posturing (this is where most are stuck and where those with the mindset I mentioned are stuck 3) resolution through movement.

I am interested in how you can diagnose such.

Pain which changes with movement. See the above long answer post. Yes, it really is that simple.

The exception would be that you treat, those who have disc damage with pain, the same. Please explain why that is not a potential problem.

Well, if they didn't have pain they likely wouldn't make it to me, so I'm not quite sure what you're asking me here. Please clarify a bit and I'll be glad to answer.

[John A. Casler]

Originally Posted by Jason

Anoop-
Surely Mr Casler, who it seems has no credentials or academic training in any medical discipline, is not purporting to evaluate and treat any medical problems in his clients? That would seem to be quite a legal and ethical situation, to me.

Hi Jason,

That is correct. Although I majored in PT in college, I did not finish the degree. I do not diagnose, or specifically treat patients.

Originally Posted by Jason

I think lost in this debate is whether the particular program John is recommending produces better training outcomes or pain reduction than a more standard or "traditional" program - either in performance enhancement or in rehabilitation. It doesn't seem as if there's any evidence one way or another in that way, beyond a biomechanical theory. I think it bears mention that similarly complex biomechanical models (such as the facet alignment theory in manipulative medicine or the disc bulge theory of McKenzie) utterly failed in terms of their ability to adequately explain pain and dysfunction or as a paradigm for training and prevention. While John may indeed have detailed knowledge of a theoretical biomechanical paradigm, it remains to be seen whether such a theory is practically useful - in either training or rehabilitation. To judge by the past history of such systems, this program's future is indeed grim.

The "grimness" is born mostly from the complexity of need. While we all think we know what that is, it is different to each and every person.

Based on that knowledge, the system I suggest deals with looking to how that Torso Stabilizes during all manner of activities and actions. It also deals with the fact that when the system fails, many times an injury (and pain) result.

This involves a more specific protocol to "rehab" and then recondition the TSM. Doings so then supports healing, supports function, and supports less reoccurrence.

There is little theory in my suggestion other than a possible refinement to some of the training protocol. Let me know what you might find theoretical.

The Torso Stabilization Mechanism is a real entity, that is not mine, but what each of us posses, and use everyday.

If what I have suggested seems strange to some, it may simply be that they are assuming it does things it doesn't, or because they have not been exposed to all the elements integrated into the system, or because they have been taught incorrectly and swamped by the unsuccessful attempts to address some of these issues.

Originally Posted by Jason

On the Richardson/Hodges/Hides and TVA/Multifidus thing - I don't think the primary researchers in this area are talking about this deep subsystem as important for core stability by itself. After reading McGill's work and ideas, the emphasis has shifted from stability to motor control, and that there may be some sort of benefit to training muscular control in people with LBP, rather than strengthening per se. It seems to me that such programs work via a graded exposure and cognitive-behavioral mechanism more so than a biomechanical one, as current research certainly seems to demonstrate.

That research was and is still quoted all over the world. It is also a significant part of many therapy protocols. My problems with it, was that is "WAS" quite insignificant to the whole of the TSM, yet for years was front stage.

I have stated that McGill seemingly now has gained acceptance and my suggestions are of a similar content. I have no idea haw many times I must continue to say, that it is not a "strengthening" program, as much as a "conditioning" program, and the motor control and stability control is exactly that. You say "cognitive behavior mechanism", I say develop awareness.

Originally Posted by Jason

I think by accusing Richardson et al of a belief that they have abandoned when new evidence presented itself, you are demonstrating a lack of awareness of the current research perspectives in rehabilitation. But as I brought up earlier, not having any academic training or credentials in a medical discipline certainly puts you at a disadvantage when it comes to these areas.

I do not try and keep up with Richardson et al's current path, since it offered little to no substance.

Originally Posted by Jason

Similarly, I know very little about throwing a discus. But then I'm not claiming to have the best discus program around, so I suppose that makes sense.

You look like you could do alright in the event.

Originally Posted by Jason

I appreciate your willingness to share with us, and I agree with your assessment that the electronic world has it's communication limitations.

There are some "toughies" here, and that is a good thing. Part of the problem in the field is that too many sheep followed certain groups and bents to very steep cliffs and jumped off.

Barrett has been on lists (before this one I believe) where similar discussions invoked very interesting exchanges with a departed contemporary of mine Mel Siff, myself, and any number of Sports Scientists and Therapist of various types.

I have discovered that part of the communications limitation, is based on not only the medium, but also the fact that the computer takes on the "summed" personality and content of all you have engaged in the past to a large degree, and much like the Imagio of "puppy love", people have a tendency to "fill in" the unknown areas with whatever they have seen in the past. or what they "want" to project onto the person.

Obviously this creates an even greater lack of understanding in such a complex subject.

[anoopbal]

I'm sorry, but I thought I did answer you when I said my suggestion has only to do with pain as the result of biomechanical problem. So no I have not read the authors you asked about.

But to further address the issue, I would need to know what "nervous system pain" you are interested in, its source, and any other elements, that might distinguish it from impingement, mechanical or chemically irritating pains.

Hi John

Statements like the above only speaks loud about your lack of knowledge in pain physiology.

The authors I wrote above are reaserchers in PAIN. The authors you read are experts in BIOMECHANICS. So since you deal with pain whom do you think you should read more of?

I would suggest you to read the book by these authors. Considering you make money doint this, the money spent will be worth.And you seemt ohave a passsion for this feild. Wont take you more than 2 weeks to read up the material.

I also came here with all this biomechanical wisdom of pain. Have read both books from MCgill, which is the bible of the rehab "experts" in sports feild.

Once you read all the apsects of pain and not just the biomechanical role. and then argue why your system is effective, people WILL listen.

As a side note, people can decipher you better , if you just outline how pain originates and is sensed. Like, what happans when someone gets hurt, how he perceives pain and what makes chronic pain different than acute?

Anoop

[Jason Silvernail]

Hi John.
Thanks for your reply.

You mentioned that you don't diagnose or specifically treat patients, but aren't these medical claims on your website?

"99% of all back problems are caused by a deconditioning of the Torso Stabilization Mechanism...My exercises programs, course instruction, and monitoring give you the tools to achieve and maintain back/torso stability and enjoy a full and active life....Most importantly we will develop an exercise program to put things back together. I have developed very specific exercises that, when performed regularly, will even "recondition" the slow to heal disc body!!!! No one else can make such a claim."

It seems to me that last sentence admits that it's a medical claim. You don't feel this is problematic - legally and ethically?

You mentioned to Cory that your program would only work for someone who had pain due to a need to condition the TSM. Since you don't diagnose people, do you rely on someone else to determine who can benefit from your program, or do you just use the 99% figure as a guide and just turn away the 100th person?

My point about your system being theoretical is that I'm not aware of any data that demonstrates it's superiority over more "traditional" approaches. I won't dispute the biomechanical basis of your program (I'll take your word that it's sound), but that still doesn't tell us whether the system is practically useful or what relation biomechanics has to pain. This is a point some others are addressing here also.

All pain and treatment issues aside, the theory part is that you say your training program is better and you certainly charge an impressive rate. With no evidence of efficacy for your system, that's where we're at, we just have your word. I grant that it's based on sound biomechanical principles, but so are a lot of other training programs. You can't show that yours produces a better training results - or can you?
Thanks.

[bernard]

Randy,

Did I say a word that you quoted?
I do not think so! You are trying to disturb the discussiion because your friend John have huge difficulties to bring a little clue about his miraculous claims.

Originally Posted by John A. Casler

that it is the abdominal musculature that maintains quadrupedal posture,

I brought the gorilla's picture to "support" this silly affirmation: Its belly is sufficiently speaking for readers.

Originally Posted by by ???

Musculature is maintained by artificial training

I never said that! I said that body builders are maintening their bulgy musculature by artificial training. Ask Governator about his daily training when he was Mr Universe.

Originally Posted by John A. Casler

However, you might observe that when the attitude of the spine and torso is horizontal rather than vertical, that it is the abdominal musculature that maintains quadrupedal posture, and is subsequently activated at all times during normal locomotion and activity.
As we "rose up" to more bipedal attitudes, we have lost that ab conditioning relevant to having a balanced antagonist to the spinal extenders which now serve as dominant in maintaining posture.

Randy, if we lost something with this affirmation it is not abs but surely intelligence.

BTW, you're are also ignoring the curves and I brought some pictures and phrases pointing out the flaws of your TSM mechanisms.
You're certainly true, either. It is certainly not important at all. I will ask my car mechanic to remove these silly and useless things on the shock-absorbers: these damned curved springs.

Useless since they are only able to transform a vertical loading to an horizontal one, absorbing smoothly loads for the comfort of the drivers. Fortunately my personal "bipedal" car works in the same way but it is clearly not your point of view.

[John A. Casler]

Originally Posted by Jason

You mentioned that you don't diagnose or specifically treat patients, but
aren't these medical claims on your website?

"99% of all back problems are caused by a deconditioning of the Torso
Stabilization Mechanism...My exercises programs, course instruction, and
monitoring give you the tools to achieve and maintain back/torso stability
and enjoy a full and active life....Most importantly we will develop an
exercise program to put things back together. I have developed very specific
exercises that, when performed regularly, will even "recondition" the slow
to heal disc body!!!! No one else can make such a claim."

It seems to me that last sentence admits that it's a medical claim. You
don't feel this is problematic - legally and ethically?

Hi Jason,

Strangely enough, I am not sure how you and Bernard got that web address, since it is only a "mock up" and I have not published or posted that address anywhere.

I threw it together, when a friend of mine was making suggestions about possibly doing a site some time ago. Obviously it is apparent that it is not a professional website for public consumption, and I had forgotten what is actually there, since I didn't know people could access it.

I don't have an active website, and the address for that one, is not posted anywhere I am aware of.

Originally Posted by Jason

My point about your system being theoretical is that I'm not aware of any
data that demonstrates it's superiority over more "traditional" approaches.
I won't dispute the biomechanical basis of your program (I'll take your word
that it's sound), but that still doesn't tell us whether the system is
practically useful or what relation biomechanics has to pain. This is a
point some others are addressing here also.

While I can see the "emphasis" here on pain, when I entered this thread, it
was based on the title "Useless Core Strengthening" which did not say anything about some specialized
but unspecified type of "pain".

It is my belief that the Torso/Core has a complex system of hard and soft tissue, as well as several processes, that cooperate to manage force loads to it, through it, and from it.

This system like any other, can decondition. Because of this, the functional aspects of its management ability suffers.

Lack of support and force management leads to certain structures moving towards overload and failure.

That is it, plain and simple.

Originally Posted by Jason

All pain and treatment issues aside, the theory part is that you say your
training program is better and you certainly charge an impressive rate.With
no evidence of efficacy for your system, that's where we're at, we just have
your word. I grant that it's based on sound biomechanical principles, but so
are a lot of other training programs. You can't show that yours produces a
better training results - or can you?

While I have posted critical comments against some in this area, I doubt I specifically said what I suggest is far better (although I would certainly think it so from my perspective)

Interestingly enough, there could be no sufficient answer to such a
question, since the area is so broad as to not allow such. Strangely enough
there are "no" systems of conditioning or therapy that are able to offer
"evidence of efficacy" beyond those of the underlying principles and successful application.

McGill, Feldenkrais, Egoscue, etc, etc, cannot with any certainly prove their systems superior to any other. It is all based on comprehensive analysis of their science, mechanics, and implementation.

You know that LBP has many times been proven to have a several week cycle,
both "with and without" treatment, so claiming to cure such is almost
impossible.

That given, then we must rely on "deciphering" the GENERAL reasons such a
high percentage of the population experience LBP. Then not only why they
experience it, but why they generally have frequent and episodic bouts. Old
ladies, and Olympic Athletes, all seem to have this malady in common.

We could blame it on aging and deterioration, but it happens to many when
they are younger. We could blame it on accidents, but many have it without
ever suffering such trauma.

We also must reasonably believe that NO organism can be made to withstand any and all force loads without damage.

So the next best concept would be to rehab, recondition and possibly even progressively strengthen, this TSM so that it can function at a higher level than the same system left to decondition.

The question then arises, what is the best way to provide this conditioning. That is what I thought we were discussing and that is what I posted to.

[bernard]

Originally Posted by John A. Casler

Strangely enough, I am not sure how you and Bernard got that web address, since it is only a "mock up" and I have not published or posted that address anywhere.

I threw it together, when a friend of mine was making suggestions about possibly doing a site some time ago. Obviously it is apparent that it is not a professional website for public consumption, and I had forgotten what is actually there, since I didn't know people could access it.

I don't have an active website, and the address for that one, is not posted anywhere I am aware of.

John,

We just "googled" "John Casler Bio Force" with information given on your profile page.
http://www.google.fr/search?q=john+C...+force&start=0
Just saying that Google found it out from nowhere is incredible.
It is a huge referencing job to be ranked like that.

[Diane]

McGill, Feldenkrais, Egoscue, etc, etc, cannot with any certainly prove their systems superior to any other. It is all based on comprehensive analysis of their science, mechanics, and implementation.

And the "fit" depends on the comprehensive capacity of the recipient.

At least one of these constructs is nervous system based. This may not make it more comprehensible or accessible, but such a construct fits with reality better than systems that do not consider the nervous system, that rely solely on biomechanical or structural explanations.

[Jason Silvernail]

Hi John.

Re:medical claims-
Regarding the website (near the top of a Google search of your name BTW so not hidden in any way) - do you still feel those statements I quoted are an accurate statement of your position regarding your program? If so, you do agree that there are ethical/legal issues there? If not, you might consider changing it or at least adding a disclaimer. I wonder, if the statements aren't current, are the seminar prices?

Re:Efficacy-
I'm not really sure what you're getting at here by saying it's impossible to know. If you can't argue the superiority of your system in getting results (perhaps it's that out of date webpage issue again), then how can you sell it? If you can't argue the superiority of one program over another then why be so hard on Richardson et al or other back experts who are....how did you put it...shooting in the dark was it?
I agree that there are good principles to base a program on and not so good principles to base a program on. I also agree about the adaptability of the body to imposed stress. Efficacy of any training or rehab program can be demonstrated by either outcomes evidence, solid construct validity, or preferably both. Your program doesn't have outcomes evidence and it's highly detailed biomechanical constructs are not based on what we know of human physiology and pain. I bring pain up because the title "The Useless Core Strengthening" was in relation to it's ability to treat/prevent pain, and your comments above are talking about LBP in prevention/treatment. So it's not as if you're only discussing athletic performance.

I guess in any case if you don't have outcomes evidence and you don't have construct validity beyond what other systems offer, then what exactly are you selling? Or how is your approach not simply another opinion? Remember, you said there was no way to prove with certainty the superiority of one system versus another. If that's the case then what are we talking about on this thread?

[Jon Newman]

I've been reviewing some of this conversation and checking out some of the literature and I'm wondering what constitutes having a "stable core" so that someone trying to achieve such a thing knows they have achieved it. Is it something that can be measured? I'm not concerned about pain in this question at all, just an objective and meaningful definition of a "stable core".

Any ideas?

[Jon Newman]

Well I haven't found an answer myself yet but I did find this study

Spine. 1997 Oct 1;22(19):2207-12.

Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture.

Cholewicki J, Panjabi MM, Khachatryan A.


STUDY DESIGN: This study examined the coactivation of trunk flexor and extensor muscles in healthy individuals. The experimental electromyographic data and the theoretical calculations were analyzed in the context of mechanical stability of the lumbar spine. OBJECTIVES: To test a set of hypotheses pertaining to healthy individuals: 1) that the trunk flexor-extensor muscle coactivation is present around a neutral spine posture, 2) that the coactivation is increased when the subject carries a load; and 3) that the coactivation provides the needed mechanical stability to the lumbar spine. SUMMARY OF BACKGROUND DATA: Theoretically, antagonistic trunk muscle coactivation is necessary to provide mechanical stability to the human lumbar spine around its neutral posture. No experimental evidence exists, however, to support this hypothesis. METHODS: Ten individuals executed slow trunk flexion-extension tasks, while six muscles on the right side were monitored with surface electromyography: external oblique, internal oblique, rectus abdominis, multifidus, lumbar erector spinae, and thoracic erector spinae. Simple, but realistic, calculations of spine stability also were performed and compared with experimental results. RESULTS: Average antagonistic flexor-extensor muscle coactivation levels around the neutral spine posture as detected with electromyography were 1.7 +/- 0.8% of maximum voluntary contraction for no external load trials and 2.9 +/- 1.4% of maximum voluntary contraction for the trials with added 32-kg mass to the torso. The inverted pendulum model based on static moment equilibrium criteria predicted no antagonistic coactivation. The same model based on the mechanical stability criteria predicted 1.0% of maximum voluntary contraction coactivation of flexors and extensors with zero load and 3.1% of maximum voluntary contraction with a 32-kg mass. The stability model also was run with zero passive spine stiffness to simulate an injury. Under such conditions, the model predicted 3.4% and 5.5% of maximum voluntary contraction of antagonistic muscle coactivation for no extra load and the added 32 kg, respectively. CONCLUSIONS: This study demonstrated that antagonistic trunk flexor-extensor muscle coactivation was present around the neutral spine posture in healthy individuals. This coactivation increased with added mass to the torso. Using a biomechanical model, the coactivation was explained entirely on the basis of the need for the neuromuscular system to provide the mechanical stability to the lumbar spine.
PMID: 9346140

One thing that caught my eye in the main text, maybe because I wasn't expecting it, was the following:

The EMG signal levels recorded from the trunk muscles in a neutral posture were very low and presented some technical difficulties. The heart beat contamination of the raw signal was evident, but it was eliminated with an adaptive filtering algorithm. Additionally, the electrode background noise, the amplifier noise, and any resting muscle activity were obtained for each subject lying down in a relaxed supine position. These baseline EMG values then were subtracted from all of the trial data. Therefore, the 1% to 3% MVC EMG levels observed in the present study represent the actual noise-free muscle activity above their resting states.

The low level of muscle coactivation documented in the present study is also consistent from the point of view of muscle fatigue. Jonsson 13 has published data on acceptable levels of muscle contractions sustained over a long period of time that serve as ergonomics guidelines. He showed that the prolonged 5% MVC muscle contraction correlated with muscular pain. It seems reasonable to expect that the requirement of spine stability in a neutral posture should not demand more than 5% MVC of muscle coactivation, because that could lead to muscle fatigue during the course of the entire day.

and this

The authors of the present study analyzed the coactivation of combined trunk flexor and extensor muscles. A variety of muscle coactivation strategies existed, however, when the six monitored muscles were looked at individually. Most of the individuals maintained a constant level of internal oblique muscle activity regardless of the trunk angle. Some individuals activated the multifidus in a similar manner. Others exhibited an overlap of activity between all of the trunk flexors and extensors. Such individual differences were not surprising, given the vast redundancy present in the human neuromuscular system. Similar individual differences were observed in the muscle recruitment strategies during the execution of the trunk isometric moments.3 The redundancy in the neuromuscular system makes it very flexible and adaptable to the changes in the everyday environment; however, it also makes motor control more complex and vulnerable to errors. The hypotheses of such errors as the etiology of some low back disorders can be studied in the future with spine stability models that contain adequate anatomic detail.

[Jason Silvernail]

Good find, Jon.
This is pointing (again) away from strength/stability models and towards a motor control model for understanding these concepts.
It's worth noting that even under load, the %MVIC was pretty low.

I would reiterate my previous point in that researchers in the area are looking at this from the motor control perspective. Here's a link that explains this better:
Motor Control and LBP

I attached the full text of the study protocol.

J

[bernard]

From this paper:

Evidence that people with back pain tend to adopt a strategy for increased stiffness and stability at the expense of spinal function.

And it is clear that this strategy doesn't work!

[Jon Newman]

I agree Jason that those %MVCs were pretty low. It seems that it would be quite an easy to task to produce those 5%+ levels without even being aware of it--until it hurts.

Hi Bernard. Which paper is that quote from?

[bernard]

Jason provided it.

[John A. Casler]

Originally Posted by Jason Silvernail

Re:medical claims-
Regarding the website (near the top of a Google search of your name BTW so not hidden in any way) - do you still feel those statements I quoted are an accurate statement of your position regarding your program? If so, you do agree that there are ethical/legal issues there? If not, you might consider changing it or at least adding a disclaimer. I wonder, if the statements aren't current, are the seminar prices?

Hi Jason,

That site as I said earlier was a mock up and not supposed to be "active" since I hadn't written most of it myself. It was written by a friend who was trying to give me ideas, and had read some of my work. So please disregard it.

Originally Posted by Jason Silvernail

Re:Efficacy-
I'm not really sure what you're getting at here by saying it's impossible to know. If you can't argue the superiority of your system in getting results (perhaps it's that out of date webpage issue again), then how can you sell it? If you can't argue the superiority of one program over another then why be so hard on Richardson et al or other back experts who are....how did you put it...shooting in the dark was it?

I can only assume that you are well versed in this area, so how do you know that anything you do, is effective? You can't.

Given that most research shows that a high percentage of LBP will cycle out of the acute stage at about the same speed with or without treatment, it is difficult to presume or prove any system.

Couple that with the number of causes, and you have a rather vague idea of efficacy.

Your only option is to assemble an understanding of all the processes, and mechanisms and know that a large majority of problems are caused by mechanical failure, leading to damage.

While you may disagree with that, I would suggest that it has a greater likelihood than some other "obscure" cause. Or I might better say that the "obscure" causes, might be far less in number.

My critique of the former stance of the Aussies, was that they became obsessed with a rather small player, and almost manufactured new Biomechanics, and Neurophysiology to accommodate their direction.

Originally Posted by Jason Silvernail

I agree that there are good principles to base a program on and not so good principles to base a program on. I also agree about the adaptability of the body to imposed stress. Efficacy of any training or rehab program can be demonstrated by either outcomes evidence, solid construct validity, or preferably both. Your program doesn't have outcomes evidence and it's highly detailed biomechanical constructs are not based on what we know of human physiology and pain. I bring pain up because the title "The Useless Core Strengthening" was in relation to it's ability to treat/prevent pain, and your comments above are talking about LBP in prevention/treatment. So it's not as if you're only discussing athletic performance.

While you speak of "efficacy" being based on success, I would doubt that you could clearly state that you know the answers, or the cures.

You like me, are totally basing your assumptions on what you "know" (education) and what you have tried and appeared to work. (practice)

We know aspirin can help a headache, but we also know that headaches go away by themselves. So if you get a headache, and take an aspirin, what caused it to go away?

Your comments are well taken, but I would suggest from the small amount I have written (and probably not very well) you don't have a complete grasp on my philosophy.

LBP is rampant. If we had a cure, it would not be. So where does that place us? As mentioned before there are incidence of tissue damage without pain. Does that mean mechanical/chemical damage/irritation is not the cause of the "majority" of LBP? I think not.

Could there be other sources to the pain? Of course. I'm all ears to know about and explore these, but I feel the majority is caused by a failure to provide the support needed to the soft tissues.

Originally Posted by Jason Silvernail

I guess in any case if you don't have outcomes evidence and you don't have construct validity beyond what other systems offer, then what exactly are you selling? Or how is your approach not simply another opinion? Remember, you said there was no way to prove with certainty the superiority of one system versus another. If that's the case then what are we talking about on this thread?

Go back and read the first couple paragraphs of my first post.

My posts were to share and discuss the TSM. The validity of mine or any system rests in a comprehensive understanding of how it works, and why it works. Since a good part of this thread has been rather aggressive, non-substenative fluff, it might be difficult to fully comprehend everything.

Is what I suggest better than other systems? Of course I think so, but I don't know "every" system. If I find new information, I will integrate it into my awarness and use it. I have no interest in being an originator, but more a compiler. I also have no "axe to grind". If I find something better for my purposes tomorrow, I will adopt it in short order.

I would find it far more constructive to discuss "specifics" and how they relate to what (I assume) all of us are interested in, than to languish in "attitude".

My position is both enhanced, and obscured by having the condition myself. The enhancement comes from having a "working lab" to learn from, the obscurity comes from not having "all" other causes.

One thing for certain, is that we have a TSM (Torso Stabilization Mechanism) that includes all the structures, tissues, and processes that sum to allow us to function. These elements can and do de-condition and deteriorate. This deconditioning reduces function, protection and can lead to pathology.

My philosophy and system is based on re-conditioning this Mechanism to the degree possible and or needed for the individual.

It seemed that some glommed onto my references to "heavy weight training" and felt that was required for the program and it is not. It was simply an example of having a very severe back problem, and how, with the proper reconditioning and awareness, the system can perform quite well.

As in most therapy, progressive integration of load and ROM is used to provide some of this conditioning.