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The Performance Lab A place to discuss the role of physical exercise on health in diseased and non-diseased states.

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Old 15-08-2007, 05:09 PM   #251
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Little anecdote to share.. I may have inadvertently stumbled upon one of the secrets that skinny people all use consciously or unconsciously to keep hunger pains to a minimum or eliminate them. Point of disclosure: I am NOT one of these skinny people.

I had a hunger pang last night shortly after going to bed, which I would ordinarily have either a) got up to feed with something, or b) endured for awhile, then got up to feed it with something. This has been the story of my life...

Instead, for some reason completely unknown to me, I took long slow deep breaths and did core contraction on exhalation with each one. At the end of three or four of these, the hunger pang was gone, and hasn't come back yet even though it's nearly 8 AM here.

I'm usually quite a slave to these, have always found myself woefully inadequate to fight them, but this silly little maneuver seemed effective; although I'm also quite sure my hungry centers will eventually find a way around the application of mechanical counterstimulation and deliberate autonomic NS rerouting I employed, I'm enjoying the feeling of supremacy, however shortlived it may be, over an annoying and potentially artery-clogging, life-threatening call from the deep physiological parts of my brain.

It makes sense that if employment of deep breathing and abdominal contraction/hollowing on exhalation works to give the conscious awareness portion of the cortex relief from somatic pains (nothing to do with bones/joints), and/or for visceral pain such as childbirth, it could be found to positively diminish hunger pain, for however brief a moment, in otherwise overly-nourished or even obese people.

I will keep this alive for awhile, for further personal study. I'll let you know if it helps me lose any weight. Along with sensible eating and walking on the treadmill I mean.
It makes sense to me that losing weight is based on avoiding temptation which is in turn based on successful downregulation of impulses to eat, like hunger pangs that take over the whole of one's conscious awareness and are by their very nature distressing. Those hunger pangs are the quicksand under any well-intentioned, well-designed weight loss plan. If the quicksand can turn into concrete, even for a little while, one can get past them instead of falling prey to them. Then neuronal "learning" or re-wiring can take over; graded exposure, long term potentiation, habituation, all those.

Gee skinny people, thanks a whole bunch for having never shared this tip with any of us chubbies before.
Maybe you just never realized what you were doing with ab hollowing exercises, or when you really used them, or what they were actually good for.. instead you made us feel bad for having tummies and told us we had to lose them, or that our posture was bad, or that the tummies didn't "look" good... all sidetracks off the main point - downregulation of the beast within, just for those moments it rises up to strike.
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Old 15-08-2007, 06:26 PM   #252
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Diane,

I was tempted to describe different delicious foods here, but instead I will make this observation. Hunger in today,s society, for most of us, often has little to do with nutritional status, instead it is a signal by our minds that SOMETHING is wrong, this can be thirst, lack of stimulus, motion or emotional etc., your body may have just been telling you that it lacked SOMETHING and that was satisfied by the exercise you did. Now if you can figure out what that SOMETHING was maybe you can feed it directly.
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Old 15-08-2007, 06:32 PM   #253
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Now if you can figure out what that SOMETHING was maybe you can feed it directly.
In retrospect, clearly it was deepbreathing/corehollowing exercise deficiency that needed feeding. Just in that one tiny temporal intersection in the whole ongoing machination of the entire universe.
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Old 15-08-2007, 10:17 PM   #254
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Randy, you are right - hunger is a need, the consummation of which is highly varied. If a person has not eaten for a day or days, food will fill that need. If hunger is felt twenty minutes after a normal sort of meal, it is a signal for something else.

I am almost always hungry. Yet I am just below the normal range of weight to height; and I never practise TrAs and that stuff, nor have I ever been near a gym or its equipment. The brain is a peculiar beast.

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Old 15-08-2007, 10:32 PM   #255
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I wonder if there is a difference between a hunger "pang" - sharp, explosive, vicious, overwhelming in its demand to be satisfied NOW, not in 20 minutes.. and ordinary hunger, as in the "I am amost always hungry" type of background rumble or ordinary interoception Nari suggests is normal for her. I also wonder if, Nari, you don't do some unconscious ab work. Ab work without even being aware of what you are doing. I will lay odds it comes so efortlessly to you that you do it without knowing you do. Just a thought..
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Old 15-08-2007, 11:01 PM   #256
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If I do activate abs, I am totally unaware of it. Perhaps, that is a possible answer to the always-hungry thing, but I need more convincing!
Tell you what, I'll do a little experiment and the next time I am 'starving' I will consciously facilitate abs et al. Let you know...

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Old 27-08-2007, 08:56 AM   #257
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Arch Phys Med Rehabil. 2007 Jan;88(1):54-62.Related Articles, Links
Quantification of lumbar stability by using 2 different abdominal activation strategies.

Grenier SG, McGill SM.

Spine Biomechanics Laboratory, Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, ON, Canada. sgrenier@laurentian.ca

OBJECTIVE: To determine whether the abdominal hollowing technique is more effective for lumbar spine stabilization than a full abdominal muscle cocontraction. DESIGN: Within-subject, repeated-measures analysis of variance was used to examine the effect of combining each of 4 loading conditions with either the hollow or brace condition on the dependent variables of stability and compression. A simulation was also conducted to assess the outcome of a person activating just the transversus abdominis during the hollow. SETTING: Laboratory. PARTICIPANTS: Eight healthy men (age range, 20-33y). INTERVENTIONS: Electromyography and spine kinematics were recorded during an abdominal brace and a hollow while supporting either a bilateral or asymmetric weight in the hands. MAIN OUTCOME MEASURES: Spine stability index and lumbar compression were calculated. RESULTS: In the simulation "ideal case," the brace technique improved stability by 32%, with a 15% increase in lumbar compression. The transversus abdominis contributed .14% of stability to the brace pattern with a less than 0.1% decrease in compression. CONCLUSIONS: Whatever the benefit underlying low-load transversus abdominis activation training, it is unlikely to be mechanical. There seems to be no mechanical rationale for using an abdominal hollow, or the transversus abdominis, to enhance stability. Bracing creates patterns that better enhance stability.

Publication Types:PMID: 17207676 [PubMed - indexed for MEDLINE]
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Old 27-08-2007, 09:30 AM   #258
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Yay!!! Beryl Kennedy in 1976 taught us appropriate bracing, using the obliques. For whatever reason, let's say neural, it seemed to be useful during a strenuous activity; but no value any other time.

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Old 27-08-2007, 10:07 AM   #259
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Thanks for that, Bernard.
More evidence pointing again away from "stability" models and toward "motor control" ones.
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Old 28-08-2007, 07:35 AM   #260
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This isn't anything new, Mcgill and others have shown this for quite a long time. The rationale behind TrA training was never for mechanical stabilization, it was always to correct a motor control pattern. The problem, which is not unusual, is that many people misapplied or misunderstood the concept and we were left with a bunch of "stomach suckers" and "abdominal awareness" ideas.
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Old 28-08-2007, 07:42 AM   #261
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Quote:
The rationale behind TrA training was never for mechanical stabilization, it was always to correct a motor control pattern.
Yet another idea that became mesodermalized?
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Old 28-08-2007, 09:42 AM   #262
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The paper cited above is here =>
Quantification of lumbar stability by using 2 different abdominal activation strategies.
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Old 01-12-2007, 04:59 AM   #263
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Quote:
doi:10.1016/j.apmr.2007.10.002
Copyright © 2007 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Published by Elsevier Inc.

Commentary

Expert Opinion and Controversies in Musculoskeletal and Sports Medicine: Core Stabilization as a Treatment for Low Back Pain

Christopher J. Standaert MD and Stanley A. Herring MD
Department of Rehabilitation Medicine, Department of Orthopaedic and Sports Medicine, and Department of Neurological Surgery, University of Washington, Seattle, WA.

Available online 28 November 2007.

Abstract

Standaert CJ, Herring SA. Expert opinion and controversies in musculoskeletal and sports medicine: core stabilization as a treatment for low back pain.

Although there are a wide variety of therapeutic exercises that have been proposed as treatments for low back pain (LBP), the last 20 years have seen the development of a substantial focus on the use of exercises that are intended to address intersegmental stability in the lumbar spine. These exercise programs are varyingly referred to as lumbar stabilization, segmental stabilization, or core stabilization, among other terms, and are aimed at improving the neuromuscular control, strength, and endurance of a number of muscles in the trunk and pelvic floor that are believed to play important roles in the dynamic stability of the spine. Although it is difficult to quantify, there appears to have been a tremendous degree of penetration of these treatment concepts into the therapeutic arena, the medical literature, and the lay press. Despite this, there are few prospective studies on patients with LBP, and there is even more limited discussion of the concepts of patient selection, dose-response, and long-term outcome associated with these approaches. There also is a significant lack of uniformity regarding the meaning of “core stabilization” and what therapeutic exercises may be most effective.

Key Words: Exercise; Low back pain; Rehabilitation

Article Outline

Controversies

The Efficacy of Stabilization Exercises in Treating LBP
The Degree of Importance of the Multifidi and Transversus Abdominis
Core Stabilization Exercises as a Means of Preventing Further Injury

Practical Approaches

Are Lumbar Stabilization Exercises an Effective Treatment for LBP?
Do We Know Anything About Dose-Response or How Far to Take Core Training?
Is It Really All About the Transversus Abdominis and Multifidi?
Can Core Exercises Help Prevent Low Back or Extremity Injury?
Prescribing Lumbar Stabilization Exercises

Conclusions
References
FullText
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Old 04-12-2007, 10:01 PM   #264
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Although this study is on neck pain I thought I'd post it here because the idea is essentially the same.
Quote:
Manual Therapy
Article in Press, Corrected Proof

Training the cervical muscles with prescribed motor tasks does not change muscle activation during a functional activity

Deborah Fallaa, Gwendolen Julla and Paul Hodges

Abstract

Both low-load and high-load training of the cervical muscles have been shown to reduce neck pain and change parameters of muscle function directly related to the exercise performed. The purpose of this study was to investigate whether either training regime changes muscle activation during a functional task which is known to be affected in people with neck pain and is not directly related to either exercise protocol. Fifty-eight female patients with chronic neck pain were randomised into one of two 6-week exercise intervention groups: an endurance-strength training regime for the cervical flexor muscles or low-load training of the cranio-cervical flexor muscles. The primary outcome was a change in electromyographic (EMG) amplitude of the sternocleidomastoid (SCM) muscle during a functional, repetitive upper limb task. At the 7th week follow-up assessment both intervention groups demonstrated a reduction in their average intensity of pain (P<0.05). However, neither training group demonstrated a change in SCM EMG amplitude during the functional task (P>0.05). The results demonstrate that training the cervical muscles with a prescribed motor task may not automatically result in improved muscle activation during a functional activity, despite a reduction in neck pain.
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Old 06-12-2007, 05:46 AM   #265
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Quote:
Originally Posted by bernard View Post
John,

Just try this african experience with a tight belly.
ouf long thread!!

i am a french speaker and my english reading are slower than the french ones... so right now i am only done to comment no77

but i will still make a reply then continue my reading.

so... i like to think of CS as something usefull. and i think of CS as something neuromuscular, more than strenght. i dont teach CS to everyone with LBP. i ususally choose my patients. there must be a symptomatic instability. and sometimes i try it with chronic LBP patients. most people wants exercice and they know (they heard) that ABs are good for them. When i know everything is stable i recommend not to do those exercices. (i think it'S o'sullivan who categorized people with too much stable vs unstable patients). we have in fact to release muscles tensions in those cases.

so i think CS is good, but must be applied without being choregraphed, and with the patients that really needs it. so the debate to know if CS is good or not is maybe not the question, but when to apply it! (and how).

an other thing, i see most people here offer resistance to think about a compressive force on the spine. i dont see there a big issue. first, we need to apply compression to walk. compression will stress the vertebras, which needs it to avoid osteoporosis. then, compressive force will increase stability. the easy exemple: think of say 5 wood blocks one on each other. try to move one of those block, say the one in the middle: easy. now add a pressure on the top (even light) and the blocks are now tighten up. so i think the good point is weightier that the bad point in this story.

when i saw this african woman i decided to post since i know of an other study. do you think those africans are pain-free? maybe they are. but do they have nice disks?

The study took a population in a dock workers somewhere in europe who was bringing goods out of the boat by placing on their head the material, just like the woman here. the radiography showed a spine that looked twice the age of the workers. do they had pain: no, in fact less than the average worker. they had enormous osteophytes to protect the disks, as a reaction to the compressive forces.

so the woman have probably horrible disks. do we care? no, since they may be pain-free. but do i want compressive force with a result like this? well, here the forces were huge. if a minimal compressive force can bring much stability, than i am for it.

my 2 cents,
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Old 06-12-2007, 06:58 AM   #266
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pht3k,

This is a long thread with some long posts.
I'll just point out some of your statements that enlightens the real problem:

Quote:
Originally Posted by pht3k
we have in fact to release muscles tensions in those cases.
Exactly => release is the good term. CS is the opposite.

Quote:
Originally Posted by pht3k
there must be a symptomatic instability.
Instability is measured on static RX images.
Quote:
Originally Posted by pht3k
i see most people here offer resistance to think about a compressive force on the spine. i don't see there a big issue.
Not really, compressive forces are inherent to life but we (sorry, I) reject a constant useless activation.
Quote:
Originally Posted by pht3k
they had enormous osteophytes to protect the disks, as a reaction to the compressive forces.
Yes! A reaction to a silly work that justs tell us that it is silly. We are not designed to do such jobs. Man is not faulty, neither the spine. The problem comes from our "bad" society.

BTW, African women aren't dockers and I'm sure they are not doing the same... You make an extrapolation without any correlation.
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Old 06-12-2007, 10:47 AM   #267
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from abstract posted 27.08.2007 08.56 AM by Bern
Arch Phys Med Rehabil. 2007 Jan;88(1):54-62.Related Articles, Links
Quantification of lumbar stability by using 2 different abdominal activation strategies.

Grenier SG, McGill SM.

From the abstract: "and lumbar compression were calculated."

I dont have access to the full-text article. (Could not find it for free). I would apreciate if someone can tell me how they calculated lumbar compression?
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Old 06-12-2007, 01:23 PM   #268
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Quote:
I dont have access to the full-text article.
That is normal because you're not a SomaSimpler.
You need to post 10 (valuable) messages or (Join the SomaSimplers' Group!)
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Old 07-12-2007, 05:20 AM   #269
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Quote:
Originally Posted by bernard View Post
Instability is measured on static RX images.
well here in quebec we make a difference between physical therapy instability vs orthopedic instability. the orthopaedic instability is shown with rx, like you said. but when pts are talking about instability, we in fact are talking about hypermobility at a particular segment or articulation. that was what i was talking about.

Quote:
Originally Posted by bernard View Post
BTW, African women aren't dockers and I'm sure they are not doing the same... You make an extrapolation without any correlation.
the study i am refering to is (if my memory is still ok) a study cyriax was talking about in one of his books. and the goal, when they used this population, was to have a radiographic idea of the spine of those african people. btw, cyriax is known like you surely know for some infiltrations techniques, capsular pattern of the various articulations of the body, transverses frictions, and inert/contractile differentiation (mise en tension selective). and i like this guy because he is one of the first person i know to have said that a majority of doctors are wrong when they always say the culprit is the arthosis, or degeneration. sadly, this is the same story now, 40 years later...

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Old 07-12-2007, 06:50 AM   #270
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You may look attentively at this thread
http://www.somasimple.com/forums/showthread.php?t=525

Quote:
we in fact are talking about hypermobility at a particular segment or articulation.
I'm not aware that we are able to scrutinize such an articulation without any participation of the other ones.

If Cyriax was effectively a pioneer I can't follow you about dockers/African women:
They do not use the spine the same way. African women let the load "going" to their legs it is why they have this supple, harmonious walking.
Dockers aren't educated to such a difference.
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Old 07-12-2007, 06:57 AM   #271
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Quote:
Originally Posted by bernard View Post
I can't follow you about dockers/African women:
They do not use the spine the same way. African women let the load "going" to their legs it is why they have this supple, harmonious walking.
Dockers aren't educated to such a difference.
hum, well i can't tell
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Old 07-12-2007, 07:04 AM   #272
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Read this one
http://www.somasimple.com/forums/sho...&postcount=136
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Old 07-12-2007, 07:28 AM   #273
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Quote:
Originally Posted by Jon Newman View Post
Do you have any sources for the preventative aspect?
Hides et al24,25
studied patients with acute, first-time episode of unilateral
LBP, comparing stabilization exercises particularly targeting
the multifidus muscle with usual medical management. No
significant differences in disability or pain were found after 4
weeks,25 but the stabilization group experienced significantly
fewer recurrences at 2- to 3-year follow-up.24

24. Hides JA, Jull GA, Richardson CA. Long-term effects of specific
stabilizing exercises for first-episode low back pain. Spine 2001;
26:E243-8.
25. Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is
not automatic after resolution of acute, first-episode low back
pain. Spine 1996;21:2763-9.
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Old 07-12-2007, 07:31 AM   #274
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Originally Posted by bernard View Post
ok i will and i will look at your lumbar instability thread soon also
but for now i have to sleep... 1h30 am here
cya,
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Old 07-12-2007, 01:45 PM   #275
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Hi pht3k,

Here's a link to the full text for those with access to the SoS. I'll make some commentary by the end of the weekend. Feel free to add your own.
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Old 08-12-2007, 04:20 AM   #276
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Hi pht3k,

The context of my question focused on the preventative influence of strength on new incidence of pain. The studies you posted did not focus on that relationship, at least not directly. (I was especially interested in the *stronger is better* argument forwarded in the thread.)

The studies you cite are interesting and I hope there is a follow-up per the authors closing comments in the discussion section.
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Old 10-12-2007, 07:24 AM   #277
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Originally Posted by John A. Casler View Post
Nervous tissues do not respond for no reason. They are messengers. One cannot say "pain, causes pain" unless it is purely a "psychosomatic" cause. Even pain caused by chronic pain signals creating irritation is caused by an electro-chemical irritation.
Chronic pain seems in some cases to be due to some cells in the spinal cord, the microglia. But how do such cells cause the ensuing chronic pain? It seems that they release a small protein that disrupts normal inhibition of pain signalling. no irritation here.

http://www.nature.com/nature/journal...l/438923a.html

And like Diane said, nervous cells can secrete too. They can even produce an impulse without mediators. Butler described such an impulse site AGIS, auto-generated impulse site.

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Old 10-12-2007, 07:31 AM   #278
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I'm not sure to follow you, there.
Even an AIGS needs some ions channels to enable the firing. It is a electro-chemical process, ever.
A nerve dysfunction belongs to electro-chemical processes, either "psychologic" pains. All pains are real.
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Old 10-12-2007, 07:42 AM   #279
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Originally Posted by Jon Newman View Post
Hi pht3k,

The context of my question focused on the preventative influence of strength on new incidence of pain. The studies you posted did not focus on that relationship, at least not directly. (I was especially interested in the *stronger is better* argument forwarded in the thread.)

The studies you cite are interesting and I hope there is a follow-up per the authors closing comments in the discussion section.
Sorry Jon, i thought you were asking for preventative influence of stabilization exercices.

So, according to the articles i read in the past days, there is pretty strong evidence for a preventative influence of those exerices with an acute lbp patient. But, depending the articles, there is conflicting evidences for the chronic lbp patients. Of course, those chronic patients are those who need the pain approach more than the biomechanicahl approach. So, JAC, that'S why we need too the pain approach. I am not yet personally using this method for acute problem, like Diane said she is doing, but surely it is worth at least have in memory the red flags to maybe be able to identify those 2-3% who are going to go chronic to apply a precoce pain approach.

Well that'S the way I treat now, but I would like to get better with pain approach to eventually mix biomech and pain approaches together. I think the perfect PT is the one who master both.

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Old 10-12-2007, 07:45 AM   #280
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Originally Posted by bernard View Post
I'm not sure to follow you, there.
Even an AIGS needs some ions channels to enable the firing. It is a electro-chemical process, ever.
A nerve dysfunction belongs to electro-chemical processes, either "psychologic" pains. All pains are real.
what i wanted to say is that nerve are not only messengers. they can produce impulse by themself. in AIGS, there is no real receptors like we are used to think of.

Last edited by pht3k; 10-12-2007 at 08:01 AM. Reason: now->no
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Old 10-12-2007, 07:46 AM   #281
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Quote:
there is pretty strong evidence for a preventative influence of those exercices with an acute lbp patient
There is evidence that moving is a key issue but not really in those exercises.
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Old 10-12-2007, 07:49 AM   #282
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in AIGS, there is now real receptors like we are used to think of.
No! They are but their functionings are disturbed. An AIGS works like a timer and it rings when electro-chemical conditions are met.
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Old 10-12-2007, 08:00 AM   #283
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now should have been no
now=no
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Old 10-12-2007, 08:14 AM   #284
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pht3k, pain can also be there, "just because". For no good reason. Phantom limb pain for example. Pain in the virtual body, in a limb that does not exist. Goes away by seeing a mirror image of a normal limb moving, that the mind knows is a fake, an illusion, but that the visual cortex does not. How do you explain pain like that (and its relief) by using a biomechanical explanation? By thinking biomechanically?
The usual explanation is that providing a movement illusion (in this case visual) is what kicks the brain over into better function and dispels pain. (Patrick Wall, consummatory movement to quench "need" state.)

What if all (persistent) pain is from the "virtual" body, not the actual body?
What sort of "virtual body" does the back have? Not very much, if you look at the S1 representational map of the body surface. It's hard to provide mirror therapy for pain in the back. But, a movement illusion fed through kinesthetic channels might suffice. Voilá, a movement illusion supplied kinesthetically instead, through one sort of (hideously expensive "biomechanical") manipulation or another. Or even just skin stretch, which at least has some research to back that it provides the brain with a movement illusion (Gandevia). Thoughts?
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Old 10-12-2007, 08:33 AM   #285
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Pain is pain, pht3k, regardless of its origin or cause, known or unknown. In "psychosomatic" conditions (now an outmoded word), it is still the same pain without the label.

I am interested in the definition of AIGS which you quoted:
Quote:
auto-generated impulse site
I had learned it was abnormal impulse generating site; perhaps Butler has changed the acronym??

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Old 10-12-2007, 02:30 PM   #286
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Hi pht3k,

Quote:
Sorry Jon, i thought you were asking for preventative influence of stabilization exercices.

So, according to the articles i read in the past days, there is pretty strong evidence for a preventative influence of those exerices with an acute lbp patient.
Well I think the results were interesting enough to warrant further research to answer ever more refined questions. In fact, I think the article raised more questions than supplied answers (which is a good thing and a normal part of the research process). One of the issues I struggle with in the EBM arena is the "one right way" implication of research.

Can you expand on your thoughts about the preventative aspect of the stabilizations exercises? What's going on there and how would you design another experiment to try to test your ideas?
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Old 10-12-2007, 08:08 PM   #287
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Quote:
Originally Posted by Diane View Post
pht3k, pain can also be there, "just because". For no good reason. Phantom limb pain for example. Pain in the virtual body, in a limb that does not exist. Goes away by seeing a mirror image of a normal limb moving, that the mind knows is a fake, an illusion, but that the visual cortex does not. How do you explain pain like that (and its relief) by using a biomechanical explanation? By thinking biomechanically?
The usual explanation is that providing a movement illusion (in this case visual) is what kicks the brain over into better function and dispels pain. (Patrick Wall, consummatory movement to quench "need" state.)

What if all (persistent) pain is from the "virtual" body, not the actual body?
What sort of "virtual body" does the back have? Not very much, if you look at the S1 representational map of the body surface. It's hard to provide mirror therapy for pain in the back. But, a movement illusion fed through kinesthetic channels might suffice. Voilá, a movement illusion supplied kinesthetically instead, through one sort of (hideously expensive "biomechanical") manipulation or another. Or even just skin stretch, which at least has some research to back that it provides the brain with a movement illusion (Gandevia). Thoughts?
Diane thanks a lot for this reply. I know that pain can be there just because, for no good reason; I did read butler and moseley, and i went to their classes too. I know about mirror therapy too. I think it's ramachandran who popularized it.

When riding today to come at work, i was asking myself how do they treat neuro for those chronic lbp patients. I already do the neurodynamics since 8 years and explain pain since 2 years, but i didnt do much more in this area. Your post gave me a lot of useful info to undertand your point of view, and gave me some hints about your treatments. It is much appreciated.

nari: I switched by accident the I and the G. And i always tought it was Auto!? I searched the internet and found nothing about Auto... it really is Abnormal. Probably that's what i thought i heard and it seemed logical to me so i kept it in mind!? Linguistic barrier might be the cause. I dont know; i cant really remember for sure; i did the course 8 years ago.

Jon: I will come back with this later; patients waiting for me...

Have a good day,
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Old 11-12-2007, 06:00 AM   #288
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Can you expand on your thoughts about the preventative aspect of the stabilizations exercises? What's going on there?
Well, we know that there might be some atrophy of the multifidus. So my goals are to give some awareness and motor control, and why not regain the CSA of the multifidus. I usually dont ask people to contract their abdominal wall for dayliving activities. I dont want the core to be stiff (hard as rock), i just want the muscles to do their job, and i hope that the CSA get back, allowing a narrowing of the neutral zone of those segments with laxity. If the CSA is normal then there is more resistance to movement, giving more stability, without limiting the ROM. So this is not the stiff spine most people here were affraid of.

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And how would you design another experiment to try to test your ideas?
I don't know. Never really thought of making a study about this.
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Old 11-12-2007, 06:52 AM   #289
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If the CSA is normal then there is more resistance to movement, giving more stability
You didn't answered to my previous questions:
  1. Is stability/instability measurable dynamically?
  2. Is stability an insurance of pain free backs?
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Old 11-12-2007, 01:54 PM   #290
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Hi pht3k,

I've started a new thread to collate information related to muscular changes.

I think there is much more going on than "strengthening". It's disappointing that pain and function data were not collected in the study (post #1) I posted in the above mentioned thread.

I'll add some more thoughts on the CSA issue later.
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Old 12-12-2007, 02:06 AM   #291
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Muscle strength and cross sectional area (CSA) are correlated but it seems to me that there is something more interesting to consider. In the Hides, et. al. (2001) studies, asymmetry seemed more important than strength (I'm pretty sure). The asymmetry itself may very well be indicative of a neurogenic issue (versus deconditioning for instance).

In the study I posted, deconditioning due to prolonged enforced bed rest resulted in decreased CSA but it is unclear whether this occurred asymmetrically although I don't have a great reason to think it would. It is also unclear whether these folks experienced pain in any significant sort of way but I don't have any reason to think this either.

Interestingly, the deconditioned folks regained their CSA (quickly) by returning to WB activities (Hides 2007) unlike the those in the Hides, et. al., (2001) study. Those in the Hides, et. al.,(2001) article received very specialized exercises with real-time visual feedback. I'm unsure if any otherwise innocuous treatment or education was provided during these interventions.

A replication of the Hides, et. al. study would be interesting with a greater number of subjects, a placebo treatment (versus no treatment), follow-up imaging to see if indeed the CSA returns to symmetrical over time and of course tracking a variety of pain/disability measures. Also helpful would be to ascertain any common characteristics that "successful" outcomes display on their way to the "successful" measure. Don't mind me, I'm just stretching my naiveté a bit.

Any thoughts?
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Old 12-12-2007, 05:08 AM   #292
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Quote:
Originally Posted by bernard View Post
You didn't answered to my previous questions:
  1. Is stability/instability measurable dynamically?
  2. Is stability an insurance of pain free backs?
we can't really clinically measure (quantitize) it, except for xray, but according to some studies even xray are not revelent if there is no clinical correlation.
but we can feel it as hypermobile with the shear tests and pasisve/physiologic movts evaluation. and if there is pain when testing the shear and muscular contraction diminish it, it looks like it's an instable/hypermobile segment that will possibly respond to stabilization ex's.
i guess you will tell me that shear testing is not valide but it's not that sure.

here's the latest instability validity study i could find on medline:
Lumbar segmental instability: a criterion-related validity study of manual therapy assessment.
BMC Musculoskelet Disord. 2005 Nov 7;6:56.
citation: This research indicates that manual clinical examination procedures have moderate validity for detecting segmental motion abnormality.

i like to use the farfan test too.

there is in no way any insurance of pain free backs with stability of course. but it still will help a % of them.

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Old 12-12-2007, 05:14 AM   #293
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the full text of this article might be interesting too but i dont have access to it:

Subjective and objective descriptors of clinical lumbar spine instability: a Delphi study.
Man Ther. 2006 Feb;11(1):11-21. Epub 2005 Jul 5.
Accurate ability to diagnose lumbar spine clinical instability is controversial for numerous reasons, including inaccuracy and limitations in capabilities of radiographic findings, poor reliability and validity of clinical special tests, and poor correlation between spinal motion and severity of symptoms. It has been suggested that common subjective and objective identifiers are specific to lumbar spine clinical instability. The purpose of this study was to determine if consensual, specific identifiers for subjective and objective lumbar spine clinical instability exist as determined by a Delphi survey instrument. One hundred and sixty eight physical therapists identified as Orthopaedic Clinical Specialists (OCS) or Fellows of the American Academy of Orthopaedic Manual Physical Therapists participated in three Delphi rounds designed to select specific identifiers for lumbar spine clinical instability. Round I consisted of open-ended questions designed to provide any relevant issues. Round II allowed the participants to rank the organized findings of Round I. Round III provided an opportunity to rescore the ranked variables after viewing other participant's results. The results suggest that those identifiers selected by the Delphi experts are synonymous with those represented in related spine instability literature and may be beneficial for use during clinical differential diagnosis.


Jon: maybe we should continue with csa in the other thread you created. Here's a quick tought: maybe there is symetrical nonusage atrophy vs asymetical "inhibition" atrophy. the first might recover faster than the "inhibited" one. just a thought.

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Old 12-12-2007, 05:44 AM   #294
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Quote:
Jon: maybe we should continue with csa in the other thread you created. Here's a quick tought: maybe there is symetrical nonusage atrophy vs asymetical "inhibition" atrophy. the first might recover faster than the "inhibited" one. just a thought.
Hi pht3k,

I think you're right about the inhibition idea. I'm afraid if we discuss csa separately we might lose sight of its purported relation to spinal instability (correctable by specialized stability exercises) and further, that this spinal instability predisposes people to further injury. This is the main hypothesis that is being forwarded.
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Old 15-12-2007, 09:55 PM   #295
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btw, there is a nice paper from o'sullivan to diagnose instability and to categorize some instability patterns. we know that treatments procedure are sometimes not validated with studies. a reason might be that there is too much different lbp causes. so, a categorization might help to restrict the studies to more specific groups, maybe more responsive overall to the treatment. time will tell, but it seems logical. about the concern around breathing discussed here in the thread, o'sullivan evoke this too. and about the core stabilization, he is not speaking in term of strength, but in term of control and movement pattern correction. i like the way he categorize instability patterns. much more interesting to me than the 'extension' mckenzie approach.
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Old 16-12-2007, 12:08 AM   #296
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Hi pht3k,

Here's a link to Peter O'Sullivan (I'm assuming this is the one you're referring to) and a list of projects he contributed to. With a list like that, he's in no danger of perishing.
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Old 16-12-2007, 01:07 AM   #297
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hi,

this is effectively the one i was reffering to.
sorry i forgot to include the title of the article i was referring to...
here we go:

Man Ther. 2000 Feb;5(1):2-12.
Lumbar segmental 'instability': clinical presentation and specific stabilizing exercise management.

O'Sullivan PB.
School of Physiotherapy, Curtin University of Technology, Selby Street, Shenton Park, WA, Australia.
Lumbar segmental instability is considered to represent a significant sub-group within the chronic low back pain population. This condition has a unique clinical presentation that displays its symptoms and movement dysfunction within the neutral zone of the motion segment. The loosening of the motion segment secondary to injury and associated dysfunction of the local muscle system renders it biomechanically vulnerable in the neutral zone. The clinical diagnosis of this chronic low back pain condition is based on the report of pain and the observation of movement dysfunction within the neutral zone and the associated finding of excessive intervertebral motion at the symptomatic level. Four different clinical patterns are described based on the directional nature of the injury and the manifestation of the patient's symptoms and motor dysfunction. A specific stabilizing exercise intervention based on a motor learning model is proposed and evidence for the efficacy of the approach provided.

Article: sos

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Old 16-12-2007, 01:20 AM   #298
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Is there any use of motor control exercises when the pain has "moved up" the nervous system? I am assuming pain which lasts for more than 3-6 months have caused changes in the nervous sytem irrespective of the initial biomechanical issues.

Or when you are doing motor control exercises its positively affecting the CNS too and therby relieving pain?

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Old 16-12-2007, 01:21 AM   #299
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Hi pht3k,

You accidentally uploaded an article from Sullivan different than the one you're referencing. It looks like a good read also.
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Old 16-12-2007, 01:34 AM   #300
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Quote:
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Hi pht3k,

You accidentally uploaded an article from Sullivan different than the one you're referencing. It looks like a good read also.
oops sorry
i wanted to do it fast and i did some errors ...
corrected now
and i made a new post for the article i posted by accident here.

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