core stability methods

[alophysio]

Hi gc [long post warning!!! It is way too early but i am avoiding writing a letter at the moment!]

No problems on when you reply! People have replied months and even years later on this forum!

I think you are right - we do agree on the theory etc. My assistant read this thread and told me i was too particular but i guess i like to make sure my thoughts are expressed in a particular way.

In my personal experience, i used to be more flexible in the way i positioned the L/S but i have found it better to get lumbopelvic-hip neutral and use pillows or props to help support the T/S and C/S and gradually get down to neutral up higher.

The reason why L/S neutral is important to me is because i have found it easier to activate the TA, LM and pelvic floor (PF).

In looking for compensations, you are right in saying there are many reasons for what we see. However, thoracolumbar extension in the presence of lumbar decreased lordosis and decreased hip flexion is something i see a lot of - perhaps it is simply because the people i see are office workers etc.

Another consideration is that Pilates was originally taught to ballet dancers - these girls tend to be lordodic (has anyone seen a ballet dancer who had excessive kyphosis problems??) so teaching them flat back may actually have been inspired because they would need to learn to control their spines in flexion as well as their usual extension (which is why they may have developed problems and sought out rehab with Joseph Pilates...)

As for Peter O'Sullivan, he doesn't believe in isolation of TA and then LM or PF but rather a functional co-contraction of TA and LM. I think this is because of his 1997 published study on stabilisation of spondylolithesis patients.

As for the Hodges tapping into a "pathway", from what i can gather, it is a motor learning strategy that imposes a "break" in the patient's usual motor control strategy.

By enforcing an isolation of TA in a bilateral co-contraction, you are bringing patients right back to a very basic "push" type strategy - Pushing being simultaneous angular rotation like shot putting. I guess it is considered easier to push something accurately rather than throw with sequential angular rotations. Think of how a novice throws and then develops their baseball throw etc...

Garry Allison did some research that suggeted that in "normals", the TA activated UNILATERALLY - he did this by measuring TA bilaterally and doing the Hodges series of unilateral rapid, unexpected arm raises.

THe whole biomechanical argument is that TA and Deep Fibres of LM don't generate enough torque to actually change things. Nor do they do so in enough time. It is like teaching "proprioception" exercises to ankle sprain patients - the time taken for joint receptors to actually cause a change in ankle positioning is about 100ms or more yet an accident event will take 70ms so by the time you realise you are going too far, it is too late - the balance exercises hopefully just keep you in the right position at the right strength.

There are other people looking at the role of iliopsoas in stability. I think there is some older (20 years old?) that showd that Iliopsoas is really iliacus generating an anterior tilting of the pelvis and psoas generating the posterior tilting to balance that out - and that iliopsoas is not really a strong hip flexor... I will try to find it sometime...

I have heard from older therapists who remember your "DAB" - while this may help a lot of people, particularly those who used an internal oblique strategy, it CERTAINLY WON"T help everyone. I would say that those who teach obliques as a strategy are simply assuming that the TA and LM will activate properly - and so in patients who don't have a problem in automatic activation, his would be fine BUT in those who do not automatically activate properly, then this DAB method, like McGill's co-contraction brace using the erector spinae and obliques WILL NOT help their problems (theoretically).

I would estimate that 99% of personal trainers, gym instructors, Pilates instructors and even a lot of physios teach obliques as the stabilisation strategy because their patients can "FEEL" it working. A 30% contraction of LM or TA or PF will not feel very strong at all - which is the whole "does it do anything biomechanically" point...

As for Yaro's question... i think you meant "what simple and effective [exercise] do we use?"

I use 5-6 simple exercises taught in a specific way...

1. Cat Stretch
2. Bridge Roll-up
3. Single-Leg Bridge (SLB)
4. Modified 100s
5. Modified Clams
6. 4-point "Swimming"

The focus of the first two exercises are on segmental motion control, dissociation of the pelvis and hips, T/S and pelvis/L/S and control of the shoulders. SLB is for glut strength while maintaining neutral L/S. Mod 100s is for control of IAP using TA/LM/PF co-contractions before leg movement. Mod Clams is for Glut Med. 4-pt-Swimming is for LM, using muscles like gluts with contralateral lats, control of hip position using glut med, scap stability, etc etc.

Sorry about the long post. It would be interesting to hear thoughts on the above. I now have to write that report i have been avoiding!

[linbin]

hi
the lumbopelvic movements are done to make the patient aware of the neutral zone.core spinal exercises are done in the neutral zone initially.isolation ex of transveerse abs and multifidus is done.then progresses to cocontraction of both and superimposing limb movements.progress to various functional positions.oblique strengthening is done i feel is based on the fact that transverse abdominis and obliques merge to thoracodorsal fascia to form tje "corset".so obliques also contribute to spinal stability. another point is that isolating a muscle action is difficult practically.