Back Mythologists

[Guest guest]

,

Would you mind elaborating on some of your thoughts on back rehab as listed

below? Unfortunately, very few of the modern texts or research articles seem

to present the thorough approach to back rehab as advocated by yourself and

others on this list. There are many clinically respected authors as you list

below who have a great deal of influence on how many clinicians practice, in

particular, those who are recently qualified generally have to work with

generally accepted practices and like you comment many clinicians spend a

lot of time looking for that magic bullet, myself included.

Casler:

The special " emphasis on stretching, while somewhat

valuable, is way out of proportion and " tight muscles "

are more of a " protective symptom " than a significant

" cause " . I find it refreshing that McGill and a couple others

are now bringing things back on track and into

perspective.

Steve Aspinall:

Clinically there is such a broad range of back problems that many different

things work for different people, the obvious difficulty is choosing

techniques based on sound scientific principles, clinical reasoning and past

evidence. I would say that there now seems to be less an emphasis on

stretching and more an emphasis on progressive movement. I think McGills

work is excellent, but I dont think it is the whole story. There just seems

to be too many patients who respond excellently and quickly to

movement/mobilisation based therapy as opposed to stabilisation and vice

versa. Who are the others who are bringing things back on track?

Casler:

Those who don't include discussion and awareness of

every aspect of Torso Stabilization, from Valsalva, to

Ribcage Stiffness, to Diaphragmatic Hypertrophy and activation.

Those who don't understand the stabilizing

contributions of the interlaced lattisimus and

ThoraColumbar Fascia, laterally tensioning the spine

and when and how these forces can be valuable.

Those who have no idea of how to breath, when to

breath and when to " hold the breath " for adequate IAP

and ITP.

Those who don't understand how maintaining a

" specific " spinal curvature can create an almost

" indestructible " spinal disc under extreme loading yet

altering the position can make a disc so " exposed " that

it can burst for almost no apparent reason under no

external load at all.

Those who cannot understand how " bracing " works

compared with " hollowing " .

Those who rely on EMG readouts and don't understand

the difference between eccentric readouts and

concentric readouts, and try to develop theory from

this perspective

Those who don't realize the relationship between

the TvA, eccentric action, Thoracolumbar tensioning and

activation of the diaphragm.

Steve Aspinall:

Could you possibly give a bit more information about torso stabilisation,

ribcage stiffness and diaphragmatic hypertrophy and lots of the stuff

mentioned above? I know its time-consuming but there seems to be very little

in the existing literature that covers these topics, obviously let me know

if I am wrong about that. Could you include some specific examples of

specific exercises and maybe a generalised example of a total back program?

Your help is much appreciated.

Steve Aspinall BSc (Hons) GSR

CityPhysio

Manchester UK

[Guest guest]

Thanks, !

Great material.

Verdell

Lansing, MI