I’m a recent PTA graduate. And this is still being taught! 😬 Im glad I came across this. I also appreciate that your videos are always backed by evidence and research.
Use your own clinical reasoning to judge cause and determine an appropriate treatment modality. I like these videos but this one is full of researcher bias and I haven't made it to the end yet.
@@ixifutureproof9286 What/where is the researcher bias? I'm a PTA student doing clinicals now and I'm talking about drawing in all the time. I'd like to research this more. Thanks!
I've been a physio for quite a few years now and have treated a lot of patients with LBP. I have used Mckenzie, movement control, core exercises etc. None of the concept have been perfect, none have been completely flawed. Matching the right approach, or mix thereoff, to the right patient, seems to yeild the Best results. At least that's My experience for what it's worth 😉
The problem with these interventions is the narrative that supports them. "Unstable spine" or "weak core" that needs to be fixed or contracted in a specific way might induce unnecessary notebook or kinesiophobia in patients. Besides, we know little about pain and its relation to exercise...
@@danielcaetano8036 Id add, the assumption that there is a weakness in muscles and neuromuscular control completely ignores the structural integrity. Ligament laxity, bone spurs, degenerated cartilage. Etc
But this is semantics. A good quality physio uses the approach the OP makes. Not fixate on wording and believing that you need to use research to pinpoint one gold standard cause or treatment modality.
@@Arminsaf2 This is so true but it seems like it's built into the business model. What I mean is..."Your back hurts because your core is weak. I'm a trainer and I can make your core stronger so you won't be in pain. Sign up with me!" vs. "Your core is decently strong but you still have back pain...hmmmm. I can strengthen your core which may or may not get you out of pain". One answer supports the model and the other not so much.
@@johnnybeefum yup, follow the green trail as I say. I see a bunch of the popular trainers who say they have the answer but completely ignore anatomy and physiology.
I think it's getting more and more important to let people with LBP to be more self confident by moving and to make them do what they really enjoy, rather than being too much restrictive or narrow minded. By the way great content as usual!
I believe that the didactic system is not evolving at the same pace as researches are, and therefore the gap between what we learn when students, and what is really going on. thank you for keeping us up to date, and most importantly- keeping our mind open for changes- which is in my opinion fundamental in our profession.
I watch on a video about the shoulderpain : "it takes 17 years for 14% of scientific data to arrive in physiotherapy practice ” and "25% of Patients receive unnecessary or even dangerous therapy" ! So I don't blame the teachers or the school : but try to be more open :)
My lower back was messed up for years and PT's kept giving me core excercises- turned out I had extremely tight glutes so it pulled on my lower back and hip. Been rolling it for 2 weeks- what relief!
I am not a professional, but I have intermittently resolved my own back pain over the last 15 years (since high school football). The times when my back pain has been best-managed have been when my hips and back were flexible (versus when my core was “stable” or “strong”)
More progressive branches from traditional (commonly referred to as “classical”) Pilates now exist which actually build from current studies and our ever-changing and growing knowledge of our bodies and how they move and function. Most still maintain the importance of core strength or core functionality, but actually encourage mechanics more fully as a whole body approach integrating more fascia integration. A good example would be polestar Pilates. I definitely would recommend that practice over say simple or commercialized Pilates. It’s expanded on and created by licensed physical therapists and doctors who have the scientific studies to corroborate with them. Mind you, it’s interesting how many studies which once are revered as being absolute, often later are changed, discredited, or are adapted as our technology and capabilities to study the body increase. Practices such as, say cupping or even acupuncture, for years were disregarded and mocked by western medicine professionals, however, flash forward just a few years and science is now able to explain/prove the physiological processes involved which in fact show improvements in specific uses. At the end of the day it comes down to full body/mind approaches because like he said even neurological effects can be applicable to specific pains or even gains as well. Our bodies are complex and integrative so approaching therapies should be considerate of that as well and include a dynamic and inclusive approach to both healing or function and improvements. The basis of Pilates was an attempt to include both eastern and western modalities in order to provide a more dynamic approach to strengthening and mobility. Often times media likes to focus on Pilates being exclusively core when, in practice, even classical Pilates focused on core as merely the basic building block or foundation for much more than that. Movement is what Pilates is ultimately about. But having a good knowledge of how movement and breath play into (and often are dysfunctional or used incorrectly (potentially negligently) is a good basis for most Pilates studies.
Its really informative to the corrent resolution of back pain. More over the kinetic control and stabilisation have vital role. Thanks for the viedio. We are looking forward like this type of informatics..
These videos saying "core strengthening may not be the solution for back pain..." seem very popular these days because it's "busting myths" about back pain. However, I know I have a much better life quality after strengthening my core muscle with a grade 2 spondylolisthesis and scoliosis. While core strengthening might not be the ONLY solution, I think we should also be careful to down play the importance of strengthening core. I say this as a patient's point of view. 5:27 --- > what is this exercise?
On top of that studies always show what works for a group of people and you might be different as an individual. spondylolisthesis might be a different story. Yet still we would argue that what made you better is probably a graded loading program for your lower back and not that your multifidi and TrA are firing faster etc.
Drawing in maneuver is pulling the belly button in. The patient can be in different positions as they do this while sometimes doing arm or leg movements. At least that’s what I know it to be. Gentlemen I have a question. Have you come across research for this technique on hernias?
I abandoned the idea of the multifudus and tra a while ago but I still think those folks who suck at stabilizing their spine and using their hips can benefit from this work. I do like the idea of gradually loading as well. The pain science stuff is just as overstated as the trA. All we know is the medical field is not doing a great job with LBP
I have been treating exclusively patients with spine problem for more as 12 years with therapy based on the McKenzie concept. I have helped a lot of patients that where unsuccesfull in other practices or stood for the decision of an operation. In my opinion mechanically for the greater group of aspecific spine problems it is a problem of the assymetrical loading of the spine. Mostly to much flexion because of the prolonged flexed sitting positions, sometimes aggravated by frequent flexed lifting. A lot of these patients have a reduced ROM for extension. To asses that you first have to get a feeling what ROM is about normal depending on age, male or female and overall personal ( hyper?-) mobility. To normalize the intradiscal pressure distribution, the normal mobility of the segments including the facet joints and to reduce the pain, a bit of symmetrical extension selfexercises maybe not enough. At that point many therapist think McKenzie does not work, but actually there it begins. Controlling the right intensity and amount of reps, manual Therapist assistance, lateral assymetrical loading, thorough functional sitting posture instructions (which McKenzie hardly provides) as well as training lifting techniques, may all be necessary to have succes. Of course by all of this therapy the optimistic attitude of a fearless therapist plays also an important role to lessen catastrophic thinking, fear of movement and hypersensitivity. When pain subsides, abnormal movement patterns and felt core weakness do mostly simultaneously. Stimulating to return gradually to work or sport (for example a tennis trainer with recurrent episodes of back pain) mostly was enough to return to a very satisfying level of activity and self security. Instructions for future more equal flexion and extension loading were given to prevent recurrences. The fact I have seen very little numbers of patients again after succesfull treatment but therefore got from them referrals even after several years, made me think that was succesfull too.
Are you saying the various core exercises such as the planks, side planks and bird dog, etc are useful in the early going but should progress to more functional/ dynamic, compound exercises that would require core muscles to engage inevitably ?
Great myth busting here. My lumbar spinal injury was fixed with no isolated TRA work whatsoever. (L5/s1 with 3mm anterolisthesis). I have full ability to flex and extend and even deadlift 200 plus kilograms. No I did not have surgery for those that ask. I still get asked as well......''How am I able to do this?'' I reply ''by not doing isolated TRA work.'' Tra is a global muscle (people still call it local and I have no idea why especially that it is miles away from the vertebra), it turns on with any movement we do and involved in increasing intra-abdominal pressure. Great job guys.
This is a hell of a subject, in general what needs to be corrected is the movement not a specific exercice. You can hold 1 minute plank but if your movement is wrong it means nothing. I tried of course many approaches for back pain, what seems to work is to improve the movement. But I only works with active or highly trained people. If inactivity causes back pain you simply need to move more, it’s like the weight loss dilemma you don’t need “fat burning supplement” move more or eat less is sufficient. Stable core is like “an apple a day keep the doctor away" a ridiculous superficial way to solve a big problem. I took physiotutors spine course, very good course!
I've had thoracic back pain for a while and suddenly started to get low back pain too, despite doing all the stability exercises. I even wondered, how can I get low back pain, when I already train lower back stability without even lifting anything heavy. Seems there's barely any correlation.
It could potentially be that during those exercises there is an offload effect to lumbar vertebrae. My question to you would be, do you experience more pain during backwards bending? Or during forward bending?
Every time I try “core” exercises, I get sciatica and calf twitching. The following helps - Lightweight barbell low rack pulls help. Pull-ups with knees flexed and ankles locked also help. Hiking up hills. Swimming.
Two facts. 1. Athletes get back pain too - with amazing core muscles. 2. Lab studies are one thing, but real world experience and anecdotal evidence plays a huge role in understanding the problem more deeply.
Wait, hold on, WHAT?! We literally learn in scool that this is the way to treat patients with lower back pain! (Ps. I am a Dutch last year student. Please forgive me if my English isn't perfect) Not saying you are wrong btw, I am just surprised
Same for me, I‘m a physical therapist student in germany, I havent been able to help a friend with low back pain for 2months now, and he is very compliant in his exercises and overall athletic. Now I‘m trying to expand my horizon a bit.
Hey guys, chiropractic student here (Canada). Unfortunately we’re taught the same in regards to “core stability exercises” for low back pain. Current research evidence shows that it is not the case and reserach has shown that general exercise is just as effective as “core exercises” for chronic low back pain. I recommend checking out these papers: bjsm.bmj.com/content/early/2019/10/28/bjsports-2019-100886 (Owen Et al 2019) journals.plos.org/plosone/article?id=10.1371/journal.pone.0052082 (Wang Et al. 2012) www.ncbi.nlm.nih.gov/pmc/articles/PMC5381485/ (Stilwell Et al. 2017) www.jospt.org/doi/pdf/10.2519/jospt.2016.0609 (O’Sullivan 2016) As physiotutors explained instead of focusing on low level “motor control” exercises for the “core” and explaining low back pain via a purely biomechanical model (i.e - “spine instability”), these core exercises are still good for low level entry type movements for those who’d like to start exercises. However it is important that there is a progression with the exercises specially towards value based activities that the person finds meaningful to their life (e.g - bending over, sport related, etc.). Taking a whole biopsychosocial approach we should focus on the person in front of us and create a needs analysis (Craig Liebenson) and explain that pain is multifactorial rather than due to a specific structure which may cause a nocebo. Sadly there are still a lot of schools teaching outdated research which not only does harm to students but to patients as well. I encourage you guys to constantly question critically what we’re being taught in school and see if it aligns with what the current research is saying. You will probably experience cognitive dissonance like I had in the past and it will be uncomfortable but if its in the pursuit of truth and for the greater good of our patients then maybe its worth it.
Even the KNGF guideline mentions that any exercise program works. Maybe it is taught so that you know what it is and it can be an option. Just know that it is not the best or only option. The best option always depends on the situation. So instead of performing a trick, listen carefully to a patient and provide a tailored treatment plan incorporating your own experience and evidence.
@@stefanr00 Yeah but shoudlnt they say that then? I mean when we know what it does and what it doesnt we can only improve our overall therapeutic efficacy right?
Wow, what a thought provoking video. I have many things to ask but I think the most important is whether these studies that were not "in favor" of showing positive clinical benefits following TrA activation training featured participants that were able to be placed in the treatment-based classification system for LBP? I would imagine that this would tarnish any effect given this specific intervention if these patients are in inappropriate groupings. To be clear, I tried to find this information for myself but was unable to obtain the full articles. The abstract just says "with chronic nonspecific LBP of at least 3 months' duration..." And this does not seem to be clear on which treatment they should be receiving. I would imagine that "core activation exercises" would do nothing for people who fall into the "traction" or "specific directional exercise" groups. I'd be interested in knowing if this specific and local TrA activation training would be of any benefit to people who fall into the "stabilization" category of the TBC for LBP.
Hi David, thanks. The studies do not show that there is no clinical benefit of low load/motor control exercise, but they are just not superior. TBC is not as effective as we would like it to be. Take this article for example: www.ncbi.nlm.nih.gov/pubmed/22333955
You mention the TRA not acting like a corset, but if recruited bilaterally, why would it not act like one? My lecturer is always saying that it is a corset, so this is new to me.
So as a 1,5 year low, mid, upper back + neck & shoulder pain sufferer (who definitely acknowledges that my anxiety disorder could be playing a big part in keeping this pain going, I've had tons of pain education in my search for improvement), I would be wondering... What exercises CÁN I do that would be helpful?
Hi, it has been a year and I certainly hope you are feeling much better and managing your pain. I am currently still a physio student and I have personally struggled with non-specific lower back pain. Generally speaking, if you are doing exercise in a similar pattern to what you do in your day to day, and modifying it to increase the load (with the aim to strengthen), it is likely to do more good than harm. If you find yourself doing exercises in movements that would normally irritate your pain, I would regress it and have a grasp of which kind of movements are more comfortable and which kind of movements cause more pain. Search up some exercises for elderly people, they are generally safe functional movements that you can progress on. It is hard to say what you can do over the internet without assessing your range of movement and muscular strength. Personally, I find patients with very irritable pain enjoy doing exercises in the water as it takes away some load on their spine. Most importantly, It might be worthwhile to seek help from professionals to rule out serious underlying issues and then proceed to treat your symptoms.
I disagree because many studies have shown back pain to be significantly reduced following stabilizer exercises aimed at the transverse abdominis and multifidus muscles. In addition, Stuart McGill, a world-renowned expert in spine function, prescribes stabilizing exercises.
I dont think he is saying stabilizing muscles aren't important but isolating them for exercise vs whole body functional movements and psychosocial factors are better in the long term. Squats and Walking > Planks and Bridges
@@tank7162 Squats don’t work the low back directly as it’s a hip dominant movement. Stabilisation exercises work the low back, especially the multifidi muscles which keep you erect and strengthens the unstable vertebrae, Stabilisation exe>squats.
I'm trying to understand this...as a lay person. Could it be potentially 'enough' to train different areas of the body with the aim to safely increase strength, flexibility, mobility and coordination etc as it relates to how a person needs to use his body daily, and in general, and the rest (eg stability) will take care of itself? It's been my experience that after I cut out years of core specific exercises, a lot of the low back pain, hip tightness and muscle guarding which were holding me in extension went away. And, in combination with tissue work and stretching, I started to be able to derive some benefit from low level glute exercises. previously there was no activation. Trying to breathe better, varying posture patterns and taking breaks seem to help too. I'm a long way off and there's a lot of faulty mechanics and mobility/strength deficits to work through. So I'm open to different ideas, I suppose. Apologies if I misunderstood what you're sharing.
It's an interesting dynamic as it doesn't seem to be the cause of lower back pain but can often be the solution? Also what is the relevance of this to people blaming neck instability for neck pain? In the same approach of local stabilisers being weak/delayed in activation?
The only part of this I could agree with is on pyscho social issues being associated with LBP prognosis. But mate, the TVA does act as a corset when activated through its connection to the thoraco lumbar facia. This is obvious when contracting the TVA it also simultaneously contracts the multifidus. The core is one big dynamic unit. People who have proper functioning cores know this, because theyre feeling it themselves, we dont need EMGs to tell us. EMGs arent always accurate anyways so its best not to solely rely on them. So your anatomy is incorrect but not only that, if you’ve trained someone from poor core (all of the muscles of the trunk, not just abdominals) activation to optimal activation, both static and dynamic, you would see the difference. Better stability throughout the body, higher range of motion, higher power output, etc and mainly LESS PAIN. Not sure if making this vid was just for click bait in hopes of getting more viewership or just an earnest lack of proper education and experience but this could seriously hurt people my friend.
Hm this reinforces a few things I read in Clinical SPorts Medicine by Brukner and Khan. The multifidi is atrophied and there is delayed activation of TA in patients with LBP but this is thought to be an effect and not a cause. What I dont get is why several updated texts continue to stress core stability and then later on state it has not been well researched or that research showing the connection is poor.
@@asstaco Its really under the chapter Core Stability in the text book i mentioned but their references are; Hides JA, RIchardson CA. Multifidus muscle is not automatic after resolution of acute first episode low back pain. Spine 1996:21 Cowan SM, Schache A, Brukner P et al. Delated onset of transversus abdominis in long standing groin pain. Med Sci Sports Exerx 2004; 36
Hmm very interesting... I just watched a couple of podcasts and interviews with Dr. Stuart McGill, who is believed to be the "leading spine Biomechanist" in this field, and I believe that he would disagree with you... do you think that you can get him around or get an interview with him in any other way to have a dialogue?
Mcgills research was leading the physio profession in the 90s but now with Peter O Sullivan and his work we have a different thinking when it comes to LBP
Time and time again for the last 20 years in the LBP literature, his theory of core stability does not hold up. However it is still a prevailing thought in the health care/ fitness.
@@XxLifePro803xX I think he would be saying that it depends what kind of injury mechanism or pain creating mechanism is going on there. He is talking about some kind of micro movements in the lower spine, where stability would surely help, (as long as stability means, that a joint is only moving as it is supposed to be, which would exclude such). Can you give reason on why his theory does not hold up?
Rare and wonderful to finally find someone who knows exactly what they are talking about. My copy of the original text by Richardson and Jull is almost full of highlighted paragraphs. I read it 5 times and practised with the Chattanooga Cuff on many clients. It never worked. Lederman's article form 2008, The myth of Core Stability, is referenced here. It's a terrific article. Thank you SO MUCH for publishing this material. I wish all the BS core nonsense would go away. Exercisers are so gullible. Planks are still popular! The abundance of pseudo science on TH-cam is demoralising. Well done Kai and thanks again. Best wishes from New Zealand, where everybody is still misinformed about so called core conditioning and what they believe to be the core, which is, as you state, a myth.
I am a graduate of the same university as Paul Hodges, around the same time. At the time I thought the whole concept was a deviation from sanity by people who don't live in the real world. Hodges went on to be celebrated by Uni of Qld, and the Australian physiotherapy profession. To me that sealed the physio profession as upper middle class gits, dwelling in ivory towers with feet off the ground. Unfortunately, I don't think physiotherapy researchers are any closer today to understanding low back pain pathology. I rarely meet a physio who knows anything about circulation to lumbar tissue, the delivery of nutrients, oxygen dependency of various structures, removal of metabolic waste, and how these are compromised to prematurely degenerate discs, facet jts, ligaments, vertebrae. Until the physio profession stops treating low back pain as a movement, posture, and strength issue, they will be going around in the same old circles as they have for the last 30 years. I look forward to the day most physios have half a clue about the affect of atherosclerosis on lumbar spine health.
So would it make more sense to tell a patient that you’re improving CORE strength for their big muscles and smaller muscles at the same time when exercising?
I believe if you configure the body as close to physiological norm as possible, you will reap the best results. So core stability is of course one big variable of low back problems, or general stability of your body for that matter. If you keep tweaking your low back every time you do something bit more dynamic because you can't use your core, the chances of developing unstable segment in your spine are just enormous and you don't need hundred sketchy studies in order to realize that. If people are also unable to activate core the right way, then surely it's much easier to dismiss the whole concept. I usually see combination of factors though, starting from really tight knee flexors, muscular imbalances, degenerative changes in lower back, psychological factors etc, so one has to address all of it to get the best result.
Ich schreib mal auf Deutsch auf Verdacht, dass ihr das versteht. Im zweiten Punkt eurer Zusammenfassung heißt es, man könnte die Multifidi nicht im Training konkret ansprechen. Mir ist klar, dass man die Muskeln nicht isoliert trainieren kann. Wenn man sich jedoch auf wacklige unterlagen, vibrationsplatten oder ähnliches stellt und dem Patienten kleine koordinative aufgaben gibt (bzw. Einbeinstand plus Aufgabe fürs Spielbein), werden doch auch diese kleinen Rückenmuskeln verstärkt angesprochen, oder? Ich habe da vielleicht gefährliches Halbwissen, deswegen bitte um Korrektur, falls möglich. Danke für die schönen Videos bisher. Ihr gebt sehr guten Content. Macht also bitte weiter so!!
Mahlzeit, habe mir das Video nicht angeguckt, aber versuche zu antworten. Es ist richtig, das die tiefliegende Muskulatur nicht isoliert trainiert werden kann, sie arbeitet reflexiv. Stellt sich die Frage - wie funktioniert das nun? Die Halte- und Stützmotorik ist funktionelle Neuroanatomie. Das extrapyramidale System (EPS) reguliert die motorischen Handlungen die NICHT willkürlich gesteuert werden. Die Halte- und Stützmotorik arbeitet über Reflexe und wird vom Hirnstamm reguliert. Die wichtigsten extrapyramidale-Bahnen bzw. Systeme sind: 1. Mittelhirndach (Tractus tectospinalis) 2. Tractus vestibulospinalis (Gleichgewichtssystem) 3. Tractus reticulospinalis (Foramtio resticularis im Hirnstamm) Über diese wirklich sehr wichtigen Bahnen kann jeder an der posturalen Stabilität arbeiten. Wie das funktioniert würde aber den Rahmen sprengen. Die Gruppe der Musculi Multifidi stabilisieren allein schon aufgrund ihrer geringen Größe nicht wirklich die WS. Sie besitzen bspw. eher eine propriozeptive Aufgabe - vermitteln dem Gehirn Feedback über die Stellung der einzelnen Wirbelkörper. Die Multifidi können bspw. über die Augen angesteuert werden. Was das Training auf instabilen Unterlagen betrifft, hast Du dir die Antwort schon fast selbst gegeben. Typischerweise sind Übungen auf solchen Krams schwerer als normal, weil das Gehirn diese Situation als Gefahr einstuft. Das Resultat ist ein verminderter Leistungsoutput weil die "großen/oberflächlichen" Muskeln nicht mehr arbeiten. Sinnvoll dagegen ist es, das die tiefliegenden Muskeln mit den oberflächlichen Muskeln immer im Verbund arbeiten und das Gehirn die Situation als sicher und vorhersehbar einstuft. Das Thema instabile Unterlagen ist eh etwas speziell bzw. kontrovers. Naja, vllt habe ich ein bissel Licht ins Dunkle bringen können =)
Wir stellen uns eher die Frage: Warum sollte ich die Multifi oder TrA überhaupt ansprechen wollen? Wir kennen keine wissenschaftlichen Artikel die einen Vorteil von Übungen auf wackligen Unterlagen und Vibrationsplatten zeigen gegenüber normalen Übungen.
Depends on the patient. For some actually relaxing their core more is the solution. The effect of resistance training (in all MSK conditions) is way broader than making someone stronger. There are a lot of people with a strong core who still have back pain.
The research we provide is pretty solid and there just isn't on the opposing side. If there was then we would have done a more balanced video presenting good arguments for both sides
Physiotutors There are SO many reasons why someone could have back pain. I just feel like core work could help some. And for those with others reasons core work may not work. What if someone has back pain due to an anterior pelvic tilt and their core is found to be weak.. should someone not feel like core work would help their situation if we know the core directly impacts an anterior tilt.
@@Physiotutors i cant activate my right from left side in sync in my pelvic floor, the right side is always extremely tense and wont let go. which wont let my activate my transverse in sync either or my rectus abdominus. docs are currently working on releasing the right side tightness
@@crev1018 I have the same tightness problem except it’s in the hips and whole left leg in general. Did you see a musculoskeletal doctor for your problem?
I'd be really interested in your opinion on this. A lot of the research and data available on low back pain nowadays talks about psychosocial factors, fear avoidance etc. But how do you measure that? Client history etc but Is it not the case that people know that low back pain is very difficult to accurately determine therefore a lot of people who complain of low back pain tend to be depressed, maybe a bit hypochondriac, perversely enjoy complaining about 'oh my backs killing me' and recieving sympathy, people looking for time off work with Drs lines. In my opinion if you study a cross section of people with back pain and try various treatments/rehab protocols etc these people will not improve because they don't want to improve. So the back pain isn't caused by psychosocial factors rather people with psychosocial issues complain of back pain that is either not there or not as serious as they report because it gives them an excuse, gives them sympathy and attention. I'm not dismissing people with mental health issues but I just think it's not helping in the quest to improve back pain treatment protocols. If you perform a physical treatment on someone who's pain is related to 'psychosocial' factors and don't get the result you wanted and then state the treatment is not effective that's just crazy to me. If someone has a history of depression/mental health/stress and they present with a bad back and you treat them 3-4 times with no improvement send them to a psychiatrist. Don't add to the 'back pain doesn't respond to physical treatment' narrative. Add it to the mental health patients with sore backs aren't likely to respond to treatment as well as a patient with a genuine cause of back pain.
A lot of factos can be assessed objectively by questionnaires (e.g. Tampa, IPQ etc.). Functional assessment can help during the assessment as well. Could it be that your own bias about patients with low back pain is preventing you to really listen to their story, to be empathetic and to ultimately have better treatment outcomes?
@@awilson96 How's that...? The point of view presented is to strengthen the back, not the abdominal region. I fully concurred, just added a complimentary stretching of counterparts. Which btw, when you're strengthening one side (via a series of concentric or flexing movements), you're also passively stretching, or extending the eccentric side of those movements. In some cases it is also beneficial or necessary to actively stretch those areas as well. Have a good day... 😉
@@Physiotutors With all due respect and from my standpoint of ignorance as a nonprofessional, I think you should not rule out any neuromuscular impairment, due either to genetic cause or to adaptations to environment, such as those prompted by trauma or lifestyle. From my own experience, and by comparing myself to healthy individuals, I can tell that the way external forces are distributed in my muscle-skeletal system (including passive connective tissue), is very different from theirs. I can tell that healthy people can maintain correct isolation between the muscles that control limb movement and trunk specific muscles which should support the spine without wilful intervention. In my case, I my trunk cannot accomplish this and is constantly "borrowing" the assistance of limb muscles (especially lower body where it is more noticeable, but in upper limbs it is equally bad). I have a feeling that mangled proprioceptive "messaging" has a lot to do with this. The "solution" that I am trying on my own (after many unsuccessful professional interventions), is to copy the correct way of healthy people, by training in trunk limb isolation through stretching, re-training external force distribution in the trunk with functional exercises, paying attention to correct joint alignment and breathing. This is not easy at all, but I have seen some progress. As you said, strength training can help too. But there is the danger of concentrating on individual muscles and forgetting the whole. I tend to agree with some of your explanations. Thanks for the video.
As you said LBP has multi-factors but Active lumbar stabilization which includes TRA has a huge effect on spine health. For ex, lifting or bending forward to pick up something etc. I believe that nonspecific LBP is static long lasting posture problem rather then muscle strengthening itself. So if you don’t protract your head for hours looking at something on tv or your iPad every day you won’t get neck pain. Final words patient education is essential part our job and people should regularly do exercises ( cardio, strength) based on their interest…
"Active lumbar stabilization which includes TrA has a huge effect on spine health" - do you have any evidence for that statement? Most of the evidence out there does not show an association between posture and low back or neck pain. Psychosocial factors have a way bigger influence.
Great video, not really a fan of the cover though, which says "busted" on the image of a woman training using something like a pilates machine, because the image might be misinterpreted by some viewers. In any case thanks for these helpful videos!
This video is full of researcher bias and uses semantics and questionable quality evidence to make a point. In summary: Core activation *does* stabilise the lumbar spine and therefore the corset analogy *could* fit. A lack of quality research that reliably identifies the activation of the deep core/spinal stabilisers does not mean that it doesn't happen! Basing this video on timing of activation research does not mean and being able to question it with ? quality research does not mean is has no role. You are wrong about multifidus timing btw. I have seen the research that demonstrates this - but don't bother asking me to find it for you as I'm treating actual patients during a pandemic. Timing and strength *alone may* not be *solely* responsible for a positive outcome! I have successfully treated a lot with LBP patients and have never pinpointed one cause for the patients experience - even if they say, I did this and the pain started there it is often the straw that broke the camels back (pun intended). Chronic LBP is always multi modality and if you apply any single approach to your patient's you will seldom/if ever get results. I can get my patients to activate trans ab, it does have a positive effect for many in that when adopted frequently they change their posture and reduce aggravating factors. Even this description is far too simplistic. An ability to reel off research does not demonstrate deep understanding and intelligence. There lots of rubbish research out there that the authors admit when you question them about it.
you mean someone with herniated disc will never lift heavy or super heavy weights regardless of how hard he tried to make the back and core muscles strong!!!!!???
Just work on core muscles to solve your LBP sounds stupid. You don't need core muscles to move properly and avoid LBP sounds stupid too. Maybe we should create treatments that focus on many points other than just one technique.
Only way to permanently fix a low back is deep core activation via integration and activation of the TVA, pelvic floor and diaphragm. Functional Patterns plank or horizontal horse stance. Second key is activating the POS and AOS. Ignoring this, you'll never have fully address problem. This is only functional when you integrate this into the gait pattern. For example, if you don't address the hip hike in the gait pattern you can't fix it. Especially without a different compensation. Look up Functional Patterns Instagram and the changes the system is capable of, especially with scoliosis. It just works, perfectly. It has answers for everything. Well, besides the emotional aspect. That's really important.
I’m a recent PTA graduate. And this is still being taught! 😬 Im glad I came across this. I also appreciate that your videos are always backed by evidence and research.
Use your own clinical reasoning to judge cause and determine an appropriate treatment modality. I like these videos but this one is full of researcher bias and I haven't made it to the end yet.
@@ixifutureproof9286 What/where is the researcher bias? I'm a PTA student doing clinicals now and I'm talking about drawing in all the time. I'd like to research this more. Thanks!
I've been a physio for quite a few years now and have treated a lot of patients with LBP. I have used Mckenzie, movement control, core exercises etc. None of the concept have been perfect, none have been completely flawed. Matching the right approach, or mix thereoff, to the right patient, seems to yeild the Best results. At least that's My experience for what it's worth 😉
The problem with these interventions is the narrative that supports them. "Unstable spine" or "weak core" that needs to be fixed or contracted in a specific way might induce unnecessary notebook or kinesiophobia in patients. Besides, we know little about pain and its relation to exercise...
@@danielcaetano8036 Id add, the assumption that there is a weakness in muscles and neuromuscular control completely ignores the structural integrity. Ligament laxity, bone spurs, degenerated cartilage. Etc
But this is semantics. A good quality physio uses the approach the OP makes. Not fixate on wording and believing that you need to use research to pinpoint one gold standard cause or treatment modality.
@@Arminsaf2 This is so true but it seems like it's built into the business model. What I mean is..."Your back hurts because your core is weak. I'm a trainer and I can make your core stronger so you won't be in pain. Sign up with me!" vs. "Your core is decently strong but you still have back pain...hmmmm. I can strengthen your core which may or may not get you out of pain". One answer supports the model and the other not so much.
@@johnnybeefum yup, follow the green trail as I say. I see a bunch of the popular trainers who say they have the answer but completely ignore anatomy and physiology.
I think it's getting more and more important to let people with LBP to be more self confident by moving and to make them do what they really enjoy, rather than being too much restrictive or narrow minded.
By the way great content as usual!
Ditto.
I believe that the didactic system is not evolving at the same pace as researches are, and therefore the gap between what we learn when students, and what is really going on.
thank you for keeping us up to date, and most importantly- keeping our mind open for changes- which is in my opinion fundamental in our profession.
I watch on a video about the shoulderpain : "it takes 17 years for 14% of scientific data to arrive in physiotherapy practice ” and "25% of Patients receive unnecessary or even dangerous therapy" ! So I don't blame the teachers or the school : but try to be more open :)
@@josephlam3727 not just physio. Basically across all medical/healthcare professions are like this.
Awesome video. Love how you put everything into context at the end. Thank you.
My lower back was messed up for years and PT's kept giving me core excercises- turned out I had extremely tight glutes so it pulled on my lower back and hip. Been rolling it for 2 weeks- what relief!
how did u fix it. my low back is in major pain
@@soheal3674 use a lacrosse ball and roll glute. Could be a tight muscle
@@jjm2069 you probably rolling out the piriformis
Rolling? As in foam rolling?
I had this and was given glute strengthening exercises, that made symptoms significantly worse. Extremely infuriating
Thank you for making this video. I'm a PTA in an LTAC setting & I love the information your channel provides
I’m glad to be going to a school that teaches this! Great work! More people need to jump into this style of thinking.
where is your school?
Ruben K George Fox University
I am not a professional, but I have intermittently resolved my own back pain over the last 15 years (since high school football). The times when my back pain has been best-managed have been when my hips and back were flexible (versus when my core was “stable” or “strong”)
Thank You. The TrA and drawing in method is so outdated and in my 14 years of working as a clinician I never understood nor tried to teach it.
wow just found this channel and it's awesome
Glad you found us! Happy watching
Great video. Will definitely change my approach on training clients with lower back pain.
I agree with you wholeheartedly. For this reason I have never been sold on Pilates, as a Fitness Instructor
More progressive branches from traditional (commonly referred to as “classical”) Pilates now exist which actually build from current studies and our ever-changing and growing knowledge of our bodies and how they move and function. Most still maintain the importance of core strength or core functionality, but actually encourage mechanics more fully as a whole body approach integrating more fascia integration. A good example would be polestar Pilates. I definitely would recommend that practice over say simple or commercialized Pilates. It’s expanded on and created by licensed physical therapists and doctors who have the scientific studies to corroborate with them. Mind you, it’s interesting how many studies which once are revered as being absolute, often later are changed, discredited, or are adapted as our technology and capabilities to study the body increase. Practices such as, say cupping or even acupuncture, for years were disregarded and mocked by western medicine professionals, however, flash forward just a few years and science is now able to explain/prove the physiological processes involved which in fact show improvements in specific uses. At the end of the day it comes down to full body/mind approaches because like he said even neurological effects can be applicable to specific pains or even gains as well. Our bodies are complex and integrative so approaching therapies should be considerate of that as well and include a dynamic and inclusive approach to both healing or function and improvements. The basis of Pilates was an attempt to include both eastern and western modalities in order to provide a more dynamic approach to strengthening and mobility. Often times media likes to focus on Pilates being exclusively core when, in practice, even classical Pilates focused on core as merely the basic building block or foundation for much more than that. Movement is what Pilates is ultimately about. But having a good knowledge of how movement and breath play into (and often are dysfunctional or used incorrectly (potentially negligently) is a good basis for most Pilates studies.
Its really informative to the corrent resolution of back pain. More over the kinetic control and stabilisation have vital role. Thanks for the viedio. We are looking forward like this type of informatics..
These videos saying "core strengthening may not be the solution for back pain..." seem very popular these days because it's "busting myths" about back pain. However, I know I have a much better life quality after strengthening my core muscle with a grade 2 spondylolisthesis and scoliosis. While core strengthening might not be the ONLY solution, I think we should also be careful to down play the importance of strengthening core. I say this as a patient's point of view. 5:27 --- > what is this exercise?
On top of that studies always show what works for a group of people and you might be different as an individual. spondylolisthesis might be a different story. Yet still we would argue that what made you better is probably a graded loading program for your lower back and not that your multifidi and TrA are firing faster etc.
Drawing in maneuver is pulling the belly button in. The patient can be in different positions as they do this while sometimes doing arm or leg movements. At least that’s what I know it to be. Gentlemen I have a question. Have you come across research for this technique on hernias?
I abandoned the idea of the multifudus and tra a while ago but I still think those folks who suck at stabilizing their spine and using their hips can benefit from this work. I do like the idea of gradually loading as well. The pain science stuff is just as overstated as the trA. All we know is the medical field is not doing a great job with LBP
I have been treating exclusively patients with spine problem for more as 12 years with therapy based on the McKenzie concept. I have helped a lot of patients that where unsuccesfull in other practices or stood for the decision of an operation. In my opinion mechanically for the greater group of aspecific spine problems it is a problem of the assymetrical loading of the spine. Mostly to much flexion because of the prolonged flexed sitting positions, sometimes aggravated by frequent flexed lifting. A lot of these patients have a reduced ROM for extension. To asses that you first have to get a feeling what ROM is about normal depending on age, male or female and overall personal ( hyper?-) mobility. To normalize the intradiscal pressure distribution, the normal mobility of the segments including the facet joints and to reduce the pain, a bit of symmetrical extension selfexercises maybe not enough. At that point many therapist think McKenzie does not work, but actually there it begins. Controlling the right intensity and amount of reps, manual Therapist assistance, lateral assymetrical loading, thorough functional sitting posture instructions (which McKenzie hardly provides) as well as training lifting techniques, may all be necessary to have succes. Of course by all of this therapy the optimistic attitude of a fearless therapist plays also an important role to lessen catastrophic thinking, fear of movement and hypersensitivity. When pain subsides, abnormal movement patterns and felt core weakness do mostly simultaneously. Stimulating to return gradually to work or sport (for example a tennis trainer with recurrent episodes of back pain) mostly was enough to return to a very satisfying level of activity and self security. Instructions for future more equal flexion and extension loading were given to prevent recurrences. The fact I have seen very little numbers of patients again after succesfull treatment but therefore got from them referrals even after several years, made me think that was succesfull too.
@@stacer1962 Agree to this to the weak reasoning behind the core stability training.
A Biopsychosocial approach of low back pain. Excellent point of view and presentation. I could not agree more!
My colleagues are guilty of teaching these exercises!! I just sent this video to them! 😁😄
Nothing wrong with low load motor control exercises per se. They are just often based on false assumptions.
This is a great summary!
Are you saying the various core exercises such as the planks, side planks and bird dog, etc are useful in the early going but should progress to more functional/ dynamic, compound exercises that would require core muscles to engage inevitably ?
Excellent video! I tried to have this discussion with my professors and was essentially dismissed.
No surprise to read your comment. The health professionals in my city seem only interested in getting you to come back for another consult.
That's disappointing and negligent/arrogant on their part.
I always combine the training in functional excersices because found that to many people Don’t understand the concept of single muscle contraction
It's just not how our brains and bodies work
Because Isolation is a construct, not a neuromuscular reality
There is nothing better to protect the lower back than strengthening the surrounding muscles. Period.
Would simple core stability exercises suffice to keep the spine healthy?
@@andyl9900 Stability exercises are basically isometric strength exercises. They train the muscles. Same result.
protect yes. After damage? no.
Just interviewed @rehabscience and he gave a great description as to why this is true!
Really appreciate this video, hope there is more powered evidence in Lx pain exercise rehab soon in the future.
Great myth busting here. My lumbar spinal injury was fixed with no isolated TRA work whatsoever. (L5/s1 with 3mm anterolisthesis). I have full ability to flex and extend and even deadlift 200 plus kilograms. No I did not have surgery for those that ask. I still get asked as well......''How am I able to do this?'' I reply ''by not doing isolated TRA work.'' Tra is a global muscle (people still call it local and I have no idea why especially that it is miles away from the vertebra), it turns on with any movement we do and involved in increasing intra-abdominal pressure. Great job guys.
What helped?
So what helped you?
This is a hell of a subject, in general what needs to be corrected is the movement not a specific exercice. You can hold 1 minute plank but if your movement is wrong it means nothing.
I tried of course many approaches for back pain, what seems to work is to improve the movement. But I only works with active or highly trained people.
If inactivity causes back pain you simply need to move more, it’s like the weight loss dilemma you don’t need “fat burning supplement” move more or eat less is sufficient.
Stable core is like “an apple a day keep the doctor away" a ridiculous superficial way to solve a big problem.
I took physiotutors spine course, very good course!
One of the funniest intros I’ve ever seen. This reminds me of the SNL skit of pump you up
I've had thoracic back pain for a while and suddenly started to get low back pain too, despite doing all the stability exercises. I even wondered, how can I get low back pain, when I already train lower back stability without even lifting anything heavy. Seems there's barely any correlation.
So why does my lower back pain feel less when I do ab/core exercises?
It could potentially be that during those exercises there is an offload effect to lumbar vertebrae. My question to you would be, do you experience more pain during backwards bending? Or during forward bending?
Marvelous! The best video!
Great video
Correct
Thx
Every time I try “core” exercises, I get sciatica and calf twitching. The following helps - Lightweight barbell low rack pulls help. Pull-ups with knees flexed and ankles locked also help. Hiking up hills. Swimming.
@J What do you mean what are they trying to say? They literally said it. Lol
you are working too much. Start slow and light.
could you guys please make a video on quadriceps mucle activation for different regions, like you did with hamstrings... pleaseeee!! :D
Another practise pearl!
Two facts. 1. Athletes get back pain too - with amazing core muscles. 2. Lab studies are one thing, but real world experience and anecdotal evidence plays a huge role in understanding the problem more deeply.
Wait, hold on, WHAT?! We literally learn in scool that this is the way to treat patients with lower back pain! (Ps. I am a Dutch last year student. Please forgive me if my English isn't perfect)
Not saying you are wrong btw, I am just surprised
You Spoke my words my friend
Same for me, I‘m a physical therapist student in germany, I havent been able to help a friend with low back pain for 2months now, and he is very compliant in his exercises and overall athletic. Now I‘m trying to expand my horizon a bit.
Hey guys, chiropractic student here (Canada). Unfortunately we’re taught the same in regards to “core stability exercises” for low back pain. Current research evidence shows that it is not the case and reserach has shown that general exercise is just as effective as “core exercises” for chronic low back pain. I recommend checking out these papers:
bjsm.bmj.com/content/early/2019/10/28/bjsports-2019-100886 (Owen Et al 2019)
journals.plos.org/plosone/article?id=10.1371/journal.pone.0052082 (Wang Et al. 2012)
www.ncbi.nlm.nih.gov/pmc/articles/PMC5381485/ (Stilwell Et al. 2017)
www.jospt.org/doi/pdf/10.2519/jospt.2016.0609 (O’Sullivan 2016)
As physiotutors explained instead of focusing on low level “motor control” exercises for the “core” and explaining low back pain via a purely biomechanical model (i.e - “spine instability”), these core exercises are still good for low level entry type movements for those who’d like to start exercises. However it is important that there is a progression with the exercises specially towards value based activities that the person finds meaningful to their life (e.g - bending over, sport related, etc.). Taking a whole biopsychosocial approach we should focus on the person in front of us and create a needs analysis (Craig Liebenson) and explain that pain is multifactorial rather than due to a specific structure which may cause a nocebo.
Sadly there are still a lot of schools teaching outdated research which not only does harm to students but to patients as well. I encourage you guys to constantly question critically what we’re being taught in school and see if it aligns with what the current research is saying. You will probably experience cognitive dissonance like I had in the past and it will be uncomfortable but if its in the pursuit of truth and for the greater good of our patients then maybe its worth it.
Even the KNGF guideline mentions that any exercise program works. Maybe it is taught so that you know what it is and it can be an option. Just know that it is not the best or only option. The best option always depends on the situation. So instead of performing a trick, listen carefully to a patient and provide a tailored treatment plan incorporating your own experience and evidence.
@@stefanr00 Yeah but shoudlnt they say that then? I mean when we know what it does and what it doesnt we can only improve our overall therapeutic efficacy right?
Any evidence on Redcord Neurac Neuromuscular training to help with dec LBP and improving functional outcomes? Great video.
Wow, what a thought provoking video. I have many things to ask but I think the most important is whether these studies that were not "in favor" of showing positive clinical benefits following TrA activation training featured participants that were able to be placed in the treatment-based classification system for LBP? I would imagine that this would tarnish any effect given this specific intervention if these patients are in inappropriate groupings.
To be clear, I tried to find this information for myself but was unable to obtain the full articles. The abstract just says "with chronic nonspecific LBP of at least 3 months' duration..." And this does not seem to be clear on which treatment they should be receiving. I would imagine that "core activation exercises" would do nothing for people who fall into the "traction" or "specific directional exercise" groups. I'd be interested in knowing if this specific and local TrA activation training would be of any benefit to people who fall into the "stabilization" category of the TBC for LBP.
Hi David, thanks. The studies do not show that there is no clinical benefit of low load/motor control exercise, but they are just not superior. TBC is not as effective as we would like it to be. Take this article for example: www.ncbi.nlm.nih.gov/pubmed/22333955
REad The Myth of Core Conditioning by Ayal LKederman (2008)
You mention the TRA not acting like a corset, but if recruited bilaterally, why would it not act like one? My lecturer is always saying that it is a corset, so this is new to me.
So as a 1,5 year low, mid, upper back + neck & shoulder pain sufferer (who definitely acknowledges that my anxiety disorder could be playing a big part in keeping this pain going, I've had tons of pain education in my search for improvement), I would be wondering... What exercises CÁN I do that would be helpful?
Hi, it has been a year and I certainly hope you are feeling much better and managing your pain. I am currently still a physio student and I have personally struggled with non-specific lower back pain. Generally speaking, if you are doing exercise in a similar pattern to what you do in your day to day, and modifying it to increase the load (with the aim to strengthen), it is likely to do more good than harm. If you find yourself doing exercises in movements that would normally irritate your pain, I would regress it and have a grasp of which kind of movements are more comfortable and which kind of movements cause more pain. Search up some exercises for elderly people, they are generally safe functional movements that you can progress on.
It is hard to say what you can do over the internet without assessing your range of movement and muscular strength. Personally, I find patients with very irritable pain enjoy doing exercises in the water as it takes away some load on their spine. Most importantly, It might be worthwhile to seek help from professionals to rule out serious underlying issues and then proceed to treat your symptoms.
Well said sir tq
I want to hear a debate between you guys and Stuart McGill
For a great explanation video type in WAP (wrong activation process)
I disagree because many studies have shown back pain to be significantly reduced following stabilizer exercises aimed at the transverse abdominis and multifidus muscles. In addition, Stuart McGill, a world-renowned expert in spine function, prescribes stabilizing exercises.
I dont think he is saying stabilizing muscles aren't important but isolating them for exercise vs whole body functional movements and psychosocial factors are better in the long term. Squats and Walking > Planks and Bridges
@@tank7162 Squats don’t work the low back directly as it’s a hip dominant movement. Stabilisation exercises work the low back, especially the multifidi muscles which keep you erect and strengthens the unstable vertebrae, Stabilisation exe>squats.
LOVE IT
What about Stuart McGill's research? Is side plank and bird dog good for back pain associated with JHS?
I'm trying to understand this...as a lay person. Could it be potentially 'enough' to train different areas of the body with the aim to safely increase strength, flexibility, mobility and coordination etc as it relates to how a person needs to use his body daily, and in general, and the rest (eg stability) will take care of itself? It's been my experience that after I cut out years of core specific exercises, a lot of the low back pain, hip tightness and muscle guarding which were holding me in extension went away. And, in combination with tissue work and stretching, I started to be able to derive some benefit from low level glute exercises. previously there was no activation. Trying to breathe better, varying posture patterns and taking breaks seem to help too. I'm a long way off and there's a lot of faulty mechanics and mobility/strength deficits to work through. So I'm open to different ideas, I suppose. Apologies if I misunderstood what you're sharing.
It's an interesting dynamic as it doesn't seem to be the cause of lower back pain but can often be the solution? Also what is the relevance of this to people blaming neck instability for neck pain? In the same approach of local stabilisers being weak/delayed in activation?
9:35 answers your question
The only part of this I could agree with is on pyscho social issues being associated with LBP prognosis. But mate, the TVA does act as a corset when activated through its connection to the thoraco lumbar facia. This is obvious when contracting the TVA it also simultaneously contracts the multifidus. The core is one big dynamic unit. People who have proper functioning cores know this, because theyre feeling it themselves, we dont need EMGs to tell us. EMGs arent always accurate anyways so its best not to solely rely on them.
So your anatomy is incorrect but not only that, if you’ve trained someone from poor core (all of the muscles of the trunk, not just abdominals) activation to optimal activation, both static and dynamic, you would see the difference. Better stability throughout the body, higher range of motion, higher power output, etc and mainly LESS PAIN.
Not sure if making this vid was just for click bait in hopes of getting more viewership or just an earnest lack of proper education and experience but this could seriously hurt people my friend.
Don't argue with anecdotes, friend. Use actual evidence to support your statements, like the author of the video has done.
Hm this reinforces a few things I read in Clinical SPorts Medicine by Brukner and Khan. The multifidi is atrophied and there is delayed activation of TA in patients with LBP but this is thought to be an effect and not a cause. What I dont get is why several updated texts continue to stress core stability and then later on state it has not been well researched or that research showing the connection is poor.
Can you give me the title of this paper? Id like to read it too
@@asstaco Its really under the chapter Core Stability in the text book i mentioned but their references are; Hides JA, RIchardson CA. Multifidus muscle is not automatic after resolution of acute first episode low back pain. Spine 1996:21
Cowan SM, Schache A, Brukner P et al. Delated onset of transversus abdominis in long standing groin pain. Med Sci Sports Exerx 2004; 36
Did the Allison study measure the TVA pre-activation + activation in NWB supine or clsd chain walking 🚶♂️? Great video guys
Hmm very interesting... I just watched a couple of podcasts and interviews with Dr. Stuart McGill, who is believed to be the "leading spine Biomechanist" in this field, and I believe that he would disagree with you... do you think that you can get him around or get an interview with him in any other way to have a dialogue?
@Seyed Roshan okay, thanks for the clarification
Mcgills research was leading the physio profession in the 90s but now with Peter O Sullivan and his work we have a different thinking when it comes to LBP
Time and time again for the last 20 years in the LBP literature, his theory of core stability does not hold up. However it is still a prevailing thought in the health care/ fitness.
@@XxLifePro803xX I think he would be saying that it depends what kind of injury mechanism or pain creating mechanism is going on there. He is talking about some kind of micro movements in the lower spine, where stability would surely help, (as long as stability means, that a joint is only moving as it is supposed to be, which would exclude such).
Can you give reason on why his theory does not hold up?
He’s a Biomechanist . . . Of course he’d disagree that this wasn’t a biomechanical problem!
Rare and wonderful to finally find someone who knows exactly what they are talking about. My copy of the original text by Richardson and Jull is almost full of highlighted paragraphs. I read it 5 times and practised with the Chattanooga Cuff on many clients. It never worked. Lederman's article form 2008, The myth of Core Stability, is referenced here. It's a terrific article.
Thank you SO MUCH for publishing this material. I wish all the BS core nonsense would go away. Exercisers are so gullible. Planks are still popular! The abundance of pseudo science on TH-cam is demoralising. Well done Kai and thanks again. Best wishes from New Zealand, where everybody is still misinformed about so called core conditioning and what they believe to be the core, which is, as you state, a myth.
I am a graduate of the same university as Paul Hodges, around the same time.
At the time I thought the whole concept was a deviation from sanity by people who don't live in the real world.
Hodges went on to be celebrated by Uni of Qld, and the Australian physiotherapy profession.
To me that sealed the physio profession as upper middle class gits, dwelling in ivory towers with feet off the ground.
Unfortunately, I don't think physiotherapy researchers are any closer today to understanding low back pain pathology.
I rarely meet a physio who knows anything about circulation to lumbar tissue, the delivery of nutrients, oxygen dependency of various structures, removal of metabolic waste, and how these are compromised to prematurely degenerate discs, facet jts, ligaments, vertebrae.
Until the physio profession stops treating low back pain as a movement, posture, and strength issue, they will be going around in the same old circles as they have for the last 30 years.
I look forward to the day most physios have half a clue about the affect of atherosclerosis on lumbar spine health.
I'm a layman with chronic lower back pain. Does this mean that strengthening the multifidus won't have any effect on lower back pain?
Can u put pictures with brief explanation
We don't do TrA exercises instead do global core exercises with rec ab and obliques usually to good effect
Nice EBP records
So would it make more sense to tell a patient that you’re improving CORE strength for their big muscles and smaller muscles at the same time when exercising?
No. You have missed the essence of the video
I believe STUART MCGILL
I believe if you configure the body as close to physiological norm as possible, you will reap the best results. So core stability is of course one big variable of low back problems, or general stability of your body for that matter. If you keep tweaking your low back every time you do something bit more dynamic because you can't use your core, the chances of developing unstable segment in your spine are just enormous and you don't need hundred sketchy studies in order to realize that. If people are also unable to activate core the right way, then surely it's much easier to dismiss the whole concept. I usually see combination of factors though, starting from really tight knee flexors, muscular imbalances, degenerative changes in lower back, psychological factors etc, so one has to address all of it to get the best result.
Don't feel like you really took the content of this video in consideration. The factors biomechanical factors you mention have no evidence base.
Ich schreib mal auf Deutsch auf Verdacht, dass ihr das versteht. Im zweiten Punkt eurer Zusammenfassung heißt es, man könnte die Multifidi nicht im Training konkret ansprechen. Mir ist klar, dass man die Muskeln nicht isoliert trainieren kann. Wenn man sich jedoch auf wacklige unterlagen, vibrationsplatten oder ähnliches stellt und dem Patienten kleine koordinative aufgaben gibt (bzw. Einbeinstand plus Aufgabe fürs Spielbein), werden doch auch diese kleinen Rückenmuskeln verstärkt angesprochen, oder? Ich habe da vielleicht gefährliches Halbwissen, deswegen bitte um Korrektur, falls möglich. Danke für die schönen Videos bisher. Ihr gebt sehr guten Content. Macht also bitte weiter so!!
Mahlzeit,
habe mir das Video nicht angeguckt, aber versuche zu antworten.
Es ist richtig, das die tiefliegende Muskulatur nicht isoliert trainiert werden kann, sie arbeitet reflexiv. Stellt sich die Frage - wie funktioniert das nun? Die Halte- und Stützmotorik ist funktionelle Neuroanatomie. Das extrapyramidale System (EPS) reguliert die motorischen Handlungen die NICHT willkürlich gesteuert werden. Die Halte- und Stützmotorik arbeitet über Reflexe und wird vom Hirnstamm reguliert. Die wichtigsten extrapyramidale-Bahnen bzw. Systeme sind:
1. Mittelhirndach (Tractus tectospinalis)
2. Tractus vestibulospinalis (Gleichgewichtssystem)
3. Tractus reticulospinalis (Foramtio resticularis im Hirnstamm)
Über diese wirklich sehr wichtigen Bahnen kann jeder an der posturalen Stabilität arbeiten. Wie das funktioniert würde aber den Rahmen sprengen.
Die Gruppe der Musculi Multifidi stabilisieren allein schon aufgrund ihrer geringen Größe nicht wirklich die WS. Sie besitzen bspw. eher eine propriozeptive Aufgabe - vermitteln dem Gehirn Feedback über die Stellung der einzelnen Wirbelkörper. Die Multifidi können bspw. über die Augen angesteuert werden.
Was das Training auf instabilen Unterlagen betrifft, hast Du dir die Antwort schon fast selbst gegeben. Typischerweise sind Übungen auf solchen Krams schwerer als normal, weil das Gehirn diese Situation als Gefahr einstuft. Das Resultat ist ein verminderter Leistungsoutput weil die "großen/oberflächlichen" Muskeln nicht mehr arbeiten. Sinnvoll dagegen ist es, das die tiefliegenden Muskeln mit den oberflächlichen Muskeln immer im Verbund arbeiten und das Gehirn die Situation als sicher und vorhersehbar einstuft. Das Thema instabile Unterlagen ist eh etwas speziell bzw. kontrovers.
Naja, vllt habe ich ein bissel Licht ins Dunkle bringen können =)
Wir stellen uns eher die Frage: Warum sollte ich die Multifi oder TrA überhaupt ansprechen wollen?
Wir kennen keine wissenschaftlichen Artikel die einen Vorteil von Übungen auf wackligen Unterlagen und Vibrationsplatten zeigen gegenüber normalen Übungen.
If core strengthen is not a solution for radiating back pain what is then 😢
Depends on the patient. For some actually relaxing their core more is the solution.
The effect of resistance training (in all MSK conditions) is way broader than making someone stronger. There are a lot of people with a strong core who still have back pain.
@@Physiotutors that seems to be my problem, but I have no idea how to get it to relax.
I thought you were already millionaires! 😂
Haha we wish!
Sorry, but How do I know your findings/research is right over those who have research/findings say the opposite??
The research we provide is pretty solid and there just isn't on the opposing side. If there was then we would have done a more balanced video presenting good arguments for both sides
Physiotutors There are SO many reasons why someone could have back pain. I just feel like core work could help some. And for those with others reasons core work may not work.
What if someone has back pain due to an anterior pelvic tilt and their core is found to be weak.. should someone not feel like core work would help their situation if we know the core directly impacts an anterior tilt.
i have core imbalance with chonic lbp
How do you know you have core imbalance?
@@Physiotutors i cant activate my right from left side in sync in my pelvic floor, the right side is always extremely tense and wont let go. which wont let my activate my transverse in sync either or my rectus abdominus. docs are currently working on releasing the right side tightness
@@crev1018 I have the same tightness problem except it’s in the hips and whole left leg in general. Did you see a musculoskeletal doctor for your problem?
I'd be really interested in your opinion on this. A lot of the research and data available on low back pain nowadays talks about psychosocial factors, fear avoidance etc. But how do you measure that? Client history etc but Is it not the case that people know that low back pain is very difficult to accurately determine therefore a lot of people who complain of low back pain tend to be depressed, maybe a bit hypochondriac, perversely enjoy complaining about 'oh my backs killing me' and recieving sympathy, people looking for time off work with Drs lines. In my opinion if you study a cross section of people with back pain and try various treatments/rehab protocols etc these people will not improve because they don't want to improve. So the back pain isn't caused by psychosocial factors rather people with psychosocial issues complain of back pain that is either not there or not as serious as they report because it gives them an excuse, gives them sympathy and attention. I'm not dismissing people with mental health issues but I just think it's not helping in the quest to improve back pain treatment protocols. If you perform a physical treatment on someone who's pain is related to 'psychosocial' factors and don't get the result you wanted and then state the treatment is not effective that's just crazy to me. If someone has a history of depression/mental health/stress and they present with a bad back and you treat them 3-4 times with no improvement send them to a psychiatrist. Don't add to the 'back pain doesn't respond to physical treatment' narrative. Add it to the mental health patients with sore backs aren't likely to respond to treatment as well as a patient with a genuine cause of back pain.
A lot of factos can be assessed objectively by questionnaires (e.g. Tampa, IPQ etc.). Functional assessment can help during the assessment as well. Could it be that your own bias about patients with low back pain is preventing you to really listen to their story, to be empathetic and to ultimately have better treatment outcomes?
Don't think questionnaires are objective. Sorry to disagree 👎
Makes sense, strengthen the back, and stretch out the hip flexor group (particularly the illiacus).
What's your reasoning behind the illiacus?
@@Physiotutors Well, it's one of the three hip flexors, and it tends to be ignored, along with the rectus femoris and the adductors.
@@donquixote... Again, you're missing the point of the video.
@@awilson96 How's that...? The point of view presented is to strengthen the back, not the abdominal region. I fully concurred, just added a complimentary stretching of counterparts. Which btw, when you're strengthening one side (via a series of concentric or flexing movements), you're also passively stretching, or extending the eccentric side of those movements. In some cases it is also beneficial or necessary to actively stretch those areas as well. Have a good day... 😉
So no one knows how to change onset of TVA firing and let us all conclude that it has nothing to do with back pain ?
Yes, we don't know and there is little evidence that TvA firing time has to change in any way for people to become better. It's just too simplistic
@@Physiotutors
With all due respect and from my standpoint of ignorance as a nonprofessional, I think you should not rule out any neuromuscular impairment, due either to genetic cause or to adaptations to environment, such as those prompted by trauma or lifestyle.
From my own experience, and by comparing myself to healthy individuals, I can tell that the way external forces are distributed in my muscle-skeletal system (including passive connective tissue), is very different from theirs. I can tell that healthy people can maintain correct isolation between the muscles that control limb movement and trunk specific muscles which should support the spine without wilful intervention. In my case, I my trunk cannot accomplish this and is constantly "borrowing" the assistance of limb muscles (especially lower body where it is more noticeable, but in upper limbs it is equally bad). I have a feeling that mangled proprioceptive "messaging" has a lot to do with this. The "solution" that I am trying on my own (after many unsuccessful professional interventions), is to copy the correct way of healthy people, by training in trunk limb isolation through stretching, re-training external force distribution in the trunk with functional exercises, paying attention to correct joint alignment and breathing. This is not easy at all, but I have seen some progress. As you said, strength training can help too. But there is the danger of concentrating on individual muscles and forgetting the whole. I tend to agree with some of your explanations. Thanks for the video.
Damn so everything I thought was going to work isn’t lol
All I know is my lower back is weak and I need to strengthen it.
As you said LBP has multi-factors but Active lumbar stabilization which includes TRA has a huge effect on spine health. For ex, lifting or bending forward to pick up something etc. I believe that nonspecific LBP is static long lasting posture problem rather then muscle strengthening itself. So if you don’t protract your head for hours looking at something on tv or your iPad every day you won’t get neck pain. Final words patient education is essential part our job and people should regularly do exercises ( cardio, strength) based on their interest…
"Active lumbar stabilization which includes TrA has a huge effect on spine health" - do you have any evidence for that statement?
Most of the evidence out there does not show an association between posture and low back or neck pain. Psychosocial factors have a way bigger influence.
Great video, not really a fan of the cover though, which says "busted" on the image of a woman training using something like a pilates machine, because the image might be misinterpreted by some viewers.
In any case thanks for these helpful videos!
Yeah get your concern. We are sometimes a bit limited by the images we can choose plus pilates does focus a lot on the core / powerhouse etc
Really? 😑 image is fine gents, disregard Karens.
This video is full of researcher bias and uses semantics and questionable quality evidence to make a point.
In summary:
Core activation *does* stabilise the lumbar spine and therefore the corset analogy *could* fit.
A lack of quality research that reliably identifies the activation of the deep core/spinal stabilisers does not mean that it doesn't happen!
Basing this video on timing of activation research does not mean and being able to question it with ? quality research does not mean is has no role.
You are wrong about multifidus timing btw. I have seen the research that demonstrates this - but don't bother asking me to find it for you as I'm treating actual patients during a pandemic.
Timing and strength *alone may* not be *solely* responsible for a positive outcome!
I have successfully treated a lot with LBP patients and have never pinpointed one cause for the patients experience - even if they say, I did this and the pain started there it is often the straw that broke the camels back (pun intended). Chronic LBP is always multi modality and if you apply any single approach to your patient's you will seldom/if ever get results.
I can get my patients to activate trans ab, it does have a positive effect for many in that when adopted frequently they change their posture and reduce aggravating factors. Even this description is far too simplistic.
An ability to reel off research does not demonstrate deep understanding and intelligence. There lots of rubbish research out there that the authors admit when you question them about it.
How much of this myth is the fault of Stewart McGill?
you mean someone with herniated disc will never lift heavy or super heavy weights regardless of how hard he tried to make the back and core muscles strong!!!!!???
Just work on core muscles to solve your LBP sounds stupid. You don't need core muscles to move properly and avoid LBP sounds stupid too. Maybe we should create treatments that focus on many points other than just one technique.
Lol don’t take this guys advice…. Lotta BS… train core & glutes it helps in a way
There is a lot of personal opinion and unsourced information in this video
For example?
You sound like one doctor talking to another. Regular people only understand about half of what you said!
Only way to permanently fix a low back is deep core activation via integration and activation of the TVA, pelvic floor and diaphragm. Functional Patterns plank or horizontal horse stance. Second key is activating the POS and AOS. Ignoring this, you'll never have fully address problem. This is only functional when you integrate this into the gait pattern. For example, if you don't address the hip hike in the gait pattern you can't fix it. Especially without a different compensation. Look up Functional Patterns Instagram and the changes the system is capable of, especially with scoliosis. It just works, perfectly. It has answers for everything. Well, besides the emotional aspect. That's really important.
Evidence?
@@Physiotutors Your suspicion is perfectly fair. instagram.com/p/B-50-a0DyLZ/?hl=en that's one of many, many examples.
lol that's not how evidence works
@@gebin99 results are evidence. Everything else is bullshit. This phsyio has no such results so how can you talk at all?
@@Daithi_mk did you just provide an Instagram post as 'evidence'?