Monday, October 27, 2008

Magic Muscles?

Effect of Stabilization Training on Multifidus Muscle Cross-sectional Area Among Young Elite Cricketers With Low Back Pain- JOSPT: 2008;38(3):101:108
Julie A. Hides, Warren R. Stanton, Shaun McMahon, Kevin Sims, Carolyn A. Richardson

Free magazines such as Biomechanics & Training & Conditioning Magazine are considered "throw aways". However, they are not that at all. They give you a "reader's digest" version of a variety of interesting topics, then give you references at the end so you can dig in further if you wish. I like them because they give me an indication of which way the wind is blowing, sort of speak.

In one of these journals, a physical therapist interpreted the above article as "It would be wise to evaluate & retrain the multifidus in athletes involved in sports requiring repeated trunk rotation, such as baseball, golf, & hockey."

Me, being the skeptic, says:

1. Even the authors admit there was no control group used in this study.

2. These athletes cardiovascular training consisted of "cycle type ergometers".

3. Resistance Training was described as "Weight Training exercise 3x per week.

4. The authors make the statement, "subjects with LBP who received the intervention commented that their ability to squat with weights was improved after intervention, as they could “feel” where their backs were in space as they added load." This kind of gives you the idea of the type of resistance training that was going on. In addition, "Techniques of squatting and lunging were examined, and subjects were instructed to maintain their lumbar lordosis and thoracic kyphosis throughout the movement." Does this really happen in real life?

5. The authors continuously refer to the proprioceptive role of the multifidus, transversus abdominus, and pelvic floor muscles, but yet choose to train them in a "bodybuilding" type isolation style using ultasound to make sure they are isolating enough.

Ok, I buy into the fact that those 3 muscles atrophy after a localized injury to a spinal structure. Paul Hodges has documented that in vitro & vivo extensively. But allow me to refer to the 2nd edition of Dr. Stuart McGill's "Low Back Disorders". On page 110 he makes the statement, "the reason for the clinical emphasis on the multifidus may well be that the bulk of research has been performed on this muscle." He goes on to mention researchers who have found similar unilateral atrophy in other lumbar muscles. On page 120, he makes another key statement, "conceiving spine stabilizers as intrinsic or extrinsic my offer no benefit for clinical decision making. The relative contribution from every muscle source is dynamically changing depending on it's need to contract for other purposes."

Shirley Sahrmann, in her excellent book "Diagnosis & treatment of movement impairment syndromes" says on page 35, "these patients have motor control problems. The lack of extensive discussion reflects the limited information available, NOT the importance of this factor in movement impairment syndromes." In an article in SPINE in '96, Julie Hides herself suggests "impaired reflexes" being responsible for the failure of the multifidus.

What I'm getting at is, don't these muscles get stimulated the same way others do- that is by ground, gravity, and momentum? If that is true, what could be blocking this?


Brian said...

McGill also makes the point that Multifidus lays very close to the axis of rotation and the lever arm is quite small.Thus this muscle can't be a prime mover but may contribute to fine tuning(neuro muscular control). I think the spindle count is quite high in this muscle...

Joe Przytula said...

True- but the same point can be made for the rotatoris, interspinalis, semispinalis, intertransversarii et al. What if future research shows atrophy of them also? According to this isolationist approach, the TA, pelvic floor, and TA are already being isolated. Now add 4 more? See what I'm getting at?

JH said...

Well simply thinking out load, atrtophy assumes disuse and hypertrophy assumes much use. All muscles act as accelerators, decelerators, "prime movers", stabilizers, agonists, antogonists at one time or another in movements and in varying parts of movements. The roles of muscles change from onpe "phase" of movement to another.

Working in an industriasl settting we see a lot of back issues. Once pain is controlled we find that they are very strong in the movements they perform daily but very weak in any number of given exercises they do not perform on a daily basis. It is reeally as simple as giving them a variety of movements that are "new" to the body and the appropriate muscles learn how to respond resulting in a more versitile spine.

BY the way Joe I'm so glad to hear someone bring up the interspinalis. rotatoris etc muscles. They need love too.

Thanks for the blog Joe.