Wednesday, July 1, 2009


Thanks for all the great comments. Marshall gave us a great insight with his own experience with back pain; that he has what would be traditionally considered a strong core, yet he still experiences pain 4 years out despite numerous bouts of p.t.

Porterfield & DeRosa discuss this phenomenon in their excellent book, "Mechanical Low Back Pain"- "Tissue that is significantly injured or degenerated cannot attenuate stresses with the same efficiency as normal, uninjured tissue", and go on to say, "to assume that 3- 45m sessions 3X per week alone will significantly impact long range outcome is unrealistic." (p.226)

This is part of the problem when discussing core. We typically think of core training as strengthening the muscles.

Never forget that ligaments are part of the core system. They don't just connect bone-to-bone. They are rich in Pacinian Corpuscles & Ruffini endings. They are an important part of the core. If we are doing "stiffness" or "bracing" training in the neutral zone, are we stimulating these proprioceptors??? Do most injuries happen in the neutral zone, or rather in the "transformational zone"-where the body is changing directions?

Remember proprioceptors are the spirit of function. When we speak of neuromuscular training, or re-education, this is where it's at. If there is no proprioceptive stimulation, there is no load, therefore no explode. However, as Juan said so well, we need to work at the edge of their envelope of function if they are to improve, and not be injured. We need to safely take the back patient, or healthy athlete into-and out of the transformational zones. On to you guys- by the way, where have all the ladies been???


Jerimiah said...

Marshall is actually right on with the current research. One of my collegues went to a course a couple weeks ago and with the information presented, pain is nothing more than information from the body that the body percieves as dangerous. This information may truly be injurious, or it may only be percieved as injurious. One of the interesting things mentioned was that patients with LBP often have diminished 2-point discrimination, and can sometimes reduce pain simply by working on this.

bk said...

The main issue seems to be the assumption that a lack of movement is a good thing. The mast and guy wire analogy for the back assumes the spine should be rigid. But this analogy is completely contradicted by the degrees of freedom that exist in the spine and the numerous muscles, tendons, and ligaments that control those free angles. It seems that a system of levers, springs, and pulleys is a much better analogy, since tendons often reposition bones to obtain a better mechanical advantage.

It's not a back problem, but I've been struggling with a SLAP tear in conjunction with a frozen shoulder. I believe that half my injury is due to my body trying to cope with lost mechanical advantage. Some of my pain is a lie but some of it is not. And the solution is certainly not less movement. Perhaps I should try this 2-point thing on my shoulder. :-)

JH said...


Welcome back.

I'm glad to hear you talk about the ligaments of the spine being part of the "core". There is also a group of muscles I never hear abuot called the interspinalis muscles. Although small I describe them as the nuts and bolt so of the spine. The analogy I typically use is imagine a car with a 450 horse power engine. Now imagine that same car with out any bolts to hold the motor in place or no lug nuts to hold the wheels on. The powerful engine is useless without cooperation from every part of the vehicle.

Effective core training exists in what I call the sphere of influence. Within this sphere is where we are taught to respond to external forces and produce internal forces.

Grteat post Joe!! Maybe next year I can make it to GAIN.

jbeyle said...

This is a little off topic, but on my mind. I am a middle school PE teacher and do some training for middle and high school athletes during the summer. I would love to hear an athetic trainer's opinion on something. I have just noticed over the last several years that more kids come to me and have an unusually large number of aches and pains. The complain of tightness, ankle pains, knee pains, etc. I know that with the increase of technology comes an increase of sitting, but is there something else going on that contributes to this? I hope this is specific enough. If not, I'd be happy to clarify.
Thanks in advance.
Jon Beyle