I recently had the opportunity to interview Dr. Stuart McGill about his work with rehabilitation exercises for the lumbar spine.
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PhysicalTherapyContinuingEducation.Org: "Well, we know from your work that Transverse Abdominis (TrA) is not the whole answer to spinal stabilization, but isn't it beneficial to still prescribe Transverse Abdominis exercises to make sure that muscle is working well?"
Dr. Stuart McGill: "Well, I think I've just caught you in a nice little clinical controversy."
PhysicalTherapyContinuingEducation.Org: "Okay."
Dr. Stuart McGill: "Show me one study that says the Transverse Abdominis is not working."
PhysicalTherapyContinuingEducation.Org: "Well, Dr. Paul Hodges' work.
Plus I recall there was an article in JOSPT recently about Australian Football players."
Dr. Stuart McGill: "Okay.
Well, if you think Hodges' work, let's stay with that.
He's never shown that the Transverse Abdominis is not working."
PhysicalTherapyContinuingEducation.Org: "I stand corrected.
The TrA doesn't fire correctly."
Dr. Stuart McGill: "He's shown that in a very, very tightly controlled experiment of people standing - and they sort of have to relax in a very special way - and they jerk one arm into flexion.
That's the only time that he's found, in a few back pain patients, about a 30 millisecond delay in activation.
It'’s not that the TrA isn't working. It's slightly delayed in onset.
A lot of people have tried to replicate that experiment.
They haven't got as much press as Dr. Hodges has and they haven't found that pattern.
They've found delays in other muscles, absolutely, but when they sub-categorize the various flavors of back pain they've been able to show that certain back pain patients have no delays at all.
Some have much bigger delays in Erector Spinae.
There have been all sorts of studies that show Latissimus Dorsi has huge delays in rowers, for example, with back disorders.
Anyway, my point in this, it's only in this very contrived arm raise task.
You show me one other task where Transverse isn't working?
It's a myth."
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I thoroughly enjoyed speaking with Dr. McGill during this thought provoking 36 minute interview. I hope you enjoyed this excerpt.
I invite you to visit my site to listen to or download the entire interview.
My site is called Physical Therapy Continuing Education.Org.
Basically I found a way to combine my love of learning and being an internet geek. I hope you take advantage of the whole series of free interviews I am doing with some of the top rehab experts in our field.
Thank you,
Sasha Sibree, PT
PhysicalTherapyContinuingEducation.Org
