So I have decided, at the risk of losing more than a few followers, to share with all of you a few things that really get under my skin in the fitness and rehabilitation industries.
So without further ado, here we go:
1) I am really tired of e-mails and questions on the abdominal “hollowing” vs. “bracing” debate. Quite frankly, the whole damn thing is quite ridiculous at this point, and was ridiculous even some years ago. On one side of the fence you have the “corrective” view which spawned, for the most part, as a result of the research of Richardson, Jull, Hodges, and Hides of the University of Queensland in Australia. They are the research group that coined the phrase “Inner Unit” of the trunk and showed quite clearly the benefits of abdominal hollowing for the resolution of mechanical and other types of back pain via TVA retraining. This appeared to be particularly useful for those with sensory motor amnesia of the deep abdominal wall (or deep stabilizer system for the South Pacific Physios out there). Then there are the more “hardcore” trainers and researchers out there who draw on the work of Stuart McGill and other spinal “experts” that say abdominal bracing is the best way to achieve optimal stabilization of the spine during lifting. So who’s right? Well, if either camp had a detailed working knowledge of the functional anatomy of the abdominal wall, this debate would be a moot point. Why? I will take an excerpt from an article written by Matt Wallden, DO, ND, CHEK Faculty, back in 2004, which states the following:
“…..a classic study by Rizk (1980) shows that the three layers of the human abdominal wall are all intermeshed at the midline (at or around the linea alba). It emerges that the TVA fibers of one side (ie – the right side) blend with the TVA fibers of the opposite side, but at a lower (more caudal) level – therefore potentially exerting a compressive and a rotary force. In fact, Rizk (1980) suggests that the TVA should be called the “profundus obliquus” – as many of its fibers are not technically transverse!”
Wallden goes on to say:
“ Even more significant is the fact that all three layers of the abdominal wall interdigitate with one another – like the warp and weft of a textile. The TVA interdigitates with the internal oblique of the opposite side. The internal oblique interdigitates with the TVA of the opposite side and with the external oblique of the opposite side. The external oblique, as well as connecting to the opposite internal oblique, connects to the external oblique of the opposite side.”
So, what is the significance of all of this to the debate of hollowing versus bracing, Wallden explains:
“Hence, any kind of movement, muscle contraction or co-contraction is going to pre-tension and therefore stimulate the spindle cells in all other parts of the abdominal wall.”
“This then would seem to confirm McGill’s (2002) contention that abdominal bracing is more effective at stabilizing the spine than abdominal hollowing. However, despite there being great debate distinguishing between bracing and hollowing, if abdominal hollowing truly tensions the TVA bilaterally, so the internal oblique and, sequentially, the external oblique will be contracted as a result of spindle stimulation; resulting in the same abdominal bracing that McGill (2002) refers to!”
So if you are a Trainer, Practitioner, Therapist, Doctor, Auto mechanic, or just some geek off the street from the old school Warren G “Regulators” video, before you e-mail me on questions regarding hollowing versus bracing, or before another Forum thread is starting with every Tom, Dick, and Harry chiming in – do your homework! You can read Matt Wallden’s entire article Excerpt from the Core, as well as other extensive articles on abdominal function that he has researched and written at www.ptonthenet.com and http://www.primallifestyle.com.
2) I wrote a post about this one titled “Stable Versus Unstable Surface Training.” It is annoying to see the overuse of unstable surface training by the so-called “functional” Trainers, Practitioners, and Therapists out there. Before blindly placing your clients on BOSU balls, wobble boards, dyna discs, and the like, again, do your homework. Look into the reflex profile of your client or athlete and decide whether s/he needs righting reflex training (stable surface work for say a golfer or basketball player) or tilting reflex training (unstable surface work for say a surfer or skateboarder). Know why you are doing what you are doing instead of blindly following a “functional training” fad and placing everyone on unstable surfaces. As Paul Chek, Founder of the CHEK Institute, says, FAD = Forthcoming Anatomical Dysfunction, so prescribe exercises based on Needs Analysis (amongst other things) and not fitness “trends.”
3) Blindly following “research” is never a good idea. I am of the opinion, that the only way to adequately judge how effective or adequate any teaching can be is by testing it out and coming to your own conclusions. It is an everyday occurrence today to see so-called experts endorse a given technique and then a few short years later, flip-flop on the same issue because of “new” research that appears to contradict what they once endorsed to be true. Case in point is the point debated in Number 1 above. Before you invest in any research – First, try to find out who funded the research and what agenda they might have by publishing that research. Second, take those research findings and apply them in your own practice and see what happens.
That being said, it is important to also remember that it is in fact possible to find two doctors or therapists who are both very skillful and effective at the same specialty, yet they may significantly oppose each other in their personal and theoretical opinions on the same issue(s). For about the last 80 years, science has become progressively more and more bought and paid for. The result has been that on any given topic in any given industry, you can find credible “scientific evidence” in complete opposition. This is why I mentioned actively testing any theory for yourself and see what kind of results are produced. The bottom line is, when you look at your clients or patients, are you getting good results? And if so, can you subjectively or objectively measure these good results? If your answer to those 2 questions is yes, does it really matter what “research” tells you to do.
4) Another thing that really bugs me is someone who cannot admit that they do not know something. I consider myself to be a half-way smart guy; and I am smart enough to know that I do not know everything and I am not an expert in everyone else’s field. If a client has a problem/issue that I am not confident in my ability to help them with, I simply refer them to someone who I feel can help them. That is a formula that has worked very well for my clients and myself for over 15 years now.
Admitting that you do not know something, or referring to someone who you know has more skill and/or wisdom than you in a given area does not mean that you are not smart. In fact, it indicates, at least to me, the exact opposite. It shows that you have enough neurons holding hands to do the right thing. That means more than being a jack of all trades. Oh, and it has been my experience, that your clients and patients will appreciate this in a big way – usually in the form of more referrals.
5) Now I want to address the “There is no need for all of those assessments” crowd. I have read many articles by experts in the field that say that detailed assessments are unwarranted and unnecessary. You have got to be kidding me, right? I suppose first we have to establish the populous of people that these experts are seeing in a professional setting. I can tell you from my experience that if I did not accurately assess my clients, I would probably have killed a few of them by now. Granted, all of us in the industry look through a slightly different pair of glasses, but my experience is that I have clients that come to me from all walks of life and most of them have seen specialists in every conceivable area of orthopedic medicine, etc. all over this country and they have not received the results that they are looking for. With these types of cases, you better start looking where no one else has looked before, and this requires accurate assessment of the body on many levels. I have also seen clients that have been to Practitioners, Naturopaths, Chiropractors, Doctors, etc., and were told that they were getting a “holistic” approach, but when I ask them what they were doing with regards to their breathing, nutrition, sleep patterns, thoughts, etc. – they say, “Oh, I have not done any of that stuff yet, I just have had back pain for the last 10 years.” But hey, there is no need to assess these people in any real detail – yea, whatever. Remember, your program, treatment, whatever – can only be as good as your assessment. I believe the famous Professor of Orthopedic Medicine, James Cyriax who said that; but hey, what the hell did he know.
I suppose I will stop there and go catch up on the e-mail that I will receive in response to this one.
I would like to thank all of you who continue to read my posts and send me e-mails daily for your support.