PE #006: TA, “Core Stability”, Drivers and going beyond the pain experience with LJ Lee

Post image for PE #006: TA, “Core Stability”, Drivers and going beyond the pain experience with LJ Lee

by David Pope

When should Transversus (TA) be included in your patient rehab? When is TA retraining a waste of time? Are your patients running like a block of wood with legs? Is planking good for anything other than entertaining your mates? How can we go beyond just treating the pain experience to connect with your patient and improve their performance.

In Episode 6 of the Physio Edge podcast, I chat with LJ Lee for the second time, this time covering TA, “Core Stability”, and more including:

  • Retraining TA in your treatment
  • Planks
  • McGill’s Big 3 exercises
  • Body “flow” and agility Vs stiffness and rigidity
  • Specificity of exercise
  • How can the Cervical Spine affect knee pain in a squat?
  • The Discover Physio Series
  • “Salsa in your ribcage” and breathing
  • The impact of intra-thoracic pressure on the pelvic floor

 

Links of interest

Subscribe to the podcast in iTunes

Give the Physio Edge podcast a review in iTunes

Linda-Joy Lee

Clinical Edge

Discover the Sports Thorax

Discover the Sports Pelvis

Discover Physio Series

Canadian Academy of Manual and Manipulative Therapy

Diane Lee

Discover Physio

University of Queensland

Prof Paul Hodges

Sackett

Stuart McGill

“See What I’m Saying” by Rosenblum

“Mindsight” by Dan Siegel

Subscribe to the Podcast in iTunes

“Assessment of the Pelvis” online education for Clinical Edge members

Become a Clinical Edge member

Contact David

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  • Emma Cameron

    I’ve just listened to the TA podcast with LJ Lee, as with all the podcasts I really enjoyed the thought-provoking discussion. Both Dave and LJ cringed at the old plank exercises- however I’ve found in my experience as a military physio the plank can be useful to retrain a good push up position. To do a technically sound push up (which is part of the military basic fitness assessment) having a good ‘core’ position is important, and I’ve been using the plank for years to train this. If someone can’t hold a plank position I find their push up technique is usually pretty crummy too!

    I always incorporate stretching and flexibility exercises, and lumbopelvic dissociation as well- but just wondering if you have any thoughts on the plank in this setting?

    An ex-PTI from the army taught me a 3-point push up which is a push up starting with your whole body on the floor, ensuring the hips and chest leave the ground at the same time- which is maybe a more functional, dynamic use of the plank…

    Thanks, Em

    • David Pope

      Hi Emma

      Glad you have enjoyed the podcasts! I think you have good clinical reasoning in this case to provide the plank. For most sportspeople after agility, I feel the plank isn't a great idea because of the overall rigidity it encourages. Your goal in this case with the military is not for any sort of agility training (in which case it could work against you), but the outcome you are after is to achive a good body position in a pushup, and that is a decent way to achieve it. I like that you are using lumbopelvic dissociation as well, a good idea to neutralise some of the rigidity a plank can encourage. Some thoraco-pelvic dissociation and "switching off" any resting tone of the global muscles afterwards is also good to add into the mix.

      Thanks for a great question.

      Cheers

      Dave

  • I found the tittering laughter when discussing mcgill's research a little arrogant. The idea that a simple plank or any isometric exercise can lead to rigidity during completely different postures or movements a little absurd, simplistic and unsupported. Explain how even extreme prolonged planking of five minutes (not that Stu even advocates this) performed once a day could do this? Do you believe that these isometric contractions actually shorten muscle length or that somehow you train the nervous system to constantly contract all the muscles of the trunk during running? Specificity of training does not work this way. There is little evidence that you can change gait kinematics with strength exercise. Why would we think that a plank will carry over to novel tasks?

    At its simplest the plank builds capacity and increaes ones ability to tolerate loads. Changing posture and form is not strongly supported in the literature.

    I would recommend putting some of your incredulity and skepticism towards the discover physio model. It sounds predicated on motion palpation and the ability to identify abnormal movement patterns at both a segmental (arthrokinematic) or global level (janda and lewit esque). While this is an attractive model (espoused by chiropractors for decades) it can certainly be easily criticised (e.g. Ones ability to identity a lack of or asymetrical movement of L3 on L4). Thats a foundation that is certainly shaky…although i wished i believed in it or could be convinced of it because it is a beautiful model. Alas beauty is not always truth.

    Anyways, i love the podcasts, keep it up

    Greg Lehman
    Canadian physio and chiro

  • David Pope

    Hi Greg

    Thanks for your comments, glad you are enjoying the podcast. It's always nice to provoke some thought, and critically analyse what we are doing currently as well as other streams of thought. Do you personally find that patients that perform planks are easily able to dissociate movement between their thorax and pelvis or globally?

    Would anyone that uses the Discover Physio (Integrated Systems) model or that finds plank style stability training helpful like to comment?

    Great bit of discussion

    David

  • Greg

    Hi David,

    I find that patients that runners who are patients show no difference in their spine kinematics than those that don't. In fact, if i wanted these patients to lock their pelvis to,their thorax i would never rely on the plank to train it….i would make this movement goal task specific (e.g. Getting out of bed) So yes, they can dissociate these two regions during a task like running. Why would there be any carryover? I think its great to critique the idea that the spine should be rigid during athletic movement but i still can't fathom any mechanism to support how a plank held less than six to twelve hours a day would influence kinematics during any activity.

    I am curious what you think about motion palpation guiding so much clinical decision making. I heard reference to assessing navicular motion during meaninful movements. This assumes that a big navicular drop or pronation has some relevance to function and injuries…two of your other speakers (cook and dubois) and literature from various disciplines would seriously question its relevance.

    All the best,

    Greg

  • Russell Wright

    Dear Greg, why advocate a plank if it's not going to carry over into specific tasks?
    Time waster in my mind.

  • Greg Lehman

    Hi Russell,

    The benefits of tissue health and tissue capacity (strength and endurance) are carried over into other tasks. What I am saying is that the body is not so simple that if we hold a static exercise we some how become rigid. The converse is true as well…if you train a cable chop exercise while dissociating your hips from your shoulders (i.e. lead with your hips and the the shoulders follow) we should not assume that this motor program will naturally follow into the golf swing. Yes, the movements are similar (and I do like the chop) but the exercise is not enough for you to have a golf swing that sees the pelvis preceding the shoulders on the downswing. You have to train the golf swing to do this not some related but still different task. I have 3D kinematic data of my own swing that illustrates this well. Again, the body is not that simple.

    All the best,

    Greg

  • Russell Wright

    I agree Greg, you need to be more local for your stability training to the level of dysfunction & train it as specifically as possible, rather than a general exercise for your obliques against heavy resistance.

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