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What's in the mystery trunk?
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What's in the mystery trunk? - March 2, 2002 12:50:00 PM
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Diane
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OK... Whew! A new thread. Wading through that chiro madness thing was getting to be a bit like wading through peanut butter - too exhausting for this mad PT.
Now where did we leave off? Someone was talking about asthma, someone about breath-holding, someone about diaphragms stabilizing lifting activities (?) through breath-holding...then I remembered our good buddy psoas in there totally underrated most of the time, my favorite muscle.
About the trunk as a cylinder: Can we all agree that hydraulic pressure is strong? And that the body is mostly water? And that water cannot be compressed? And that the trunk can be turned into a hydraulic cylinder by holding one's breath at one end and one's bottom at the other? (Of course if you allow the bottom end to open, various bodily processes such as defecation or childbirth will be greatly enhanced, but that would be going on a tangent and let's not go there so early on.)
OK, consider the new thread started and fire away.
Diane
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Re: What's in the mystery trunk? - March 3, 2002 1:04:00 PM
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EWDC CSCS
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Hi Diane,
While the hip flexors have a role in stability, I often see them as a major problem in many of my back pain patients. Not only will tight hip flexors pull the spine into a hyperlordotic position, but a unilateral tightness my lead to an ipsilateral QL tightness, as well. Typically, I don't try to facilitate or strengthen the hip flexors, but focus more on lengthening and balancing them out with the abs.
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Re: What's in the mystery trunk? - March 3, 2002 4:20:00 PM
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Diane
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I'm completely with you there EWDC. I am always on the psoases and other abds, trying to get them UNdone...so that the "bunji cords" can balance up, front back and sides.
What else do you do with soft tissue? Curious about this new generation of chiros...
Diane
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Re: What's in the mystery trunk? - March 3, 2002 5:57:00 PM
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EWDC CSCS
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Diane,
Typical Janda/Lewit type rehab, Active (myofascial) Release, post isometric relaxation, contract relax, some muscle energy techniques, and ischemic compression. Currently looking into the Graston Technique. Yourself?
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Re: What's in the mystery trunk? - March 3, 2002 7:29:00 PM
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Diane
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EWDC,
Similar I s'pose. Eclectic blend of things that I've picked up over the decades. I use indirect technique a lot, long holds until I feel things "let go", quite a bit of side bend, in either flexion or extension, depending on what feels "tight" and goes with what looks "tight"...I stay on things and monkey around until the tissue I'm targeting feels "right". I find torque force quite handy for opening up areas that seem inpenetrable...I wait for autonomic changes that tell me the tissue is finished letting itself go and feedback from the patient to support that...
By the way, I think I figured out what your question was about from the last thread. I said something about stretch reflexes from the diaphragm possibly stimulating the psoases to contract, to help support the spine on the inside of the body.
I think that might be possible because of mechanical sorts of overlap of the two structures at the TL junction. The right crus comes all the way down to L3 or 4, whereas the left one comes less far down, to L2 or 3. They insert into the bodies. The psoases come off T12, both sides and are attached to all the vertebral bodies and transverse processes all the way down.
Makes sense to me that if one held one's breath, the cruses (plural?) would tighten, pull up on the psoases passing under them through those arches (or at least on their fascial coverings) and stretch them, stimulating stretch reflexes that would help the psoases know what to do and when.
Make any sense to you? Make sense to anyone else?
Diane
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Re: What's in the mystery trunk? - March 4, 2002 5:31:00 AM
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mcap
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Group:
Tight hip flexors and lordotic posture.....I am not sure you can make that asumption. In fact, wasn't there a study a few years back that proved otherwise?
mcap
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Re: What's in the mystery trunk? - March 4, 2002 6:29:00 AM
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mcap
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Here is the conclusin of the study in Phys ther....
CONCLUSION AND DISCUSSION: Neither univariate nor multivariate regression models account for variability in the angle of pelvic inclination or size of lumbar lordosis in adults during upright stance; no correlation was found in standing between these two variables. The use of abdominal muscle strengthening exercises or stretching exercises of the back and one-joint hip flexor muscles to correct faulty standing posture should be questioned.
I think they found a correlation in men but not so strong. What the studies really call into question are attempts to reduce lordosis by abdominal training. One of many things done in PT, all the time, without support.
Youdas JW, Garrett TR, Harmsen S, Suman VJ, Carey JR. Related Articles
Lumbar lordosis and pelvic inclination of asymptomatic adults.
Phys Ther. 1996 Oct;76(10):1066-81.
PMID: 8863760 [PubMed - indexed for MED
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Re: What's in the mystery trunk? - March 4, 2002 6:47:00 AM
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EWDC CSCS
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mcap,
The Journal of Strength and Conditioning Research likewise shot down reeducating tonic and phasic muscles for static postural correction recently. Without a conscious effort on the patient's part, no amount of stretching/inhibition or strengthening will spontaneously correct posture. However, if the hip flexors start working as agonists or synergists when they shouldn't (in other words, become overactive), posture during dynamic activities may be effected and that's when people tend to injure themselves.
[This message has been edited by EWDC CSCS (edited March 04, 2002).]
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Re: What's in the mystery trunk? - March 4, 2002 7:03:00 AM
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Andrew M. Ball MS MBA PT
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Mcap,
Once again, agreed.
Although Biomechanics is more your area than mine (isn't that the focus of your Ph.D?), I've got to chime in. This discussion is treading dangerously close to making the incorrect assumption that poor posture yields pain, and that correcting the poor posture will result in pain reduction.
A recent meta-analysis (using 18 fair to good studies) found that upon summation of the results of 1682 participants, "back schools" were very effective in correcting posture and lifting techniques, the intervention had only small effects on health economic variables (e.g. utilization of the health care system) AND NO EFFECTS on clinical variables (e.g. pain intensity).
REFERENCES:
Maier-Riehle B, Harter M. The effects of back schools--a meta-analysis. Int J Rehabil Res 2001 Sep;24(3):199-206.
Drew
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Re: What's in the mystery trunk? - March 4, 2002 7:41:00 AM
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mcap
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Drew:
Agreed. As far as I know.....no lifting technique intervention has ever been shown to reduce the frequency of LBP. I think PTs in ergonomics would be better off focusing on engineering as opposed to behavioral interventions.
EWDC:
I understand your contention, but has this been quantified or studied in any meaningful way. It may just be an assumption. And with the low back, the medical community has made many, many assumptions that have turned out not to be true. I don't know. We would have to look at activity of the Psoas during dynamic activity in symptomatic and asymptomatic controls. Dynamic EMGs can be problematic. Let me know if you know of any research.
Take care,
Marc
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Re: What's in the mystery trunk? - March 4, 2002 7:44:00 AM
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Sebastian Asselbergs
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mcap, I may have missed something, but I didn't see any tight hipflexors/lordotic posture mentioned anywhere....I thought the closest was: tight hipflexors pulling spine into hyperlordotic position - quite a different thing.
The study you quote addresses static standing posture - a position the human body rarely assumes (other than at attention in the army...), and therefore, anyone trying to improve that posture for therapeutic reasons is obviously barking up the wrong tree.
I think that tight (rather: "overactive") muscles play a role in movement, and that manual handling of those muscles, as well as stretching gently, can enhance the awareness - thus can influence feedforward and feedback of motion.
BTW, I fully agree that strengthening and stretching have no influence at all as an isolated technique to improve static posture....
Sebastian
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Re: What's in the mystery trunk? - March 4, 2002 11:35:00 AM
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Diane
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Hello,
Thanks for chiming in Sebastian. You're quite right I think that no one on this thread is arguing for strengthening abds.
I'm aguing for lengthening them, especially the psoases all the way up to the inside of T12, up under the back of the diapragm..., and balancing their "tone" so that the spine can move freely in whatever direction the patient's cortex should desire, in a painfree fashion.
I'm still feeling out EWDC to see if s/he is in agreement there, I th-i-n-k...so...
By the way, I find it really hard to think of the psoases as merely hip flexors. It seems far too truncated a job for muscles that go all the way up to T12...
I don't think anyone said that poor posture=pain. The goal in my mind is free and balanced motion. Motion is lotion. Heard that a chiropractor coined that, actually... [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
Diane
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Re: What's in the mystery trunk? - March 4, 2002 11:58:00 AM
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EWDC CSCS
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Diane,
I agree. Functional partitioning of muscles seems completely logical to me, but I'll sit on the sidelines for now and let you guys debate.
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Re: What's in the mystery trunk? - March 4, 2002 1:41:00 PM
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Sebastian Asselbergs
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Sorry, I forgot to mention that gentle handling of course can have an effect on the autonomic system - Psoas and sympathetic trunks both "dive" through the crus - I think this may be of great value.
Sebastian
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Re: What's in the mystery trunk? - March 4, 2002 8:23:00 PM
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Diane
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Completely support your point Sebastian. Also there's the small matter of the psoases containing the entire lumbosacral plexus. And the small matter of its proximity to ...oh...those three ganglia that merely run the entire GI tract.. Sounds like gentle handling is a really good idea...
Diane
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Re: What's in the mystery trunk? - March 6, 2002 7:14:00 PM
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Bobcat
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Just to back up a few:
The trunk is cylindrical in some; semi-spherical in others, and just flabby in select few.
Hydraulic pressure can be strong, but the actual influence exerted upon the trunk to maintain semi-rigidity is primarily pneumatic.
The body is mostly water by composition. I'd be interested in finding out what the body is comprised of by volume, particularly in the subsegment of the thorax, which may be primarily cavities filled with gases.
Water is actually compressible.
It's always been my impression that the conversion of the trunk into a semi-rigid cylindrical configuration is actually a segmental affair and dependent on which of the internal chambers are closed off as the result of various sphincters being adjusted, not usually inclusive of the anus.
Good design, that. Allows one utilize a compressional Val Salva to defecate when not enough roughage has been et. Thank you, God.
And now, back to your regularly scheduled programme...
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Re: What's in the mystery trunk? - March 7, 2002 3:03:00 AM
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mcap
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Mr. Cat:
Ever long for you engineering days? I know there are many occaisions when I wish I had taken that track. But then of course, I would still be complaining [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
mcap
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Re: What's in the mystery trunk? - March 7, 2002 5:21:00 AM
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Diane
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Wouldn't that be convenient for you, to be able to analyze motion in tissue that didn't stretch, wasn't slippery and wet and sensitive, didn't change volume depending on how hydrated it was, didn't have pockets of air trapped in it, didn't have a human mind or human emotions influencing it..etc etc.etc.
Yep. Instead of trying to make variable physiology and anatomy fit your perspectives of everything needing to fit into some sort of mathmatically definable mental box.
Just curious... do you two have bodies?
Diane
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Re: What's in the mystery trunk? - March 7, 2002 7:17:00 AM
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mcap
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Diane:
Biomedical Engineering and mathematical modeling is certainly fraught with errors and a very complex task. However, it is certainly a worthy endeavor and it is done all the time.
There are tons of variables, some of which cannot be accounted for - you are certainly right. But there are decent attempts. And, this kind of modeling is central to things like head restraints in cars, crash test dummies, seat belts, chair and furniture design, etc. It is part of many things we take for granted. Why then, should what we do in the clinic be beyond this?
mcap
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Re: What's in the mystery trunk? - March 7, 2002 7:29:00 AM
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mcap
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Let me add.....
That I agree that our job is more complicated than that and I would certainly never discount the contributions of the nervous systems and mental processes. Just nothing wrong with the ye ol' modeling. I think sometimes this gets discounted by PT.
mcap
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