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Motor control exercise is a popular form of [[Therapeutic Exercise|exercise]] that aims to restore [[Coordination Exercises|co-ordinated]] and efficient use of the [[Muscle|muscles]] that control and support the spine. The therapist guides the client topractisenormal use of the muscles during simple tasks. As control and skill improve the exercises are progressed to more complex and functional tasks involving the muscles of the trunk and limbs[Saragiotto BT, Maher CG, Yamato TP, Costa LO, Costa LC, Ostelo RW, Macedo LG. [https://www.cochrane.org/CD012004/BACK_motor-control-exercise-chronic-non-specific-low-back-pain Motor control exercise for chronic non‐specific low‐back pain]. Cochrane Database of Systematic Reviews. 2016(1). Available:https://www.cochrane.org/CD012004/BACK_motor-control-exercise-chronic-non-specific-low-back-pain (accessed 3.1.2022)]. |
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Motor control exercise is a popular form of [[Therapeutic Exercise|exercise]] that aims to restore [[Coordination Exercises|co-ordinated]] and efficient use of the [[Muscle|muscles]] that control and support the spine. The therapist guides the client topracticenormal use of the muscles during simple tasks. As control and skill improve,the exercises are progressed to more complex and functional tasks involving the muscles of the trunk and limbs[Saragiotto BT, Maher CG, Yamato TP, Costa LO, Costa LC, Ostelo RW, Macedo LG. [https://www.cochrane.org/CD012004/BACK_motor-control-exercise-chronic-non-specific-low-back-pain Motor control exercise for chronic non‐specific low‐back pain]. Cochrane Database of Systematic Reviews. 2016(1). Available:https://www.cochrane.org/CD012004/BACK_motor-control-exercise-chronic-non-specific-low-back-pain (accessed 3.1.2022)]. |
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During the 1990s and 2000s practitioners across the world began to recognise that the [[Core Muscles|core muscles]]eg[[腹横横腹|]],[[Lumbar Multifidus|lumbar multifidus]] and the [[Pelvic Floor Anatomy|pelvic floor]] need assessment and consideration for inclusion in an integrated treatment program for [[Low Back Pain|low back pain]][Bystrom MG, Rasmussen-Barr E, Grooten WJ. Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis. Spine (Phila Pa 1976). 2013; 38(6): E350-8]. A 2016 systematic review evaluating the effectiveness of [[Motor Control and Learning|motor control]] exercise (MCE) in patients with [[Chronic Low Back Pain|chronic non-specific low back pain]] concluded: |
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During the 1990s and 2000s practitioners across the world began to recognise that the [[Core Muscles|core muscles]]e.g.[[腹横横腹|]],[[Lumbar Multifidus|lumbar multifidus]] and the [[Pelvic Floor Anatomy|pelvic floor]] need assessment and consideration for inclusion in an integrated treatment program for [[Low Back Pain|low back pain]][Bystrom MG, Rasmussen-Barr E, Grooten WJ.[https://scholar.google.com/scholar_url?url=https://journals.lww.com/spinejournal/FullText/2013/03150/Motor_Control_Exercises_Reduces_Pain_and.18.aspx&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=10701181167903656957&ei=i6KuY96mPOeR6rQPyeixmAI&scisig=AAGBfm3TmtecdOrHQvbQPgPdyQaUVbjUiQMotor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis]。脊柱(费拉Pa 1976)。2013;38 (6): E350-8]. A 2016 systematic review evaluating the effectiveness of [[Motor Control and Learning|motor control]] exercise (MCE) in patients with [[Chronic Low Back Pain|chronic non-specific low back pain]] concluded: |
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"MCE probably provides better improvements in [[Motor Control Changes and Pain|pain]], function and global impression of recovery than minimal intervention at all follow-up periods. MCE may provide slightly better improvements than exercise and [[electrophysical]] agents for pain, disability, global impression of recovery and the physical component of [[Quality of Life|quality of life]] in the short and intermediate term. There is probably little or no difference between MCE and [[Manual Therapy|manual therapy]] for all [[Outcome Measures|outcomes]] and follow-up periods. Little or no difference is observed between MCE and other forms of exercise. Given the minimal evidence that MCE is superior to other forms of exercise, the choice of exercise for chronic LBP should probably depend on patient or therapist preferences, therapist training, costs and safety". |
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"MCE probably provides better improvements in [[Motor Control Changes and Pain|pain]], function and global impression of recovery than minimal intervention at all follow-up periods. MCE may provide slightly better improvements than exercise and [[electrophysical]] agents for pain, disability, global impression of recovery and the physical component of [[Quality of Life|quality of life]] in the short and intermediate term. There is probably little or no difference between MCE and [[Manual Therapy|manual therapy]] for all [[Outcome Measures|outcomes]] and follow-up periods. Little or no difference is observed between MCE and other forms of exercise. Given the minimal evidence that MCE is superior to other forms of exercise, the choice of exercise for chronic LBP should probably depend on patient or therapist preferences, therapist training, costs and safety". |
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== Justification for Use == |
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== Justification for Use == |
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特定的运动控制训练作为混乱关系的一部分atment protocol was based on the principles developed by Richardson and colleagues.[Richardson C, Jull G, Hodges P. Therapeutic exercise for lumbopelvic stabilisation: a motor control approach for the treatment and prevention of low back pain. Edinburgh: Churchill Livingstone; 2004]Extensive research has been published on the importance of normal motor control in the lumbar spine including but not limited to: • An anatomical and [[Biomechanics|biomechanical]] suitability of the core muscles for providing stability to structures in the lumbar spine[Barker P, Briggs, CA, Bogeski, G. Tensile transmission across the lumbar fasciae in embalmed cadavers: effects of tension to various muscular attachments. Spine. 2004; 29: 129-38][Barker P, Guggenheimer, KT, Grkovic, I, Briggs, CA, Jones, DC, Thomas, CD, Hodges, PW. Effects of tensioning the lumbar fascia on segmental stiffness during flexion and extension. Spine. 2006; 31(4): 387-405][Barker P, Briggs C. Attachments of the posterior layer of lumbar fascia. Spine. 1999; 24(17): 1757-64][Panjabi M. The stabilizing system of the spine: Part I: Function, dysfucntion, adaptation and enhancement. Journal of Spinal Disorders. 1992; 5: 383-9][Wilke H, Wolf S, Claes L, Arand M, Wiesend A. Stability increase on the lumbar spine with different muscle groups. Spine. 1995; 20(2): 192-8][MacIntosh J, Bogduk N. The biomechanics of the lumbar multifidus. Clinical biomechanics. 1986; 1: 205-13][Kaigle A, Holm S, Mansson T. Experimental instability in the lumbar spine. Spine. 1995; 20(4): 421-30][Hodges P, Eriksson M, Shirley D, Gandevia S. Intra-abdominal pressure increases stiffness of the lumbar spine. Journal of Biomechanics. 2005; 38(9): 1873-80][Hodges P, Cresswell, AG, Daggfeldt, K, Thorstensson, A. In vivo measurements of the effect of intra-abdominal pressure on the human spine. Journal of Biomechanics. 2001; 34(347-353)][Hodges P, Kaigle, HA, Holm, S, Ekström, L, Cresswell, A, Hansson, T, Thorstensson, A. . Intervertebral stiffness of the spine is increased by evoked contraction of transversus abdominis and the diaphragm: in vivo porcine studies. Spine. 2003; 28(23): 2594-601] • Feedforward mechanisms in people without a low back disorder (LBD) resulting in “pre-setting” of the core muscles in anticipation of [[Perturbation-Based Balance Training|postural perturbation]][Cresswell A, Oddsson, L, Thorstensson, A. The influence of sudden perturbations on trunk muscle activity and intra-abdominal pressure while standing. Exp Brain res. 1994; 98: 336-41][Hodges P, Richardson C. Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res. 1997; 114: 362-70][Hodges P, Richardson C. Contraction of the abdominal muscles associated with movement of the lower limb. Physical Therapy. 1997; 77(2): 132-44] |
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特定的运动控制训练作为混乱关系的一部分atment protocol was based on the principles developed by Richardson and colleagues.[Richardson C, Jull G, Hodges P.[https://scholar.google.com/scholar_url?url=http://125.212.201.8:6008/handle/DHKTYTHD_123/7945&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=16674606697935355322&ei=tKKuY7HZJOeR6rQPyeixmAI&scisig=AAGBfm0RxzM-OEOlI1b1jJbFc5OycyhLaQTherapeutic exercise for lumbopelvic stabilisation:]a motor control approach for the treatment and prevention of low back pain. Edinburgh: Churchill Livingstone; 2004]Extensive research has been published on the importance of normal motor control in the lumbar spine including but not limited to: • An anatomical and [[Biomechanics|biomechanical]] suitability of the core muscles for providing stability to structures in the lumbar spine[Barker P, Briggs, CA, Bogeski, G.[https://scholar.google.com/scholar_url?url=https://journals.lww.com/spinejournal/Fulltext/2004/01150/The_Relation_Between_the_Transversus_Abdominis.5.aspx&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=10206056708636316310&ei=1KKuY4TpFtKxywSLm5agCA&scisig=AAGBfm3CuQinJ2e2M3rLpRxz9cIGV9rbJATensile transmission across the lumbar fasciae in embalmed cadavers:]effects of tension to various muscular attachments. Spine. 2004; 29: 129-38][Barker P, Guggenheimer, KT, Grkovic, I, Briggs, CA, Jones, DC, Thomas, CD, Hodges, PW.[https://scholar.google.com/scholar_url?url=https://journals.lww.com/spinejournal/FullText/2006/02150/Effects_of_Tensioning_the_Lumbar_Fasciae_on.6.aspx&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=3378781173356912699&ei=9KKuY8jcO9KxywSLm5agCA&scisig=AAGBfm3uKybklTmG9eXbfa2GSZI63FHp6QEffects of tensioning the lumbar fascia on segmental stiffness during flexion and extension.]Spine. 2006; 31(4): 387-405][Barker P, Briggs C.[https://scholar.google.com/scholar_url?url=https://journals.lww.com/spinejournal/Fulltext/1999/09010/Attachments_of_the_Posterior_Layer_of_Lumbar.2.aspx&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=9298866629669642369&ei=FaOuY6yOE46yyAS9hoto&scisig=AAGBfm3RBi5ZBeOuwfr4ktgeJixMgtJBEAAttachments of the posterior layer of lumbar fascia.]Spine. 1999; 24(17): 1757-64][Panjabi M.[https://scholar.google.com/scholar_url?url=https://www.tigraheerenveen.nl/wp-content/uploads/2017/11/The-Stabilizing-System-of-the-Spine.-Part-I.-Funct-6280KB.pdf&hl=en&sa=T&oi=gsb-ggp&ct=res&cd=0&d=11616096125410482423&ei=LqOuY-KzEpCXywSwqaaIDw&scisig=AAGBfm0lqQ27XbNfz6umnMqc_SJj9s_uXgThe stabilizing system of the spine]: Part I: Function, dysfucntion, adaptation and enhancement. Journal of Spinal Disorders. 1992; 5: 383-9][Wilke H, Wolf S, Claes L, Arand M, Wiesend A.[https://scholar.google.com/scholar_url?url=https://europepmc.org/article/med/7716624&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=16929397915265268201&ei=SaOuY8mSNc6TywSl1LXoCA&scisig=AAGBfm1tg5yB-ZxncM8TFdHGBWa2BOLCagStability increase on the lumbar spine with different muscle groups]。Spine. 1995; 20(2): 192-8][MacIntosh J, Bogduk N.[https://scholar.google.com/scholar_url?url=https://www.sciencedirect.com/science/article/pii/0268003386901464&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=4300849241011863501&ei=aaOuY7_zB86TywSl1LXoCA&scisig=AAGBfm2APhdeR19ZsWmshLCnua39GIPzlAThe biomechanics of the lumbar multifidus]。Clinical biomechanics. 1986; 1: 205-13][Kaigle A, Holm S, Mansson T.[https://scholar.google.com/scholar_url?url=https://journals.lww.com/spinejournal/abstract/1995/02001/experimental_instability_in_the_lumbar_spine.4.aspx&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=11908744133629695413&ei=i6OuY8X5BYa8yATUzZGgCg&scisig=AAGBfm0lsKiQ3y2E-DDeCpSRDi933BGdPgExperimental instability in the lumbar spine.]Spine. 1995; 20(4): 421-30][Hodges P, Eriksson M, Shirley D, Gandevia S.[https://scholar.google.com/scholar_url?url=https://www.sciencedirect.com/science/article/pii/S0021929004004105&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=7913455018392281733&ei=q6OuY87zKM6TywSl1LXoCA&scisig=AAGBfm382hAucGiIwRg6tyZJue8hjpqtqgIntra-abdominal pressure increases stiffness of the lumbar spine.]Journal of Biomechanics. 2005; 38(9): 1873-80][Hodges P, Cresswell, AG, Daggfeldt, K, Thorstensson, A.[https://scholar.google.com/scholar_url?url=https://www.sciencedirect.com/science/article/pii/S0021929000002062&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=1193912791330267928&ei=xqOuY-mwCI6yyAS9hoto&scisig=AAGBfm2J3zE6zdniBvgp1Il2FNsY8X4t7AIn vivo measurements of the effect of intra-abdominal pressure on the human spine.]Journal of Biomechanics. 2001; 34(347-353)][Hodges P, Kaigle, HA, Holm, S, Ekström, L, Cresswell, A, Hansson, T, Thorstensson, A. .[https://scholar.google.com/scholar_url?url=https://journals.lww.com/spinejournal/fulltext/2003/12010/intervertebral_stiffness_of_the_spine_is_increased.7.aspx&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=2292042474031696466&ei=8qOuY8bGI4a8yATUzZGgCg&scisig=AAGBfm3YNcrgm1xv_O9xEKlL4SHXtrtj6gIntervertebral stiffness of the spine is increased by evoked contraction of transversus abdominis and the diaphragm: in vivo porcine studies.]Spine. 2003; 28(23): 2594-601] • Feedforward mechanisms in people without a low back disorder (LBD) resulting in “pre-setting” of the core muscles in anticipation of [[Perturbation-Based Balance Training|postural perturbation]][Cresswell A, Oddsson, L, Thorstensson, A.[https://scholar.google.com/scholar_url?url=https://link.springer.com/article/10.1007/BF00228421&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=2490314075079449303&ei=JaSuY7GyGdKxywSLm5agCA&scisig=AAGBfm3JcrmrX7bXwV0tSCd9-eOx3dZEgwThe influence of sudden perturbations on trunk muscle activity and intra-abdominal pressure while standing]。Exp Brain res. 1994; 98: 336-41][Hodges P, Richardson C.[https://scholar.google.com/scholar_url?url=https://link.springer.com/article/10.1007/PL00005644&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=8335509890907426718&ei=QKSuY8W1BIa8yATUzZGgCg&scisig=AAGBfm2ADmrSBVgHqPaZmQA-9crOI4ODPAFeedforward contraction of transversus abdominis is not influenced by the direction of arm movement]。Exp Brain Res. 1997; 114: 362-70][Hodges P, Richardson C.[https://scholar.google.com/scholar_url?url=https://academic.oup.com/ptj/article-abstract/77/2/132/2633127&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=7675833804909184605&ei=aqSuY6GtEYa8yATUzZGgCg&scisig=AAGBfm0sAZ_v0DDSJ8oVDqhiH9-odNl4vAContraction of the abdominal muscles associated with movement of the lower limb. Physical Therapy]。1997; 77(2): 132-44] |
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•核心肌肉收缩direc独立的tion of trunk forces and movements[Cresswell A, Grundstrom H, Thorstensson A. Observations on intra-abdominal pressure and patterns of abdominal intra-muscular activity in man. Acta Physiology Scandinavia. 1992][Hodges P, Cresswell, A & Thorstensson, A. Preparatory trunk motion accompanies rapid upper limb movement. Exp Brain Res. 1999; 124: 69-79] • Maladaptive differences between people with and without LBD in terms of altered feedforward mechanisms,[Hodges P, Richardson C. Inefficient muscular stabilisation of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine. 1996; 21: 2640-50][Hodges P, Richardson, CA. Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. Journal of Spinal Disorders. 1998; 11(1): 46-56][Ferreira P, Ferreira M, Hodges P. Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity. Spine. 2004; 29(22): 2560-6][MacDonald D, Moseley G, Hodges P. Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain. Pain. 2009; 142(3): 183-8]reduced core muscle cross sectional size,[Hides J, Lambrecht G, Richardson C, Stanton W, Armbrecht G, Pruett C, et al. The effects of rehabilitation on the muscles of the trunk following prolonged bed rest. European Spine Journal. 2010][Dickx N, Cagnie B, Parlevliet T, Lavens A, Danneels L. The effect of unilateral muscle pain on recruitment of the lumbar multifidus during automatic contraction. An experimental pain study. Manual Therapy. 2010; 15(4): 364-9]increased global muscle activity in certain subgroups[Dankaerts W, O'Sullivan P, Burnett A, Straker L. Altered patterns of superficial trunk muscle activation during sitting in nonspecific chronic low back pain patients: importance of subclassification. Spine. 2006; 31(17): 2017-23]and altered cortical representation of motor patterns[Tsao H, Galea M, Hodges P. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain. 2008; 131(8): 2161-71] |
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•核心肌肉收缩direc独立的tion of trunk forces and movements[Cresswell A, Grundstrom H, Thorstensson A.[https://scholar.google.com/scholar_url?url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1748-1716.1992.tb09314.x&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=9254590330650481097&ei=hKSuY6yLPOeR6rQPyeixmAI&scisig=AAGBfm2x36ysY5JKCyJw3FEqABGDwgxvqAObservations on intra-abdominal pressure and patterns of abdominal intra-muscular activity in man.]Acta Physiology Scandinavia. 1992][Hodges P, Cresswell, A & Thorstensson, A.[https://scholar.google.com/scholar_url?url=https://link.springer.com/article/10.1007/s002210050601&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=9648740362846654895&ei=oKSuY_-qOc6vywS1g6foAw&scisig=AAGBfm3ZYgJ4doixTFP2tmOA5syKq-j1MwPreparatory trunk motion accompanies rapid upper limb movement.]Exp Brain Res. 1999; 124: 69-79] • Maladaptive differences between people with and without LBD in terms of altered feedforward mechanisms,[Hodges P, Richardson C.[https://scholar.google.com/scholar_url?url=https://journals.lww.com/spinejournal/Fulltext/1996/11150/Inefficient_Muscular_Stabilization_of_the_Lumbar.14.aspx&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=10508810454767233703&ei=yaSuY92aDtKxywSLm5agCA&scisig=AAGBfm26zcOuhCeoWJZ0WfDuh5bO8nozsgInefficient muscular stabilisation of the lumbar spine associated with low back pain:]a motor control evaluation of transversus abdominis. Spine. 1996; 21: 2640-50][Hodges P, Richardson, CA.[[Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb.]]Journal of Spinal Disorders. 1998; 11(1): 46-56][Ferreira P, Ferreira M, Hodges P.[https://scholar.google.com/scholar_url?url=https://journals.lww.com/spinejournal/fulltext/2004/11150/changes_in_recruitment_of_the_abdominal_muscles_in.18.aspx&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=11835150447014700328&ei=O6WuY5j3EYa8yATUzZGgCg&scisig=AAGBfm3gqE4sNApgVkBNjMK4iBiw_a-d7AChanges in recruitment of the abdominal muscles in people with low back pain:]ultrasound measurement of muscle activity. Spine. 2004; 29(22): 2560-6][MacDonald D, Moseley G, Hodges P. Why do some patients keep hurting their back?[https://scholar.google.com/scholar_url?url=https://www.sciencedirect.com/science/article/pii/S0304395908007215&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=16314244400437277213&ei=V6WuY-eHN5CXywSwqaaIDw&scisig=AAGBfm3Iv43V09hxzyQdl6gWFLHc1oXuXwEvidence of ongoing back muscle dysfunction during remission from recurrent back pain]。Pain. 2009; 142(3): 183-8]reduced core muscle cross sectional size,[Hides J, Lambrecht G, Richardson C, Stanton W, Armbrecht G, Pruett C, et al.[https://scholar.google.com/scholar_url?url=https://link.springer.com/article/10.1007/s00586-010-1491-x&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=609324647705219577&ei=i6WuY4XQE86TywSl1LXoCA&scisig=AAGBfm3RrbKppKqVoTqoexPJtB0CAFUWGAThe effects of rehabilitation on the muscles of the trunk following prolonged bed rest.]European Spine Journal. 2010][Dickx N, Cagnie B, Parlevliet T, Lavens A, Danneels L.[https://scholar.google.com/scholar_url?url=https://www.sciencedirect.com/science/article/pii/S1356689X10000299&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=16466028050617926617&ei=pKWuY4imEpCXywSwqaaIDw&scisig=AAGBfm0DzV0NL4flAFtJ3BLVtOTpDcqFBgThe effect of unilateral muscle pain on recruitment of the lumbar multifidus during automatic contraction]。An experimental pain study. Manual Therapy. 2010; 15(4): 364-9]increased global muscle activity in certain subgroups[Dankaerts W, O'Sullivan P, Burnett A, Straker L.[https://journals.lww.com/spinejournal/fulltext/2006/08010/altered_patterns_of_superficial_trunk_muscle.21.aspxAltered patterns of superficial trunk muscle activation during sitting in nonspecific chronic low back pain patients:]importance of subclassification. Spine. 2006; 31(17): 2017-23]and altered cortical representation of motor patterns[Tsao H, Galea M, Hodges P.[https://scholar.google.com/scholar_url?url=https://academic.oup.com/brain/article-abstract/131/8/2161/268528&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=16689223255946885989&ei=B6auY_68II6yyAS9hoto&scisig=AAGBfm0NyQ25QMsP2JdquIpaZzKS2WTQMgReorganization of the motor cortex is associated with postural control deficits in recurrent low back pain]。Brain. 2008; 131(8): 2161-71] |
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[[File:Back pain lady.jpeg|right|frameless]] |
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[[File:Back pain lady.jpeg|right|frameless]] |
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This substantial literature has led to the hypothesis that correcting maladaptive motor control is an important component in the rehabilitation of LBD and prevention of recurrence.[Hodges P, Moseley G. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. Journal of Electromyography and Kinesiology. 2003; 13(4): 361-70][Richardson C, Hides J, Wilson S, Stanton W, Snijders C. Lumbo-pelvic joint protection against antigravity forces: motor control and segmental stiffness assessed with magnetic resonance imaging. J Gravit Physiol. 2004; 11(2): P119-22.] |
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This substantial literature has led to the hypothesis that correcting maladaptive motor control is an important component in the rehabilitation of LBD and prevention of recurrence.[Hodges P, Moseley G.[https://scholar.google.com/scholar_url?url=https://www.sciencedirect.com/science/article/pii/S1050641103000427&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=5181556371848924966&ei=I6auY7GFBOeR6rQPyeixmAI&scisig=AAGBfm14TRBCKcJ9kwoiYiUDjvnJrfgPFgPain and motor control of the lumbopelvic region:]effect and possible mechanisms. Journal of Electromyography and Kinesiology. 2003; 13(4): 361-70][Richardson C, Hides J, Wilson S, Stanton W, Snijders C.[https://scholar.google.com/scholar_url?url=https://europepmc.org/article/med/16235441&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=30687608771937140&ei=QqauY9bqL-eR6rQPyeixmAI&scisig=AAGBfm3Sg9zGxRRNyNbZZW7ZtOu7PvSRfALumbo-pelvic joint protection against antigravity forces]: motor control and segmental stiffness assessed with magnetic resonance imaging. J Gravit Physiol. 2004; 11(2): P119-22.] |
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*这个假说是基于我们共同的加强l data showing a reversal of the maladaptive changes observed in people with LBD[Tsao H, Hodges P. Immediate changes in feedforward postural adjustments following voluntary motor training. Experimental Brain Research. 2007; 181(4): 537-46][Tsao H, Hodges P. Persistence of improvements in postural strategies following motor control training in people with recurrent low back pain. Journal of Electromyography and Kinesiology. 2008; 18(4): 559-67][Tsao H, Druitt T, Schollum T, Hodges P. Motor training of the lumbar paraspinal muscles induces immediate changes in motor coordination in patients with recurrent low back pain. The Journal of Pain. 2010; 11(11): 1120-8][Vasseljen O, Fladmark A. Abdominal muscle contraction thickness and function after specific and general exercises: a randomized controlled trial in chronic low back pain patients. Man Ther. 2010; 15(5): 482-9] which is not achieved by less specific exercise such as abdominal bracing or general exercise.[Ferreira P, Ferreira M, Maher C, Refshauge K, Herbert R, Hodges P. Changes in recruitment of transversus abdominis correlate with disability in people with chronic low back pain. British Journal of Sports Medicine. 2009; 44(16): 1166-72][Hall L, Tsao H, MacDonald D, Coppieters M, Hodges P. Immediate effects of co-contraction training on motor control of the trunk muscles in people with recurrent low back pain. Journal of electromyography and kinesiology: official journal of the International Society of Electrophysiological Kinesiology. 2009; 19(5): 763] |
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*这个假说是基于我们共同的加强l data showing a reversal of the maladaptive changes observed in people with LBD[Tsao H, Hodges P.[https://scholar.google.com/scholar_url?url=https://link.springer.com/article/10.1007/s00221-007-0950-z&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=11037989905456936849&ei=Z6auY7yvMYa8yATUzZGgCg&scisig=AAGBfm10-mJ-Gc85sLivtwhEmhAfYyVfKwImmediate changes in feedforward postural adjustments following voluntary motor training.]Experimental Brain Research. 2007; 181(4): 537-46][Tsao H, Hodges P.[https://scholar.google.com/scholar_url?url=https://www.sciencedirect.com/science/article/pii/S105064110700020X&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=18293805487801876232&ei=zKauY6ToI8SYywTZh5fgCg&scisig=AAGBfm1IVgneVMTO2pgQGRBF3JbTkFwyBwPersistence of improvements in postural strategies following motor control training in people with recurrent low back pain]。Journal of Electromyography and Kinesiology. 2008; 18(4): 559-67][Tsao H, Druitt T, Schollum T, Hodges P.[https://www.sciencedirect.com/science/article/pii/S1526590010003251Motor training of the lumbar paraspinal muscles induces immediate changes in motor coordination in patients with recurrent low back pain.]The Journal of Pain. 2010; 11(11): 1120-8][Vasseljen O, Fladmark A.[https://scholar.google.com/scholar_url?url=https://www.sciencedirect.com/science/article/pii/S1356689X10000755&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=3589341455644921894&ei=C6euY-rJNIa8yATUzZGgCg&scisig=AAGBfm35AJaZnY9r-voJVHeimZQl6FX5NwAbdominal muscle contraction thickness and function after specific and general exercises:]a randomized controlled trial in chronic low back pain patients. Man Ther. 2010; 15(5): 482-9] which is not achieved by less specific exercise such as abdominal bracing or general exercise.[Ferreira P, Ferreira M, Maher C, Refshauge K, Herbert R, Hodges P.[https://bjsm.bmj.com/content/44/16/1166.shortChanges in recruitment of transversus abdominis correlate with disability in people with chronic low back pain]。British Journal of Sports Medicine. 2009; 44(16): 1166-72][Hall L, Tsao H, MacDonald D, Coppieters M, Hodges P.[https://scholar.google.com/scholar_url?url=https://www.sciencedirect.com/science/article/pii/S1050641107001708&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=7366745125719554297&ei=V6euY8u4HI6yyAS9hoto&scisig=AAGBfm0Jai81t-86M90psq81OHxWF0Xk_gImmediate effects of co-contraction training on motor control of the trunk muscles in people with recurrent low back pain.]Journal of electromyography and kinesiology: official journal of the International Society of Electrophysiological Kinesiology. 2009; 19(5): 763] |
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*另外,相关显示显著的改善ment for pain and activity in participants receiving specific motor control training compared to usual care[Ferreira P, Ferreira M, Maher C, Herbert R, Refshauge K. Specific stabilisation exercise for spinal and pelvic pain: a systematic review. Australian Journal of Physiotherapy. 2006; 52(2): 79-88][Rackwitz B, de Bie R, Limm H, von Garnier K, Ewert T, Stucki G. Segmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials. Clin Rehabil. 2006; 20(7): 553-67][Macedo L, Maher C, Latimer J, McAuley J. Motor control exercise for persistent, nonspecific low back pain: a systematic review. Physical Therapy. 2009; 89(1): 9-25] with larger effects demonstrable when homogenous subgroups are recruited.[Hodges P. Transversus abdominis: a different view of the elephant. British Journal of Sports Medicine. 2008; 42(12): 941-4] |
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*另外,相关显示显著的改善ment for pain and activity in participants receiving specific motor control training compared to usual care[Ferreira P, Ferreira M, Maher C, Herbert R, Refshauge K.[https://scholar.google.com/scholar_url?url=https://www.sciencedirect.com/science/article/pii/S0004951406700435&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=15789527465057237537&ei=h6euY46eOtLAywSsrIVo&scisig=AAGBfm0_aS-uhO9njqublHROm_zv5sd4jQSpecific stabilisation exercise for spinal and pelvic pain]: a systematic review. Australian Journal of Physiotherapy. 2006; 52(2): 79-88][Rackwitz B, de Bie R, Limm H, von Garnier K, Ewert T, Stucki G.[https://scholar.google.com/scholar_url?url=https://journals.sagepub.com/doi/abs/10.1191/0269215506cr977oa&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=2530897818209895447&ei=zqeuY7iaKueR6rQPyeixmAI&scisig=AAGBfm36Dd4d1zWxxUgduhR9Tjy86OOhzASegmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials]。Clin Rehabil. 2006; 20(7): 553-67][Macedo L, Maher C, Latimer J, McAuley J.[https://scholar.google.com/scholar_url?url=https://academic.oup.com/ptj/article-abstract/89/1/9/2737552&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=14578074909780481506&ei=8qeuY9PoOsSYywTZh5fgCg&scisig=AAGBfm0fnMKo_d7Zp8WNclO8Bs3PZqxcNAMotor control exercise for persistent, nonspecific low back pain: a systematic review.]Physical Therapy. 2009; 89(1): 9-25] with larger effects demonstrable when homogenous subgroups are recruited.[Hodges P.[https://scholar.google.com/scholar_url?url=https://bjsm.bmj.com/content/42/12/941.short&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=7460151779642391648&ei=HaiuY4GsGYa8yATUzZGgCg&scisig=AAGBfm2aqqk_XeEU34I2SFDaeXSnyknW4QTransversus abdominis:]a different view of the elephant. British Journal of Sports Medicine. 2008; 42(12): 941-4] |
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* Recent controversy around specific motor control training[Allison G, Morris S. Transversus abdominis and core stability: has the pendulum swung? British Journal of Sports Medicine. 2008; 42(11): 630-1][McGill SM. Low back disorders: Evidence-based prevention and rehabilitation 2nd ed. Illinois: Human Kinetics Publishers; 2008]has been refuted based on an insufficient consideration of this expansive literature as a whole. |
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* Recent controversy around specific motor control training[Allison G, Morris S. Transversus abdominis and core stability:[https://scholar.google.com/scholar_url?url=https://bjsm.bmj.com/content/42/11/930.short&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=793245229566635607&ei=UKiuY8LlKueR6rQPyeixmAI&scisig=AAGBfm2jaMXRLn6bT_tlAMicM7_dP6Abvwhas the pendulum swung?]British Journal of Sports Medicine. 2008; 42(11): 630-1][McGill SM. Low back disorders: Evidence-based prevention and rehabilitation 2nd ed. Illinois: Human Kinetics Publishers; 2008]has been refuted based on an insufficient consideration of this expansive literature as a whole. |
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* There is clear and extensive mechanistic and randomised controlled trial based data supporting the rationale for precise motor control training for LBD. |
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* There is clear and extensive mechanistic and randomised controlled trial based data supporting the rationale for precise motor control training for LBD. |
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== Clinical Application == |
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== Clinical Application == |
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Lumbar motor control training [O'Sullivan P. Lumbar segmental 'instability': clinical presentation and specific stabilizing exercise management. Manual Therapy. 2000; 5(1): 2-12] has a large amount of variability in clinical application between physiotherapists.[Ford J, Hahne A, Chan A, Surkitt L. A classification and treatment protocol for low back disorders. Part 3: functional restoration for intervertebral disc related disorders. Physical Therapy Reviews. 2012; 17(1): 55-75]and is commonly reported as a difficult concept to efficiently teach in people with LBD. [Standaert C, Weinstein S, Rumpeltes J. Evidence-informed management of chronic low back pain with lumbar stabilization exercises. The Spine Journal. 2008; 8(1): 114-20][Henry S, Westervelt K. The use of real-time ultrasound feedback in teaching abdominal hollowing exercises to healthy subjects. Journal of Orthopaedic & Sports Physical Therapy. 2005; 35(6): 338-45][Hides J, Stanton W, Freke M, Wilson S, McMahon S, Richardson C. MRI study of the size, symmetry and function of the trunk muscles among elite cricketers with and without low back pain. Br J Sports Med. 2008; 42(10): 809-13] |
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Lumbar motor control training [O'Sullivan P.[https://scholar.google.com/scholar_url?url=https://fitnessmais.com.br/download/avaliacao-fisica/estabilizacao-01.pdf&hl=en&sa=T&oi=gsb-ggp&ct=res&cd=0&d=9664533881687573630&ei=iKiuY47XMIa8yATUzZGgCg&scisig=AAGBfm2sP8k4HY-5MfkLJTV1vk0IQiCKCwLumbar segmental 'instability']: clinical presentation and specific stabilizing exercise management. Manual Therapy. 2000; 5(1): 2-12] has a large amount of variability in clinical application between physiotherapists.[Ford J, Hahne A, Chan A, Surkitt L.[https://scholar.google.com/scholar_url?url=https://www.tandfonline.com/doi/abs/10.1179/1743288X11Y.0000000037&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=9579384134772287677&ei=qaiuY7vTDZCXywSwqaaIDw&scisig=AAGBfm2B4N8APlis37s3iWlkqyLb5AoyBAA classification and treatment protocol for low back disorders]。Part 3: functional restoration for intervertebral disc related disorders. Physical Therapy Reviews. 2012; 17(1): 55-75]and is commonly reported as a difficult concept to efficiently teach in people with LBD. [Standaert C, Weinstein S, Rumpeltes J.[https://scholar.google.com/scholar_url?url=https://www.sciencedirect.com/science/article/pii/S1529943007009096&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=14727089578241730639&ei=saeuY8a5INKxywSLm5agCA&scisig=AAGBfm08wq5uDxDrI38dlNmjQzpZYkZlkQEvidence-informed management of chronic low back pain with lumbar stabilization exercises.]The Spine Journal. 2008; 8(1): 114-20][Henry S, Westervelt K.[https://scholar.google.com/scholar_url?url=https://www.jospt.org/doi/abs/10.2519/jospt.2005.35.6.338&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=9695838525695579588&ei=xKiuY73eLI6yyAS9hoto&scisig=AAGBfm1SRFXAt0GHRicHP-G3wHzrzZ711AThe use of real-time ultrasound feedback in teaching abdominal hollowing exercises to healthy subjects.]Journal of Orthopaedic & Sports Physical Therapy. 2005; 35(6): 338-45][Hides J, Stanton W, Freke M, Wilson S, McMahon S,[https://scholar.google.com/scholar_url?url=https://bjsm.bmj.com/content/42/10/809.short&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=13817960245410029639&ei=5KiuY-nkOs6TywSl1LXoCA&scisig=AAGBfm2SNif9O6KGZMYQ9hG4fyny_VYbmgRichardson C. MRI study of the size, symmetry and function of the trunk muscles among elite cricketers with and without low back pain.]Br J Sports Med. 2008; 42(10): 809-13] |
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Now a series of clinical decision making algorithms (based on established protocols) has been developed and validated in a major clinical trial.[Hahne AJ, Ford JJ, Surkitt LD, Richards MC, Chan AY, Thompson SL, et al. Specific treatment of problems of the spine (STOPS): design of a randomised controlled trial comparing specific physiotherapy versus advice for people with subacute low back disorders. BMC Musculoskeletal Disorders. 2011; 12: 104] |
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Now a series of clinical decision making algorithms (based on established protocols) has been developed and validated in a major clinical trial.[Hahne AJ, Ford JJ, Surkitt LD, Richards MC, Chan AY, Thompson SL, et al.[https://scholar.google.com/scholar_url?url=https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-12-104&hl=en&sa=T&oi=gsb-ggp&ct=res&cd=0&d=11160779804618987712&ei=BamuY9LJC-eR6rQPyeixmAI&scisig=AAGBfm2mnmOskB3OesetWxux1ARjJQl-hQSpecific treatment of problems of the spine (STOPS)]: design of a randomised controlled trial comparing specific physiotherapy versus advice for people with subacute low back disorders. BMC Musculoskeletal Disorders. 2011; 12: 104] |
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== Physiotherapy == |
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== Physiotherapy == |
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[[File:Drawin.jpg|right|frameless|531x531px]]The goal of the motor control program is to retrain the core muscles of the lumbar spine, comprising [[Abdominal Muscles|transversus abdominis]], lumbar [[Multifidus Muscle|multifidus]] and the [[Pelvic_Floor_Anatomy|pelvic floor]], to maintain a tonic and automatic contraction[Hides J, Belavy D, Cassar L, Williams M, Wilson S, Richardson C. Altered response of the anterolateral abdominal muscles to simulated weight-bearing in subjects with low back pain. Eur Spine J. 2009; 18(3): 410-8] at less than 30% of maximum voluntary contraction in daily activities. |
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[[File:Drawin.jpg|right|frameless|531x531px]]The goal of the motor control program is to retrain the core muscles of the lumbar spine, comprising [[Abdominal Muscles|transversus abdominis]], lumbar [[Multifidus Muscle|multifidus]] and the [[Pelvic_Floor_Anatomy|pelvic floor]], to maintain a tonic and automatic contraction[Hides J, Belavy D, Cassar L, Williams M, Wilson S, Richardson C.[https://scholar.google.com/scholar_url?url=https://link.springer.com/article/10.1007/s00586-008-0827-2&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=15113427093277221832&ei=YKmuY6uKIY6yyAS9hoto&scisig=AAGBfm11hVlzl4glf98UIAVBzRUONaB20gAltered response of the anterolateral abdominal muscles to simulated weight-bearing in subjects with low back pain.]Eur Spine J. 2009; 18(3): 410-8] at less than 30% of maximum voluntary contraction in daily activities. |
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Image 4: Correct and incorrect abdominal drawing in |
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Image 4: Correct and incorrect abdominal drawing in |
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* In most cases this requires initial training in non-weight bearing positions using a lower abdominal drawing in manoeuvre which has been shown to selectively activate transversus abdominis. Lumbar multifidus and the pelvic floor muscles, including [[Levator Ani Muscle|pubococcygeus]], have been shown to co-contract with transversus abdominis to provide a “corset” for the [[Lumbo-Pelvic Stability|lumbo-pelvic area]][Sapsford R. Contraction of the pelvic floor muscles during abdominal maneuvers. Archives of Physical Medicine and Rehabilitation. 2001; 82(8): 1081-8][Neumann P, Gill V. Pelvic floor and abdominal muscle interaction: EMG activity and intra- abdominal pressure. Int Urogynecol J Pelvic Floor Dysfunct. 2002; 13: 125-32] and practitioners should aim to achieve such a result in association with the lower abdominal drawing in manoeuvre. |
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* In most cases this requires initial training in non-weight bearing positions using a lower abdominal drawing in manoeuvre which has been shown to selectively activate transversus abdominis. Lumbar multifidus and the pelvic floor muscles, including [[Levator Ani Muscle|pubococcygeus]], have been shown to co-contract with transversus abdominis to provide a “corset” for the [[Lumbo-Pelvic Stability|lumbo-pelvic area]][Sapsford R.[https://scholar.google.com/scholar_url?url=https://www.sciencedirect.com/science/article/pii/S0003999301283129&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=8110561141098913096&ei=gqmuY-y0GY6yyAS9hoto&scisig=AAGBfm0FtwYgHVJONB2-q759cDMzYpdvOAContraction of the pelvic floor muscles during abdominal maneuvers]。Archives of Physical Medicine and Rehabilitation. 2001; 82(8): 1081-8][Neumann P, Gill V.[https://scholar.google.com/scholar_url?url=https://link.springer.com/article/10.1007/s001920200027&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=9756079865579858284&ei=n6muY-OmC4a8yATUzZGgCg&scisig=AAGBfm3dJojS0om3O3DITXPtoX4QiIh3yQPelvic floor and abdominal muscle interaction]: EMG活动和内部——腹部的压力。IntUrogynecol J Pelvic Floor Dysfunct. 2002; 13: 125-32] and practitioners should aim to achieve such a result in association with the lower abdominal drawing in manoeuvre. |
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* Training should initially focus on quality of movement and precise isolation of the relevant core muscles which has been shown to be important in restoring normal motor control in people with LBD. |
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* Training should initially focus on quality of movement and precise isolation of the relevant core muscles which has been shown to be important in restoring normal motor control in people with LBD. |
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* Once adequate motor control of the core muscles is achieved in non-weight bearing positions, subsequent progression to [[Back Pain Functional Scale|functional]] activities can be made. Importantly this progression involves integration of the global muscles of the spine with the core muscles during specific functional exercises as well as during strength training of the trunk. |
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* Once adequate motor control of the core muscles is achieved in non-weight bearing positions, subsequent progression to [[Back Pain Functional Scale|functional]] activities can be made. Importantly this progression involves integration of the global muscles of the spine with the core muscles during specific functional exercises as well as during strength training of the trunk. |
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* There is emerging evidence that functional retraining of normal [[Lumbosacral Biomechanics|lumbo-pelvic kinematics]] can improve motor control and clinical outcomes[Dankaerts W, O'Sullivan P. The validity of O'Sullivan's classification system (CS) for a sub-group of NS-CLBP with motor control impairment (MCI): Overview of a series of studies and review of the literature. Man Ther. 2010] and these methods should also be considered during functional motor control exercises. |
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* There is emerging evidence that functional retraining of normal [[Lumbosacral Biomechanics|lumbo-pelvic kinematics]] can improve motor control and clinical outcomes[Dankaerts W, O'Sullivan P.[https://www.sciencedirect.com/science/article/abs/pii/S1356689X10001839The validity of O'Sullivan's classification system (CS) for a sub-group of NS-CLBP with motor control impairment (MCI):]Overview of a series of studies and review of the literature. Man Ther. 2010] and these methods should also be considered during functional motor control exercises. |
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== Assessment == |
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== Assessment == |
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ASIS=[[Pelvic Landmarks|anterior superior iliac spine]] ^MVC=maximal voluntary contraction |
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ASIS=[[Pelvic Landmarks|anterior superior iliac spine]] ^MVC=maximal voluntary contraction |
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“图5:初始非负重运动控制rol training strategies'''
Adequate relaxation of the global muscles, eg rectus abdominis, external obliques and [[Erector_Spinae|erector spinae]], is required before attempting to contract the core stability muscles. Patients with maladaptive motor control strategies commonly demonstrate a dominance of the global muscles during functional tasks and at rest. In retraining a normal motor control pattern, adequate relaxation is an important first step in inhibiting tone of the global muscles, thereby allowing a more isolated contraction of the core muscles.[Richardson C, Jull G, Hodges P. Therapeutic exercise for lumbopelvic stabilisation: a motor control approach for the treatment and prevention of low back pain. Edinburgh: Churchill Livingstone; 2004] In attaining a relaxed state, a neutral spine position should also be encouraged, as this appears to improve activation of the core muscles.[O'Sullivan P, Dankaerts W, Burnett A, Farrell G, Jefford E, Naylor C, et al. Effect of different upright sitting postures on spinal-pelvic curvature and trunk muscle activation in a pain-free population. Spine. 2006; 31(19): E707-12] |
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“图5:初始非负重运动控制rol training strategies'''
Adequate relaxation of the global muscles, eg rectus abdominis, external obliques and [[Erector_Spinae|erector spinae]], is required before attempting to contract the core stability muscles. Patients with maladaptive motor control strategies commonly demonstrate a dominance of the global muscles during functional tasks and at rest. In retraining a normal motor control pattern, adequate relaxation is an important first step in inhibiting tone of the global muscles, thereby allowing a more isolated contraction of the core muscles.[Richardson C, Jull G, Hodges P.[https://scholar.google.com/scholar_url?url=http://125.212.201.8:6008/handle/DHKTYTHD_123/7945&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=16674606697935355322&ei=86muY7KcH8SYywTZh5fgCg&scisig=AAGBfm0RxzM-OEOlI1b1jJbFc5OycyhLaQTherapeutic exercise for lumbopelvic stabilisation:]a motor control approach for the treatment and prevention of low back pain. Edinburgh: Churchill Livingstone; 2004] In attaining a relaxed state, a neutral spine position should also be encouraged, as this appears to improve activation of the core muscles.[O'Sullivan P, Dankaerts W, Burnett A, Farrell G, Jefford E, Naylor C, et al.[https://scholar.google.com/scholar_url?url=https://journals.lww.com/spinejournal/FullText/2006/09010/Effect_of_Different_Upright_Sitting_Postures_on.24.aspx&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=5342507675684379242&ei=DqquY7ubCoa8yATUzZGgCg&scisig=AAGBfm3FfTDp-wy9I4EDN2cwtziP-HHG2Q影响不同的直立姿势坐在spinal-pelvic curvature and trunk muscle activation in a pain-free population.]Spine. 2006; 31(19): E707-12] |
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# An instruction to “draw the lower abdomen in towards the spine” should be used consistent with the developers of the abdominal drawing in method. |
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# An instruction to “draw the lower abdomen in towards the spine” should be used consistent with the developers of the abdominal drawing in method. |
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# In addition to these standard instructions, the terms “slowly” and “gently” can be added to emphasise the sub-maximal nature of the contraction.[Hides J, Scott Q, Jull G, Richardson C. A clinical palpation test to check the activation of the deep stabilizing muscles of the lumbar spine. International SportMed Journal. 2000; 1(4)] |
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# In addition to these standard instructions, the terms “slowly” and “gently” can be added to emphasise the sub-maximal nature of the contraction.[Hides J, Scott Q, Jull G, Richardson C.[https://scholar.google.com/scholar_url?url=https://journals.co.za/doi/abs/10.10520/EJC48442&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=9265937931300231701&ei=J6quY9fnMY6yyAS9hoto&scisig=AAGBfm3TzNy7aqjRLkQIlZ9s8Spd1QrYcAA clinical palpation test to check the activation of the deep stabilizing muscles of the lumbar spine.]International SportMed Journal. 2000; 1(4)] |
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# Tactile cues to the lower abdomen should be used in conjunction with verbal cues to provide additional emphasis on a lower rather than more general drawing in of the abdomen. |
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# Tactile cues to the lower abdomen should be used in conjunction with verbal cues to provide additional emphasis on a lower rather than more general drawing in of the abdomen. |
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#非负重部位应选择in the position where best activation of transversus abdominis is observed,[Hides J, Stanton W, Wilson S, Freke M, McMahon S, Sims K. Retraining motor control of abdominal muscles among elite cricketers with low back pain. Scandinavian Journal of Medicine & Science in Sports. 2010; 20(6): 834-42] however side lying is commonly the optimal position for initial retraining[Hides J, Stanton W, Wilson S, Freke M, McMahon S, Sims K. Retraining motor control of abdominal muscles among elite cricketers with low back pain. Scandinavian Journal of Medicine & Science in Sports. 2010; 20(6): 834-42] due to ease of obtaining relaxation of the global muscles and an improved length tension relationship in transversus abdominis compared to other positions (eg supine or crook lying). |
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#非负重部位应选择in the position where best activation of transversus abdominis is observed,[Hides J, Stanton W, Wilson S, Freke M, McMahon S, Sims K.[https://scholar.google.com/scholar_url?url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0838.2009.01019.x&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=8142443811086389917&ei=RKquY7ekKtLAywSsrIVo&scisig=AAGBfm2Z5NHyt5otzNfpB_pI7DeILI7Y3wRetraining motor control of abdominal muscles among elite cricketers with low back pain]。Scandinavian Journal of Medicine & Science in Sports. 2010; 20(6): 834-42] however side lying is commonly the optimal position for initial retraining[Hides J, Stanton W, Wilson S, Freke M, McMahon S, Sims K.[https://scholar.google.com/scholar_url?url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0838.2009.01019.x&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=8142443811086389917&ei=YaquY_feI5CXywSwqaaIDw&scisig=AAGBfm2Z5NHyt5otzNfpB_pI7DeILI7Y3wRetraining motor control of abdominal muscles among elite cricketers with low back pain.]Scandinavian Journal of Medicine & Science in Sports. 2010; 20(6): 834-42] due to ease of obtaining relaxation of the global muscles and an improved length tension relationship in transversus abdominis compared to other positions (eg supine or crook lying). |
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Palpation |
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Palpation |
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'''Figure 6: Activation and facilitation of transversus abdominis, lumbar multifidus and pelvic floor motor control''' |
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'''Figure 6: Activation and facilitation of transversus abdominis, lumbar multifidus and pelvic floor motor control''' |
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In patients where transversus abdominis is difficult to isolate, activation was facilitated by an initial focus on the pelvic floor and/or lumbar multifidus.[Critchley D. Instructing pelvic floor contraction facilitates transversus abdominis thickness increase during low-abdominal hollowing. Physiother Res Int. 2002; 7(2): 65-75] In such cases the strategies listed in Figure 6 are applied and co-contraction of transversus abdominis is concurrently monitored. In the event of co-contraction occurring, the patient should be encouraged to focus on awareness of simultaneous activation of transversus abdominis as well as the pelvic floor and/or lumbar multifidus. The pelvic floor instructions aim to illustrate the anatomy of the region and provide guidance in performing a submaximal isotonic contraction. The multifidus instructions aim to provide guidance in performing a submaximal isometric contraction. If necessary, multifidus can be facilitated by provision of kinaesthetic feedback to the patient with an initial isotonic contraction, followed by an attempt to transfer this awareness to the required isometric contraction. |
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In patients where transversus abdominis is difficult to isolate, activation was facilitated by an initial focus on the pelvic floor and/or lumbar multifidus.[Critchley D.[https://scholar.google.com/scholar_url?url=https://onlinelibrary.wiley.com/doi/abs/10.1002/pri.243&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=5297425251596789190&ei=i6quY_e8OpCXywSwqaaIDw&scisig=AAGBfm0vCaCvQT-esd7eA0lZ6zLrrhhoCwInstructing pelvic floor contraction facilitates transversus abdominis thickness increase during low-abdominal hollowing]。Physiother Res Int. 2002; 7(2): 65-75] In such cases the strategies listed in Figure 6 are applied and co-contraction of transversus abdominis is concurrently monitored. In the event of co-contraction occurring, the patient should be encouraged to focus on awareness of simultaneous activation of transversus abdominis as well as the pelvic floor and/or lumbar multifidus. The pelvic floor instructions aim to illustrate the anatomy of the region and provide guidance in performing a submaximal isotonic contraction. The multifidus instructions aim to provide guidance in performing a submaximal isometric contraction. If necessary, multifidus can be facilitated by provision of kinaesthetic feedback to the patient with an initial isotonic contraction, followed by an attempt to transfer this awareness to the required isometric contraction. |
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[[File:Abdominal curl-CDC strength training for older adults.gif|right|frameless]] |
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During all motor control training the patient should be encouraged to develop a kinaesthetic awareness of the correct motor pattern. This is important in order for the patient to have some form of proprioceptive feedback regarding correct performance of the exercises when practising between sessions. Subsequently during the treatment program, adequate kinaesthetic awareness of normal motor control is also required for transference into more functional and demanding exercises/activities. Due to the effect of even low force postural perturbation in initiating maladaptive motor patterns, patients should be instructed not to self palpate as means of providing feedback on exercise performance until more consistent motor control skills are demonstrated. Self palpation can also focus the patient on tone rather than the primary goal of an isolated drawing in of the lower abdomen. |
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During all motor control training the patient should be encouraged to develop a kinaesthetic awareness of the correct motor pattern. This is important in order for the patient to have some form of proprioceptive feedback regarding correct performance of the exercises when practising between sessions. Subsequently during the treatment program, adequate kinaesthetic awareness of normal motor control is also required for transference into more functional and demanding exercises/activities. Due to the effect of even low force postural perturbation in initiating maladaptive motor patterns, patients should be instructed not to self palpate as means of providing feedback on exercise performance until more consistent motor control skills are demonstrated. Self palpation can also focus the patient on tone rather than the primary goal of an isolated drawing in of the lower abdomen. |