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The Truth About Transversus: Clinical Application of the Research.
Myths and Misconceptions about Psoas Major: Where is the evidence?
Trapezius: Clearing up the confusion!
For Full details please contact PhysioUK
Transversus Abdominis (TrA) is probably the most discussed and most misunderstood muscle in the therapeutic rehab and fitness industry today. Training this magic muscle of the new millennium can apparently do everything from curing back pain to making world peace. It now seems that physiotherapists, rehab professionals, gym instructors and even music teachers are advising their clients about this muscle. There is hardly any activity or exercise where some form of TrA activation has not been incorporated.
There is very strong evidence of specific deficiencies in the recruitment of TrA (and other local stabiliser muscles) associated with pain, and especially with chronicity and recurrence of musculo-skeletal pain. Teaching someone to activate their TrA is incredibly easy, however merely activating or strengthening this muscle does not correct the real changes associated with pain. Understanding and correcting the pain related changes in TrA is a little more challenging.
Mark Comerford's lecture reviews some of the research evidence behind TrA and examines current trends in TrA training. It challenges some of the myths and misconceptions that currently exist and makes some suggestions for more appropriate application of TrA training based on the current research evidence.
His presentation attempts to answer some very relevant questions:
What changes occur in muscles like TrA when pathology is present?
Does the change cause pathology ... or does pathology cause the change?
Is ‘pain inhibition’ really the problem?
What is feedforward ... and what happens to function when it is abnormal?
How does recruitment threshold influence real functional movement?
Is there any real weakness of local muscles?
Are they ‘off’ in the presence of pain?
How can we tell whether the problem is muscle atrophy (weakness) or altered recruitment?
Should the clinical emphasis be on highly specific non-functional exercise strategies ...or should our priority be on functional strengthening?
What can we do to recover the real changes in muscle neurophysiology?
How can we apply this clinically?
Should rehab start with local or global muscle retraining?
How do we progress low threshold training? ... Adding load is not an appropriate progression for local muscle training!
How do we progress high threshold training?
Do we really need to ‘integrate into function’ at all ...and if so, what is appropriate & relevant?
Is there any benefit in ‘pre-setting’ or holding transversus active in function?Is there any benefit in ‘pre-setting’ or holding transversus active loaded exercise e.g. Pilates or gym based weight training Should local muscles be trained as a pain prevention measure?
Being able to answer these questions should improve your exercise retraining options and increase your professional efficiency.
Psoas is not an effective hip flexor
There is almost no evidence for psoas being short
It does not produce anterior tilt of the pelvis (instead it produces posterior tilt)
It does not produce significant movement in the spine
It has a significant stability role for the lumbar spine, the sacro-iliac joint and the hip
It is inhibited in the presence of pain
It is easily retrained
This presentation details a process for reviewing muscle function and dysfunction based on analysis of:
1. muscle structure and anatomy
2. biomechanical potential
3. neurophysiology of muscle recruitment
4. evidence of consistent changes related to pathological states
Muscle functional roles are defined in terms of local or global motor recruitment and in terms of potential for stabiliser or mobiliser function.
Psoas major has more than one functional role. It is a multi-tasking muscle and the evidence to support the ‘real’ functional roles of psoas major at the lumbar spine, the sacro-iliac joint and the hip joint are detailed. Strategies for retraining psoas function are presented.
Psoas has been convicted of crimes against stability on circumstantial evidence. The case against it has been reviewed it has been cleared of all charges.
Come along and get the latest evidence on this controversial muscle and find out about its real function!
The trapezius muscle has 3 functionally distinct divisions:
1. the upper (clavicular) fibres
2. the middle fibres
3. the lower fibres
The functions attributed to these divisions of trapezius in most of the current anatomy text books are at least 25 years out of date. This presentation will bring you up to date and challenge some accepted (but incorrect) ‘facts’.
Upper Trapezius cannot elevate the scapula above neutral
Upper Trapezius is rarely ‘short’ – it is usually excessively elongated in most people with mechanical neck or shoulder pain. We need to shorten it – not stretch it.
Upper Trapezius is not excessively overactive in people with neck and shoulder pain - and it needs to increase recruitment to manage recurrent pain. Most EMG studies that demonstrate this ‘overactivity’ have a common flaw in methodology
Upper Trapezius has similar neurophysiology to Transversus Abdominis and Segmental Lumbar Multifidus (normally has an anticipatory timing pattern and is delayed with pain)
Upper Trapezius has a similar biomechanical model to Transversus Abdominis (bilateral activation in the background of all functional movements tensions a fascial structure to control intersegmental vertebral displacement)
Upper Trapezius also experiences sudden decreases in muscle volume in response to pain similar to Segmental Lumbar Multifidus
Lower Trapezius does not pull the inferior angle of the scapula down and in. It’s activation moves the inferior angle laterally and the moves acromion superiorly producing upward rotation of the scapula
This presentation details a process for reviewing muscle function and dysfunction based on analysis of:
1. muscle structure and anatomy
2. biomechanical potential
3. neurophysiology of muscle recruitment
4. evidence of consistent changes related to pathological states
Muscle functional roles are defined in terms of local or global motor recruitment and in terms of potential for stabiliser or mobiliser function.
There is almost no reliable evidence supporting a role as a global mobiliser. It has a major stability influence on the neck, shoulder and thoracic spine Upper Trapezius has more than one functional role. It is a multi-tasking muscle and the evidence to support the ‘real’ functional roles of Upper Trapezius at the cervical spine, the shoulder girdle and the thoracic spine are detailed. Strategies for retraining upper, middle and lower trapezius function are presented.
Come along and get the latest evidence on this controversial muscle and find out about its real function!