http://www.jospt.org/garrytallison Wed, 30 Apr 2008 09:05:25 EST 0 http://www.jospt.org/issues/articleID.1372/article_detail.asp STUDY DESIGN: Experimental laboratory study supplemented with a repeated case study. OBJECTIVE: To examine bilateral muscle activity of the deep abdominals in response to rapid arm raising, specifically to examine the laterality and directional specificity of feedforward responses of the transversus abdominis (TrA). BACKGROUND: Based on the feedforward responses of trunk muscles during rapid arm movements, authors have concluded that the deep trunk muscles have different control mechanisms compared to the more superficial muscles. It has been proposed that deep trunk muscles such as TrA contribute substantially to the stability of the lumbar spine and that this is achieved through simultaneous bilateral feedforward activation. These inferences are based on unilateral fine-wire electromyographic (EMG) data and there are limited investigations of bilateral responses of the TrA during unilateral arm raising. METHODS AND MEASURES: Bilateral fine-wire and surface EMG data from the anterior deltoid, TrA, obliquus internus (OI), obliquus externus, biceps femoris, erector spinae, and rectus abdominis during repeated arm raises were recorded at 2kHz. EMG signal linear envelopes were synchronized to the onset of the anterior deltoid. A feedforward window was defined as the period up to 50 ms after the onset of the anterior deltoid, and paired onsets for bilateral muscles were plotted for both left and right arm movements. RESULTS: Trunk muscles from the group data demonstrated differences between sides (laterality), which were systematically altered when alternate arms were raised (directional specificity). This was clearly evident for the TrA but less obvious for the erector spinae. The ipsilateral biceps femoris and obliquus externus, and contralateral OI and TrA, were activated earlier than the alternate side for both right and left arm movements. This was a consistent pattern over a 7-year period for the case study. Data for the rectus abdominis derived from the case study demonstrated little laterality or directionally specific response. CONCLUSION: This is the first study to show that the feedforward activity of the TrA is specific to the direction of arm movement and not bilaterally symmetrical. The asymmetry of TrA activity during arm raising suggests that the interpretation of the role of TrA as a bilateral stabilizer during anticipatory postural adjustments needs to be revised. Future research needs to examine muscle synergies associated with the asymmetrical function of the TrA and the underlying mechanism associated with low-load stability training. LEVEL OF EVIDENCE: Therapy, level 5.J Orthop Sports Phys Ther. 2008;38(5):228-237, published online 14 December 2007. doi:10.2519/jospt.2008.2703KEY WORDS: abdominal muscles, anticipatory postural adjustments, low back pain, motor control http://www.jospt.org/issues/articleID.1372/article_detail.asp http://www.jospt.org/issues/articleID.1241/article_detail.asp Teaching is a great skill that underlies many hands-on professions and is grounded by effective communication. One quality of successful teachers is the ability to impart to the student the need to consider the weight of evidence and to see the possibility of alternative explanations for what we observe on a daily basis. The physical therapy profession has many individuals who posess these attributes as teachers, clinicians, and researchers. Individuals who are new to the profession should strive to keep up with the latest and best theories and yet always be willing to examine the potential of alternative explanations. It is this type of reasoning that will further the individual and the profession reflected in great teaching, quality clinical practice, and research breakthroughs.J Orthop Sports Phys Ther. 1007; 37(4):153-154. doi:10.2519/jospt.2007.0104 http://www.jospt.org/issues/articleID.1241/article_detail.asp http://www.jospt.org/issues/articleID.604/article_detail.asp The efficacy of specific exercise interventions that advocate training the co-contraction of the deep abdominal muscles with lumbar multifidus for treating chronic back pain conditions has not been tested. A randomized controlled trial involving 42 subjects with a specific chronic back pain condition investigated whether this form of intervention results in changes to the ratio of activation of the internal oblique relative to the rectus abdominis. Data were collected before and after the intervention, using surface electromyography, while subjects performed different abdominal maneuvers. Subjects were randomly allocated to either a specific exercise group or control group. Following intervention, the specific exercise group showed a significant (p Key Words: abdominal muscles, exercise, low back pain http://www.jospt.org/issues/articleID.604/article_detail.asp http://www.jospt.org/issues/articleID.1181/article_detail.asp Study Design: Prospective cohort study.Objectives: To classify patients with nonacute, nontraumatic neck pain according to the dominant impairment of spinal function, and to determine whether there were differences in the amount of treatment sessions required (treatment dose) to achieve a significant change in the patient’s disorder.Background: Classification of patients with mechanical neck pain may be an important process in optimizing treatment prescription and evaluating treatment response. However, patient classification has not been used to consider possible differences in the amount of treatment sessions (treatment dose) required to achieve a significant change in the neck pain disorder.Methods and Measures: Ninety-two patients with nonacute, nontraumatic neck pain were classified into 2 groups, according to the dominant impairment of spinal function. Of the 77 patients who completed treatment, 63 (82%) were classified as having a ’’movement disorder,’’ while the remainder was classified into a ’’loading disorder’’ group. Physical therapists who were blinded to the patient classification provided multimodal physical therapy treatment as considered appropriate and the patients were discharged when the optimal treatment response had been achieved.Results: There was no difference in pain intensity or global disability level between the groups at baseline. Both groups achieved a significant improvement in neck pain and disability following treatment, and there was no significant difference between groups in the magnitude of the treatment response. The number of treatment sessions received by the loading group (mean ± SD, 7.3 ± 4.5) was significantly lower than the number received by the movement group (mean ± SD, 11.5 ± 5.9; 95% CI: –7.6 to –0.8; PConclusion: For patients with nontraumatic neck pain, classification according to impairment of spinal function may be a useful indicator of the number of physical therapy treatment sessions required to achieve a significant treatment response. J Orthop Sports Phys Ther. 2006; 36(11):867-875. doi:10.2519/jospt.2006.2299Key Words: classification, neck pain, physical therapy, treatment dose http://www.jospt.org/issues/articleID.1181/article_detail.asp