Writing a systematic review was something I just finished while pursuing my advanced training in Australia. “The effectiveness of a sport-specific conditioning program in athletes with hamstring injuries: A systematic review of the literature.” That I am waiting to hear back to see where it will be published.
I am from the US and trained in the US originally as a physio. The four horseman(QL/multifidi/TvA/Ext obliques) are in ALL of the research that I have studied and continue to study and review and learn.
The work by Paul Hodges, PT has shown individuals with LBP, that the TvA becomes inactive or does not fire efficiently not performing its stabilizing role. Diane Lee, PT has shown that the QL is the tightest and weakest muscle in the lower lumbar.
Peter O’Sullivan, PT has shown that the TvA and multifidi work together with lumbar and other injuries..
So fuel the movement or as I say “Understand the Science Behind The Movement”
I am conducting a systematic review of physical fitness exercise to activate the core musculature which should offer some insight into this topic and provide a foundation for exercise prescription in determining intensity. However, the target population in asymptomatic adults.
Shooting for publication in Summer 2012.
“Few personal trainers have taken courses in human movement science, as the US is far behind compared to Australia.”
I am not sure where you are from, but the US and Fitness is still a baby with pacifier. Human movement science hah – we don’t even have basic anatomy or even CPR training. There are no education requirements for the field. Hopefully shifting in the future – however you never know with the large lobbying organizations fighting against it.
Fuel The Movement,
It is good to hear that you are interested in learning more. First, I did try to answer your questions, and will try another approach. The ONLY way to 100% verify that a disc is herniated is via a MRI or contrast film that shows such detail. If someone has LBP and leg pain that shoots or has numbness and tingling compared to someone who is without LBP and has the same symptoms, both individuals could have a herniated disc.
Second, most fitness professionals do not really know the importance of the multifidi and where it is located, so I was just reeducating on the obvious to paint a picture. If someone has poor body awareness it still begins with teaching the client how to find neutral spine, how to contact their TVA and then the multifidi. This is the essence of static not dynamic lumbo-pelvic stabilization training.
Few personal trainers have taken courses in human movement science, as the US is far behind compared to Australia. Where Human Movement degrees take place Kinesiology degrees and go in great detail down under.
So to summarize, it begins with a proper assessment after a thorough history which I am sure you are aware of since you were a nurse. Then proper exercise prescription to target the clients’ weak links while helping them achieve their specific goals. But there is not one unique way to begin teaching a client how to strengthen their core except to begin with the basics. Because all individuals have different somatotypes, physical conditioning, different or multiple injuries, age, different jobs, etc.
That is why with I always assess a patient’s ability to contract their TVA, know how to find neutral spine and now really how to properly contract their multifidi.
Chris, I understand both your points, neither answered my questions:
I know the only way to confirm a herniated disc is an MRI, if someone has no symptoms why would he or she have an MRI? So how would you know the disc was herniated? (Unless of course it was for an unrelated or very old problem).
My second question (and I am an RN, as well as a long time trainer with several certifications so I know where the multifidi are) is: How do you train someone to contract the multifidi when they have no body awareness, and cannot even contract the biceps at will? I was looking for teaching tips for such a client, not where the muscle group is.
(and I have taken many courses in human movement science over the years, but am always interested in learning more, so will check yours out, thanks)
The only way to truly confirm that someone has a herniated disc is by an MRI. The old school approach was using a technique called myelogram where they would inject die and watch it on a screen to see if there was a disc injury.
The new MRI and MRAs have such high contrast they are effective with showing everything. Soft tissue, bone, ligaments, tendons, etc. However, MRI’s also are know to miss things as well.
To target the multifidi, you must first know where it is. Anatomically the multifidi consists of a number of fleshy and tendinous fasciculi, which fill up the groove on either side of the spinous processes of the vertebrae, from the sacrum to the axis. The multifidus is a very thin muscle.
As stated previously to target and contract the multifidi properly, the client or patient has to be prone, be educated to “turn on” and isolate the multifidi first before engaging the glutes or hamstrings with the opposite leg exercise. This is done by palpating along lateral to the S.P. just above the Transverse process(TP) and asking and cuing the client to first contract the multifidi then the glutes and hamstrings. This is correct order and technique! This is also based on the literature and research…
You really should look at our human movement course as we go into great detail about this and it will totally open you eyes to understanding the synergisitic interaction with how human movement occurs, how to assess both static and dynamically, how common movement dysfunctions occur and how to train clients’ post therapy based on evidenced based research with practical application.
“Teaching The Scicence Behind The Movement”
“Synergy of Human Movement” level I course