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 Hodges research on Transverse

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PostSubject: Hodges research on Transverse   Fri May 22, 2009 4:49 am

Transversus abdominis: a different view of the elephant
Paul Hodges
Accepted 11 November 2008
It is good to see that clinical and research hypotheses are debated in the literature. The purpose of science is to challenge ideas and to consider alternative interpretations of observations. Within this, the place for neurophysiological/biomechanical studies in clinical research is not to predict the potential efficacy of a clinical approach, but to try to understand the mechanisms that underlie it. This is helpful as it provides a means to refine, improve, and direct intervention and provides a platform to develop rationales for intervention, particularly when we are faced with complex patients who do not fit the clinical prediction rule or the narrow criteria adopted for inclusion in clinical trials. If we understand the mechanisms we have a powerful tool to rationalise and test interventions. The developing debate about the role of transversus abdominis is healthy for rational consideration of motor control interventions for back pain.
I welcome this opportunity to comment on the opinions and interpretations of Allison et al1 and Cook.2 As indicated by Allison et al in their paper published in JOSPT,3 it is not the data that are questioned; it is the interpretation. It seems that we have a recurrence of the issue of the six blind men and the elephant, where we see the same animal, but from different perspectives, and draw different conclusions. There are a number of assumptions that require consideration to challenge the interpretation of Allison et al1 and the opinion of Cook.2 A key issue is that to conclude that a single observation from a single task refutes the conclusion of a whole range of different methodologies/tasks seems unfounded.

THE CHALLENGE FOR THE FUTURE
In summary, the data provided by Allison et al1 add richness to our understanding of the control of the deep muscles and ultimately the control of the trunk. As highlighted above, the data do not refute the original hypotheses of the role of transversus abdominis in trunk control; in fact, they are very congruent with the evolution of our understanding of the function of the deep muscles. The basic observations from the early studies that were conducted 15 years ago provided a starting point.25 The subsequent data have shaped and evolved the interpretation. We all agree that clinical practice often adopts research findings in a simplified and hardline approach. Allison et al’s1 data do not refute the viability and potential efficacy of the approach. Current literature suggests that the clinical application of the findings is beneficial. In an ideal world the experimental testing of an idea would be completed and all issues resolved and understood before implementation into practice, but this is not practical as nothing would ever be implemented. And, after all, research that has a clinical application must be done in an iterative manner with communication back and forth between clinicians and researchers. In that way clinical practice can inform research and research can be accurately implemented into practice. The challenge for us all is to keep our blinkers off and keep an open mind when looking at our data and looking at patients so that we have a chance to move forward.


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