Wednesday, July 19, 2006

Lower Abs, Lower Schmabs...

My recent post on how my fellow physical therapists focus on "magic muscles" and fear full ROM work at the knee and shoulder, reminded me of a humorous encounter I had a few months ago with some first year Wash U DPT students. My friend Cindi works at Wash U, coordinating research in diet & exercise and has students who help with their studies. When the students found out I was an alum, the first words out of their mouths were:

"What are your low abs?"

I said, "Why they are 5/5 of course!" 5/5 in physical therapy-ese means normal strength.

I stifled a laugh. They had obviously just been introduced to Shirley Sahrmann's low ab testing and progression and they were giddy with the challenge it presented. Now, I have learned much from Shirley and I respect her immensely; but to be perfectly honest, I have not done a low abdominal test on ANYONE in probably 4-5 years. Why? In my mind, back patients--and really anyone--need HIP/LUMBAR SPINE & TOTA BODY AWARENESS and LOWER EXTREMITY FLEXIBILITY with squatting/sit-to-stand type movements a hell of a lot more than they need to zero in on some deep abdominal muscle contractions.

Yes, they need to "brace"--but they need to learn to do it while they are moving in the context of gravity. They need to learn how to move. MOVE. CREATE GROUND-BASED FORCES AND ATTENUATE THEM. Bend their hips, knees and ankles without flexing their spine as they heave themselves about in their daily activities. Learning how to move and gaining lower extremity flexibility is much more protective for back health than simply focusing on your TA or your external obiques.

It is not just about one muscle group. Not even the hip abductors. It is about knowing your body and moving well.

Recently, I watched a person who is under the care of a prominent Wash U therapist. Back pain, cortisone shots--the whole nine yards. I happen to be working with this person's spouse on strength & conditioning stuff. Do you know what I saw? I watched the back pain patient, who was obviously intimidated by some of the simple walking lunges and other work the spouse was doing, use the WORST BODY MECHANICS IN THE WORLD to pick something up off the floor. She used ALL LUMBAR FLEXION to stoop down.

It killed me. Here was this person who was suffering from back pain--getting care from one of the top rated medical and physical therapy institutions in the country--and not one damn health care professional had taught her how to move so she can protect her back from further injury and strengthen/mobilize the structures around it.

Low abs, low schmabs. Know your ENTIRE body. Move well--on your feet, within the context of gravity. Be strong.

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