Sunday, September 21, 2008

Reflections on My Visit to the Mothership

Paul Hodges was a terrific speaker. The dude presented 5 different times over 2 days. I'm sure he was exhausted. I didn't get a chance to ask, but I'm almost sure he was a Presentation Zen guy, as his supporting AV material was beautiful, but simple. He is not a pure TrA (transverse abdominis) guy, as I thought he was going to be. As is want to happen, many people have taken his work to the extreme. He appreciates quality of movement and knows that neither the multifidus nor the TrA are solely responsible for chronic back pain and dysfunction. He understands that a variety of movement strategies are optimal for maintaining musculoskeletal health. But he did kinda go after the general idea of "bracing" that is now embraced by the fitness/therapy/performance world.

I spoke with him briefly after Saturday's session to try and get better idea of the motor control training protocols that his group used in comparison to a general exercise group, but our conversation was brief; it was clear he and Linda Van Dillen and Co. were exhausted and ready for dinner. What exactly was the general exercise protocol used? Are there specific exercises/movement strategies that facilitate torso control or the elimination of LBP? I do know that he is on my side when it comes to treatment of back pain, and is working hard to provide supporting evidence to the work comp and psych docs that purposeful rehabilitation is a worthwhile endeavor for most subgroups of chronic back pain patients. I understand it is much easier to quantify results when you control the variables and reduce the question to specific muscles/muscle groups. But it is a bit hard for me to stomach (pun intended) when so much of the work is done out of the context of moving (lower extremities), in a gravity-mediated environment. Beautiful data doesn't necessarily mean it is meaningful in the real world. And Hodges does understand that.

Shirley was the final speaker of the day and she was a trip. The focus of her talk was on abdominal musculature as the root of some issues in her patient population. I was disappointed she didn't talk more about the impact the rest of the body and movement strategies might have on back pain, but she touched on it. It is fascinating to think that she is still in the clinic and seeing patients on a daily basis. She received her PT degree 50 years ago, in 1958, and still bases much of her world view on the work of her friend, Florence Kendall. That said, she is constantly learning and keeping an open mind when presented with good evidence. Even better, Shirley has really improved her own fitness, diet and health over the last 10 years; and she is extremely worried about the problem of general fitness in our country. Now, I just have to find the opportunity to pick her brain about some of my ideas about preventing acute back issues.

It was somewhat amusing to see the juxtaposition of presentation styles and subject matter this weekend. We went from the most progressive use of current presentation technology and experimentation to the most basic use of observation skills with supporting still images from Florence Kendall's initial work. For sure, one must have an appreciation and understanding of the past to make the most of the current technology and information.

So my journey to the Mothership was a good one. I had the opportunity to hear three wonderful physical therapists speak and see several classmates and former instructors. I do think the Mothership is a little too isolated in its little ivory tower sometimes; they need to get out more and see what the rest of the world is doing, or at least invite more of the rest of the world inside. Yes, you have bright students, wonderful faculty that accumulate NIH grants, and a great program that encourages critical thinking, but there is an attitude of superiority by students and some faculty that can be incredibly off-putting to those of us now in the real world. I know it is a struggle to keep the program well-funded and that Wash U must keep up a constant PR campaign to compete against other programs in the country, but the "We're Awesome" gets a little old after a while. Student loan debt certainly contributes to making one cranky and cynical after a few years.


Garry said...

Was there anything interesting on the subject of shoulder mobility?

Seeing the sudden, dramatic loss of my father's shoulder mobility and strength about five years ago (and the general collapse of his fitness and health that followed) has made me acutely interested in the shoulders.

Great blog.

The Iron Maven said...


Sorry to say, not one word on the shoulder. It was all abs. Not even any real talk about hips, except with regard to a little discussion of hip rotation and some hip flexor/ITB stuff.



Kim said...

I've had LBP since I was 16 years old. Since I started doing air squats properly my chronic pain has gone away. I've not thought about the TrA and Multifidus in quite some time. Reading your post was like visiting with a frenemy!