SMT-3 Manual, pgs 9-48 Flashcards
511: According to Mew 2009 when is TrA, IO and EO most active?
511: TrA in ab hollowing in standing. IO and EO in ab hollowing in crook lying
512: How did Hodges et al link TrA : ?
512: TrA connected to thracolumbar fascia sometimes even absent or fused to IO, but no correlation w/ LBP has been shown.
513: What did Fast et all 1990 find relating to pregnancy and TrA?
513: 16% of pregnant women cannot do a sit up, but no correlation between sit up and back pain.
514: What did Gileard and Brown 1996 find relating to post partum and TrA?
514: It takes 4-6 weeks to reverse ab muscle length postpartum. 635/869 (73%) postpartum back pain resolves after 1 week.
515: TrA and obesity?
515: Leboefyde 2000 epidemiological studies weak association w/ LBP.
516: Ab muscles post surgery and LBP?
516: Simon et all 2004 no relationship between surgery and LBP or level of function even years after surgery.
Berlinier 1983 no link between hernia repair which is a surgery know to affect TrA and LBP.
517: Who measured TrA, IO,EO, SM and ant/ med/ post deltoid?
517: Hodges & Richardson 1996.
518: When was the most significant delay?
518: 50-450 ms
519: What is normal TrA contraction?
519: 30 ms feed forward
520: Did the TrA contract in all 3 directions?
520: No, failed to prepared spine. TrA fired after the movement.
521: What were TrA timing measures in other studies?
521: 20 ms, 1/50th of a second
522: What about the IO, EO and RA?
522: All delayed onset but only with specific arm movements.
523: What did Hodges & Richardson 1998 change in methods of TrA timing?
523: LE flexion, extension and abduction
524: What was normal timing?
524: TrA preceded RF by 110 ms, pts with LBP the onset of TrA followed prime movers RF, TFL and glut max by several 100ms.
525: What did Richardson et al 1999 test in quads?
525: reflex inhibition
526: What is reflex inhibition?
526: RI produces decreased activation level of alpha motor neuron pool at the ventral horn- delayed muscle activation as a result of increased time taken by motor neurons to reach threshold for activation.
527: How did Richardson et al 1999 test RI in quads?
527: Fluid of 25 cc in knee joint causes RI of VMO.
Fluid of 55 cc in knee joint causes RI of entire quad.
RI linked to joint effusion, pain, ligament stretch and capsular compression.
528: How does this effect RI?
528: Lowering the excitability of the alpha motor neuron pool.
529: What did Stokes and Young 1984 feel the reduction of alpha motor neuron excitability is due to?
529: Afferent discharge from joint structure.
530: Does the TrA involve a joint structure?
530: No, therefore RI likely does not affect TrA.
531: What could the changes be related to?
531: 1. in response to anticipated pain
2. in response to experimental pain
3. issue w/motor planning
532: Who demonstrated altered timing with experimental pain?
532: Hodges & Moseley 2003
533: How did they demonstrate altered timing of TrA and LM?
533: Pain free subjects were shocked to the back that were unpredictable to time and amplitude. Even the fear of the pain caused a delay.
534: Who used transcranial magnetic stimulation to show the effect of delayed TrA in the brain?
534: Tsao 2008 changes from vertex at cortical level.
535: When and what other muscles were measured?
535: Tsao 2011- LM and longissimus erector spinae
536: Who looked at cortical somatosensory cortex spreading?
536: Flor et al 1997
537: How did they measure?
537:
538: Has any study to date demonstrated that core stab exs reset timing issues?
538: No
539: According to MacDonald, Moseley and Hodges 2007 literature review has anyone recorded TrA and LM in ab hollowing?
539: No
540: According to Marras et al 2005 when do muscles usually co contract?
540: After an injury for protection, co-contraction movements are dependent and sub-conscious.
If co-contraction is a protective pain strategy why encourage LBP pts to do it?
481: In the UK Beam Trial 2004, was there a difference in the Tx groups compared to general medical practice @ 3 & 12 Mo?
481: The SMT group showed statistically significant improvements
482: Is SMT cost effective (UK BEAM Trial 2004)?
482: Yes
483: What gives better value for $ (UK BEAM Trial 2004)?
483: Manip vs Manip + Exercise
484: What was the purpose of Giles’ & Muller’s 2003 & 2005 studies?
484: To compare medication, needle acupuncture, and SMT for managing chronic spinal pain.
485: In Giles’ & Muller’s 2003 & 2005 studies, what were the dependent variables?
485: Measured at (2, 5, and 9 wk):
1. Mod. Oswestry
2. NDI/VAS
3. Sf-36
486: In Giles’ & Muller’s 2003 & 2005 studies what intervention produced the best results?
486: SMT
487: What did Giles & Muller conclude in 2005?
487: The methods were the same as 2003 but measurements were taken at 1 yr:
If not contraindicated SMT may be the only modality, of the 3 studied, that provides broad and significant long-term benefit.
488: In Giles & Muller 2005, When were their results of dependent variables taken?
488:
At 1 year
489: What did Burton et all 2000 determine SMT is better than?
489: Chemonucleolysis. For short-term reduction of pain and disability in those with disc herniations
490: What was the purpose of Koppenhaver 2011?
490: To measure changes in lumbar multifidus (LM), TrA, & IO mm thickness in pt. with LBP after lumbar SMT.
491: What dependent variables were measured (Koppenhaver 2011)?
491: LM, TrA, IO mm thickness @ L4-5 & L5-S1 using US. Measured at rest and during sub-max contractions.
Modified Oswestery Disability Index
492: What SMT technique was used in the Koppenhaver 2011 study?
492: Chicago roll_Lumbopelvic HVLA on day 1 and 3 or 4
493: Did TrA & IO thickness decrease (Koppenhaver 2011)?
493: YES
494: When did TrA & IO thickness decrease (Koppenhaver 2011)?
494: Contracted TrA and IO mm thickness decreased immediately after SMT
495: Did LM muscle thickness increase (Koppenhaver 2011)?
495: YES
496: When did LM muscle thickness increase (Koppenhaver 2011)?
496: at either 3 or 4 days after 2nd session of SMT
497: In Koppenhaver 2011, did subjects improve ODI scores?
497: YES by an average of 26.3%
498: Where did muslce thickness changes occur in Koppenhaver 2011?
498: @ L5-S1, Only change in contracted LM thickness @ 1 week only explained 7% of variance in ODI scores.
499: What are the 6 core stability assumptions?
499:
1) Certain muscles are more important for stabilization, like the TrA
2) Weak Ab mm lead to LBP
3) Strengthening Ab or trunk mm can decrease LBP
4) There is a “unique” group of “core” muscles working independent of other trunk muscles
5) As strong core will prevent back pain
6) There is a relationship between “stability” & LBP
500: What did Leaderman 2007 say about the core phenomenon?
500: The 6 cores assumptions lead to a whole industry of pilates gyms & clinics worldwide teaching “tummy tuck” & trunk bracing for injury prevention and a cure for LBP” core stability” became a cult & “TrA” it’s montra.
501: What did Lim et al 2011 compare?
501: Pilates exercises (specific gluteal activation, pelvis stabilization, & core training TrA & multifidus) vs other forms of exercise
502: What dependent variables did Lim et al 2011 measure?
502: Pain and disability @ 6 weeks, 3, 6, & 12 mo
503: What were the results of the Lim et al 2011 study?
503: Pilates was no more effective than other types of exercise at decreasing pain and decreasing disability.
504: According to Richardson et al 1999 what muscle is most closely linked to spine segmental support?
504: LM
505: How did Richardson et al 90, 92, 99, 2000 attempt to measure TrA during abdominal hollowing?
505: With surface EMG (But the TrA is deep)
506: What 2 authors validated/proved surface EMG does not measure TrA?
506: Stokes et al 2003 & Yu Okubo et al 2010
507: What did Richardson et al 1992 find between ab hollowing & pelvic tilt exercises?
507: Hollowing or bracing is a more effective stabilization pattern than posterior pelvic tilts, But TrA was not measured and posterior pelvic tilt recruits IO & erector spine in all positions
508: Can rectus abdomens directly relate to spinal stability?
508: No, pelvic tilt is a movement correction pattern
509: What did Hodges et al 1997, 2003 say about TrA stabilization?
509: TrA is a posture stabilizer in synergy w/ every other abdominal muscle
510: What did Cresswell et al 1994 say about when TrA was activated?
510: Often 1st but it is position dependent
