David Butler’s recent post, Time for Motor Freedom has created quite a buzz. Thousands have read the piece, it has been shared around social media channels more than any other noijam post and we had our busiest day ever on the blog when it was posted.
About four years ago, David wrote a noinote on the rapid uptake but inherent issues of another motor control paradigm; that of the transversus abdominus and ‘core stability’ that links in nicely here and is worth a little stroll down memory lane.
Knowledge in the wrong hands
“I have always had some trouble with the idea of core stability and could never get past the fact that the body core is actually the aorta. I am no fan of specific exercises… it’s all too biomedical for me, nor am I a fan of the still widely held notion that pain is related to the “instability” detected by many core stability practitioners. This is one of the concepts which prevents acceptance of central sensitisation. However, I am in awe of the experimental process, vigour and output at the University of Queensland, unmatched in physiotherapy anywhere in the world.
There is nothing much wrong with the research findings – it’s how they have been used by some physiotherapy teachers and the research industry to the point of almost cult like acceptance. There is always a problem with knowledge. Carl Sagan in “The Demon Haunted World” expressed great foreboding about “awesome technological powers in the hands of the few and when those representing the public interest have difficulty grasping the issues or are unable to knowledgeably question those in authority”. This statement is also related to health, for example, self medication where people repeatedly take potent pain killers and the bastardisation of the transverses abdominus research by the exercise industries and some educators.
The dodo in rehabilitation
The specific muscle activation movement will be up for many and stronger challenges in the future, but we do this to ourselves in the world of rehabilitation.
The “dodo effect”, (Rosenwieg 1936) is well known in psychology circles. It basically says that therapeutic orientation does not matter as all orientations work, as long as the single factor of faith that it will work is held by patient and therapist. Those who can remember their reading of ‘Alice in Wonderland’ may remember the dodo handing out prizes after a race where distance and time were not measured and saying “everyone has won and all must have prizes.” In the physically based rehabilitation world in addition to the more established professions of physiotherapy, chiropractic, occupational therapy and osteopathy there are subgroups and groups based on technique (eg. massage therapists, acupuncturists), geography (eg. Australian and Norwegian approaches), singular tissues (eg. focus on isolated muscles, craniosacral, disc lovers) and people’s names (eg. Feldenkrais, Maitland, Mulligan). Everyone must be getting a prize or these various groups would have evaporated. The core stability movement is currently one of these groups.
A core cannot stand alone
But is it faith or a little more than faith? Or has something additional been isolated by each group. I’d like to think so. Core stability may well provide something special for a particular group in a particular circumstance and this will need clever research to show, but it is clearly not something to be done at the exclusion of other exercises or strategies. It, as well as the other groups desperately need integration into biopsychosocial assessment and management strategies for effectiveness , expansion and to encourage rational debate on its place. The divergent approaches listed above may well converge when this happens and common factors in the approaches are established”
David Butler, noinotes September 2010
The great Carl Sagan, referenced in the noinote above has been linked to before on noijam. During the interview Sagan says something worth repeating again here:
“If we are not able to ask sceptical questions, to interrogate those who tell us that something is true, to be sceptical of those in authority then we are up for grabs for the next charlatan, political or religious, who comes ambling along.”
The overwhelming response to the motor freedom post suggests that the difficult, skeptical questions posed by David’s post and the recent motor control findings are being asked today in the therapy communities.
Perhaps motor freedom is an idea whose time has truly come?
“Memory lane Mondays”
Memory lane Mondays are posts looking back over the archives from noinotes and other noi blogs. Like a FlashBack Friday really, but for when I run out of time on a Friday!
Get up to date and get your think on; grab a copy of Explain Pain 2nd Ed, or the Graded Motor Imagery Handbook, or find an upcoming noigroup course near you.
It is truly a brave man who can turn away from, what he thought was the “Holy Grail” to think, reflect and search again……..are you ready ?
This brings to mind a lovely quote that Mick Thacker often uses;
“Don’t accept everything I say. Go and find out for yourself and make up your own mind.”
Very true! I always ask my patients to not believe me, just like Mick asked us (his students) to not believe him!…
I am skeptical by nature, and i would like my patients to be skeptical too. i encourage that.
I think we, physios as a group, should be more skeptical, and less passive learners.
Yeah, from the “Dynasty of the disc” to the “Tyranny of the transversus”. I love the idea of motor freedom. People gotto move!
One of the things that I am struggling with as I read through the NOI posts is a lack of balance or what seems like an inaccurate view of self. In this post Mr. Butler makes a wonderful statement:
“It, as well as the other groups desperately need integration into biopsychosocial assessment and management strategies for effectiveness , expansion and to encourage rational debate on its place.”
I love the Explain Pain movement and have had it change my world and the way I practice. I come to this site looking for more knowledge and better tools to be able to effectively help those I treat. But I am frequently running into the same perspective that is condemned by NOI in other subgroups, mainly that idea that the framework presented here is the only right one and everyone else is missing the boat and wasting their time in research. I wish for more conversation about how these things fit together and how the best application of each group’s research and theory might actually make a stronger whole and a more effective outcome for more people.