Dr Mel Siff Blog

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In response to Dr Mel Siff’s Subluxation Paradox http://www.melsiff.com/12359/subluxation-puzzle-and-paradoxes-by-mel-siff/

Here is some further discussion from another list on my subluxation paradox:

Mel Siff:

< Can you cite any scientific references which definitely relate these small
“disturbances” to any significant pathology? What you are iimplying is that
the spine is critically tuned, displays a very sharply defined range of
efficient functioning and has a negligible “safety factor”, so that even
minor perturbations will cause genuine pathology or pain. This is not a very
efficient way for the body to have developed and evolved, so I have to wonder
about the validity of such an hypothesis.>

Comment:

Your point about the evolution of the system is well taken. As you point out Read more…

,

Here is some continued discussion from the IWF list on the weightlifting
pulling questions which I posed recently:

One Supertraining Member contributed the following:

<< After reviewing many videos and digitizing many others it appears that
many of the best technicians in the pull (e.g. Petrov) pull flat footed as
long as possible until they begin the transition pull from the knee to the
high chest position. At that point they seem to shift to the balls of their
feet before they go into the final extension of the pull.>

Mel Siff:

*** But that is exactly what was taught in Weightlifting several decades ago
and is not the much vaunted “flatfooted” style whose merits are so widely
extolled nowadays. Way back then some lifters displayed a high heel raise, Read more…

Some years ago I seem to recall an article which concluded that loaded
hyperextension of the spine was potentially less harmful to the lumbar spine
than unloaded hyperextension such as that encountered in throwing and jumping
sports. Possibly someone else can locate that reference. This might explain
why the incidence of hyperextension injuries in Olympic weightlifting appear
to be far less common than in sports such as cricket and gymnastics.

Many have militated against all spinal hyperextension, but they seem to
forget that McKenzie techniques (as variants of the ancient yoga Cobra asana)
actually comprise controlled forced hyperextension of the spine in a posture
which does not allow the lower body to sway and dissipate stress as in the
standing Olympic Press. Sure, we have pointers such as the
peripheralisation or centralisation of pain symptoms to guide us to the
suitability of McKenzie, but why are many folk adamant about avoiding all
forms of hyperextension, irrespective of such guidelines?

Then, we also must distinguish between the strictly controlled hyperextension
of the spine in the sagittal plane during the Olympic Press, compared with
the complex lumbar hyperextension, trunk rotation, lateral pelvic tilting and
asymmetric foot impact actions involved in cricket bowling, tennis serving,
gymnastics and so forth. Are we justified in comparing simple hyperextension
in one plane with complex trunk actions in several planes?

All too often, it seems to be forgotten that even small torque about the
vertebrae can produce more strain in the peripheral annulus of the disk than
far more extensive flexion or extension. This tends to reflect itself in
training and rehabilitation programs drawn up for athletes and workers – the
(often machines-controlled) movements and stretches very rarely involve
significant use of rotatory actions, especially under progressively
increasing conditions of resistance and range. Yet, all physical therapists
have been exposed to the well-known patterns, pacing, procedures and
principles of PNF with all of its emphasis on the regular use of spiral and
diagonal patterns.

This may well explain why the incidence of injuries associated with forceful,
sudden, ballistic or large range rotation of joints may be so rife in sport -
witness for instance, the mainstays of sports therapy with its epidemic of
rotator cuff, ACL and similar injuries. Machine training and even free
weight training seems to concentrate largely on linear or uniplanar actions,
and if rotation is involved in training, it takes place only in the sport
itself or in the gym via the use of gentle yoga-like stretches and warmups.

It is not only exposure to a stressful action that can cause injury, but also
religious avoidance of so-called dangerous actions (which might occur during
actual sporting conditions). One cannot expect the body to cope with the
immense structural and functional demands placed on the body in sport unless
one methodically conditions the body to cope with progressively greater
structural and functional stresses.

Dr Mel C Siff

<< I’m just a simple coach, but I’ve seen dramatic, immediate improvements in
static posture (using a plum line assessment, such as the type described in
Kendall’s PT textbook) with several soft tissue techniques, particularly
Active Release Treatment Techniques.>>

***Interestingly, Kendall’s methods recently have come in for a great deal of
criticism in many physical therapy and biomechanics circles, especially since
they have been based upon some rather thin research involving testing of
isolated joints under static conditions. I am sure that Barrett Dorko could
supply some references on this.

‘ACTIVE RELEASE’ TECHNIQUES

For those who may not know, ‘Active Release Treatment’ (ART) is a collection
of techniques simply given a new name by chiropractor Michael Leahy from
physical therapy (especially Janet Travell’s work on trigger point and
myofascial release), classical massage, Shiatsu, osteopathy and other
well-known tissue therapies.

I wrote an Internet review of its origins and requested any so-called ART
practitioners to furnish any research or peer-reviewed clinical studies which
showed categorically that ART is equal or superior to other therapies being
used to treat the same type of musculoskeletal problem. All that I received
was a series of the usual indignant letters quoting more anecdotal evidence,
none of which even vaguely controlled for the possibility of a placebo
effect.

Most significantly, I even received an offended letter from Michael Leahy
himself, who admitted that there was nothing original about ART, but that he
had just formalised it into an organised system with his own certification
scheme. In essence, he felt that I had not adequately recognised ART as
highly effective therapeutic system and that I should give it a fairer
hearing.

He also iterated anecdotally the great success enjoyed by ART, so I wrote
back stating that it would be a pleasure for me to write (for all the
Internet groups to which I belong) another article on ART if he could kindly
send me a list of references proving all claims that have been made for its
efficacy with respect to other standard methods of physical therapy, medicine
and chiropractic. Most significantly, he failed to reply and I have not
heard from him since.

Anyway, I was referred to websites such as the following by other ART
practitioners:

http://www.chiropractic-sports.com/reference/ART.HTML

Here is an interesting extract from this site:

<The skill of application of ART is highly dependent upon the practitioner’s
knowledge of anatomy, biomechanics and most importantly touch. One must not
confuse terminology related to performing ART. Often when a practitioner is
asked if they do ART, they respond by saying “yeah I do that, it’s like
myofascial release right?” You can tell immediately that they are not
properly trained and you can be assured you will not be getting ART. To be
certified in ART, the Doctor or therapist MUST have completed a course in ART
and passed a national certification exam.>

*** The implication immediately is that ART is somehow superior to Janet
Travell’s myofascial release and trigger point work, as well as its
simplified borrowings in the form of Bonnie Prudden’s ‘Myotherapy’, a claim
which is totally unsubstantiated by research or clinical studies. There are
just as many therapists who claim equally impressive success to ART.

The reference to a “national certification exam” has nothing to do with any
medically recognised national qualification. ART certification is a private
commercial scheme administered by Leahy. You do not have to be certificated
in ART to practise its techniques because all of those techniques existed in
other therapeutic systems way before ART was conceived as a separate
therapeutic modality. The name may be protected, but all of the techniques
may be used by any other therapist who is familiar with them.

The above extract also mentioned that the success of ART depends “most
importantly on….touch”, in other words on certain individual skills of the
therapist. This is true of all therapies. I have little doubt that Leahy
probably enjoys numerous successes with ART, not simply because of the
system, but because of his special personal touch and subjective qualities.
I have personally witnessed healing success with Therapeutic Touch,
shamanism, magnets and several other ‘complementary’ therapies, BUT this does
not constitute valid scientific proof of their effectiveness. Such
observations do not rule out the possibility of a strong placebo effect.

This does not mean that I would ever state that someone should not use any
therapy because of lack of scientific validity. As one of my physics
professors one said to me about a tedious and lengthy mathematical method
that I had unhappily used to solve one of the problems that he set for us:
“If it works, use it!”. I always felt awed when I saw how craftily and
succinctly many of the world’s truly great physicists solved problems, and I
felt that I should at least be a bit more elegant with my own solutions. My
physics prof put everything into a more realistic light with that remark
which I have remembered some 35 years later.

By all means, let anyone use ART, Therapeutic Touch or what they will, but
please don’t let them make unsubstantiated claims about clinical efficacy or
underlying mechanisms if they do not exist. Rather say what the TV detective
hero, Hunter, said about his method of solving criminal problems: “Works for
me!”

STRENGTH TRAINING & POSTURE

<<The same goes with strength training exercises. I realize that there are
many studies which say that strength training does nothing to improve
posture, but again and again I’ve seen athletes demonstrate dramatically
improved static posture after participating in a strength training program.>>

*** I agree with you on this score, but it may be that the improvement does
not necessarily have to do with increases in strength, but with other
processes that resistive training may mediate, such as disinhibition of
certain muscle actions, facilitation of other muscle actions, post-exercise
relaxation, overflow, enhanced proprioceptive sensitivity, conditioning of
certain reflexes or other neurally based facilitatory processes. So, while
strength increase may not always be the direct cause of postural improvement,
other processes involved with strength training may be responsible for
causing definite change. There is some interesting scope for research here.

Dr Mel C Siff