The Transversus: It's Not Just for Strengthening Anymore | Modern Manual Therapy Blog

The Transversus: It's Not Just for Strengthening Anymore

I was performing the Mulligan Belt Traction with Pt Hip IR MWM yesterday. She is a lumbar foraminal stenosis with hip dysfunction in a capsular pattern on the same side. She has been improving steadily with IASTM to her lumbar paraspinals, hamstring, ITB, and MWM to her left hip.

While performing the MWM passively for 1-2 reps to test her movement, it was pain free. When I asked her to move with me, she stated the movement was painful in her lumbar spine.

A rule for any Mulligan MWM is that it should be 100% pain free. Instead of abandoning the technique, I instructed her on a transversus abdominus contraction. While actively contracting, she was able to IR her left hip during the technique with no pain in her lumbar spine. Her hip IR improved after 3 quick sets and remained better for her HEP.

Another patient I was treating several years ago had LBP and radiating right LE pain. After 6 visits of MDT and OMPT she was completely pain free in all ADLs except crossing her right LE over her left at the ankle; this caused radiating pain to below her knee. All repeated motions and neurodynamic testing was normal and pain free. I suggested she try the same activity with a transversus contraction which made it pain free. She performed this 2-3 times/day and within 2 days, it was firing as normal during this minimal ADL.

 Just a quick clinical pearl! Hope it helps with some of your patients!

6 comments:

  1. Interesting! Will remember this for clinical application.

    By the way, are you confident it is the TrA-contraction (which is somewhat controversial, if you ask authorities like McGill or Lederman) that causes this positive effect, or could it be a general bracing by abdominal and maybe other spinal stabilizing muscles (Psoas? Multifidii?)?

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  2. What do you propose the mechanism of action is resulting in this improvement?

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  3. I just say TrA because it is a muscle I cue. I know what McGill says. Most likely any stabilization effect is caused by multiple muscles as I don't really believe in muscle isolation anyway.

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  4. It is most likely a stability/inhibition issue which is why both patients were then able to do the activities completely Sx free. Both required simple hip movements, and a simple cue (not maximal contraction) worked very well.

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  5. Maybe slightly off topic, but do you follow the Queensland or McGill approach (or other) for individuals with lower back pain who would benefit from motor control / stability exercises.

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  6. Despite my caseload being mostly spinal 80% TMD and 20% rest of the spine, I rarely prescribe stabilization exercises. That is a carry over from my MDT background. Only when someone plateaus with a combination of OMPT and MDT do I start to prescribe stabilization. The exercises are often more difficult than repeated motion and posture correction plus simple stretching. So if I can get someone completely back to their ADLs symptom free, I don't use stabilization.

    That being said, when I do use it, I tend to use more of the Aussie approach.

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