TVA activation

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David Driscoll wrote:
1. In your opinion, what types of lower back pain patients DON'T need
direct TVA training?

John Casler writes:

I am of the opinion that everyone can benefit from improved conditioning and
fitness levels, but would wonder of an "effective" method of "direct"
training of the TvA.

In my theory, the TvA evolved as a spinal stabilizer of quadrupeds. In that
position, the weight of the contents of the abdomen created pressure/tension
on the muscle and tissues and this tension translated to the Thoracolumbar
Fascia and stabilized the spine.

As we have evolved to bipeds the stabilization function is still there, but
due to the increased demands of higher load stabilization the TvA must be a
contributor to IAP to a large degree.

I might wonder if Dr. Hodges has considered that evolutionary process and
agrees or disagrees with that assessment.

David Driscoll wrote:

2. What percentage of LBP patients do respond to TVA activation
training

John Casler writes:

I would also be interested in the method of measuring or qualifying such a
response and the basis for that qualification.

David Driscoll wrote:
3. Does the TVA ever not switch on?

John Casler writes:

This is an interesting question and suggests a motor problem. Todate I have
not seen any published evidence that aside from "pain inhibition" and
deconditioning, that the TvA actually switches off. Maybe Hodges can expand
on that.

David Driscoll wrote:

4. If your research shows that the onset of TVA activation is delayed
by a few hundred milliseconds, do I need to keep drawing in during an
exercise or task, or only at the start?

John Casler writes:

As above, I might question how the "delay" conclusion is assumed. I am
aware of the research, but wonder how much of that perceived/measured
"delay" is (as above) due to simple pain inhibition and deconditioning.

The "drawing in" also seems to be an area of controversy and one in which I
am ambivalent. That is, we all know that tensioning the TvA will mildly
compress the abdominal contents and this compression is due to the
concentric shortening of the muscle.

However, that "is not" really a "drawing in" as much as it is a "compressing
in". This is important to the point of what is occurring to contribute to
stabilization. The term "drawing in" generally conveys a "vacuum" or
reduced pressurization to the abdominal cavity and its contents. Some have
termed it "hollowing".

I would wonder if Hodges could explain just what he might mean by "drawing
in" or "hollowing" and if the perception of each is correct and that each
cause a "reduced" pressure within the abdomen and how reduced IAP adds to
the stability of the spine, since virtually the sole purpose of the TvA is
to:

1) Assist in compressing the abdominal contents to increase IAP

2) Create tension to the ThoraColumbar Fascia to increase spinal rigidity.

In the full spectrum of activations from mild to high force, I would ask Dr.
Hodges if he finds that the actual process transitions? That is; if all we
need is a mild spinal stabilization then there is little need for high
levels of IAP, and a concentric shortening of the TvA will simply create its
stabilization via the TcF tensioning.

However, under high loads and forces, significant levels of IAP need be
created (such as in a squat of deadlift) and under these conditions the role
of the TvA transitions to a slightly different function.

Due to the fact that higher levels of stabilization are required, more of
the Torso Stabilization Mechanism is called upon. This means that ALL the
abdominal musculature, the diaphragm and even the upper torso (in the act of
creating ITP join in.

This total effort then creates far greater pressures than the TvA can
contain concentrically, and it is "forced" into eccentric or static action
(where it can create higher forces).

My question is, does Dr Hodges recognize that transitional from low
force/loads to high force loads?

David Driscoll wrote:

5. Can the TVA switch on properly without drawing in? i.e. is it the
only cue for activation?

John Casler writes:

This question leads me to ask; Why would it not, when well conditioned and
not pain inhibited respond to any need volitional or reflexive.

And if Dr. Hodges feels that there is some "motor" inhibition beyond pain
inhibition, has he measured it impairment to other TvA activations like
sneezing?, coughing? and Vomiting? If the muscle is motor impaired and it
is not impaired as to these other reflexive functions, then what could be
causing a selective motor impairment?

David Driscoll wrote:

6. Does a protruding stomach mean that TVA is not switched on or in
other words does should the TVA overcome the force of bracing and a valsalva
manoeuvre

John Casler writes:

I would be interested in a good answer of this and point to my suggestions
above of the most effective use of the TvA is when it is in "forced
static/eccentric" extension.

David Driscoll wrote:

7. Should people who have not had a acute episode of lower back
Pain perform the drawing in exercise?

John Casler writes:

I am on board with this as a mild conditioning exercise, but also wonder if
Dr. Hodges employs or suggests "bracing" and tensioning exercises too? (as
McGill)

David Driscoll wrote:

8. Is it helpful to learn the exercises for when an injury does
occur -
i.e. before first incident of lower back pain?
9. If the drawing in is about retraining the nervous system to do
What it does naturally, how do we know at what point can we stop performing
it before movement/exercise?

John Casler writes:

I wonder if Dr. Hodges feels it damaging to use the terms "drawing in" and
"hollowing" rather than "tensioning" or "tightening" , or "bracing". I might
question that the "natural reflex" is really of a "drawing in", but more as
mentioned above, simply an initial concentric shortening under light
stability conditions.

David Driscoll wrote:
10. What questions do you think are still unanswered about TVA
Training and activation?

Anyway, what would you all like to know?

John Casler writes;

I am fascinated by the fascination with the TvA which is a bit
player/contributor, and wonder why such a fuss is made of it. It seems that
Richardson, Jull and Hodges have targeted the TvA and Mutifidus as the
center of their research and while I find it interesting, as above, I might
question some of the interpretations.