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instruction to ‘lift the crown jewels’ may work as well or perhaps even better! The contraction should happen with the TA and the area described above can be palpated to check this.

Once this is achieved the subject should then work on being able to breathe while sustaining this low level contraction. Limb movements are added to then begin to challenge the equilibrium and the subject is required to maintain lum- bopelvic stability ie. keeping the spine and pelvis in neutral position, using these muscles throughout the movement.

I emphasise here the importance of differentiating between rigidity and stability. If the mobilising muscles are being used for stability (in the case of rigidity) the subject may give the outward impression of success with these exercises. What is happening though is that the joints are restricted in movement and control because large levers are exerted by the superficial muscles without intrinsic support. This could potentially injurious and certainly counterproductive, at this stage of retraining. Obviously as load is increased and different tasks are attempted the requirement for use of the force producing muscles varies.

From here the progressions are endless and can be placed into exercise pro- grammes tailored for an elderly inactive subject through to a young elite athlete, the level of stability and control they require will reflect the demands of their occupation and leisure activities. Exercise balls, weights and body weight can also be used to increase difficulty.

Activating the stabilising muscles can also be used during general activities, indeed this type of use should be encour- aged as it is extremely functional and subjects may be more likely to comply.

To conclude Lumbopelvic stability is a vital part of movement and control. The evidence is continuing to mount that re-establishing this following injury is of paramount importance.

Retraining stability muscle use requires attention to detail from the teacher and the client and must progress from isolation to integrated functional use.

The evidence based method described here does differ to those found elsewhere, as indicated by the increased use of the term ‘core stability’ in gymnasiums and training regimes. However the methods used to regain this ‘stability’ vary widely and are not all evidence based. I hope that this article gives pause for the thought that many ‘core stability’ regimes may not actually provide what they state and that aiming for segmental stabilisa- tion is worth the extra effort.

References 1. Panjabi MM. The stabilizing system of the spine. Function, dysfunction, adaptation and enhancement. Journal of Spinal Disorders 1992;5(4):383-389. 2. Kendall HO, Kendall FP and Boynton DA. Posture and Pain Baltimore: Williams and Wilkins 1952. 3. Gossman MR, Sahrmann SA and Rose SJ. Review of length associated changes in mus- cle Physical Therapy 1982;62(12):1799- 1808. 4. Janda V. Muscles as a pathogenic factor in back pain. Proceedings of International Federation of Orthopaedic and Manipulative Therapists Conference New Zealand 1980;2- 23. 5. De Vita J, Walker ML and Skibinski B. Relationship between performance of selected scapular muscles and scapular abduction in standing subjects. Physical Therapy 1990;70(8):470-476. 6. Sahrmann SA. Muscle imbalance in the orthopaedic and neurologic patients. Proceedings of the Tenth International Congress of the World Confederation for Physical Therapy Sydney 1987;836-841. 7. Richardson CA. Atrophy of vastus medialis in patello-femoral pain syndrome. In Proceedings Tenth International Congress World Confederation of Physical Therapy, Sydney 1987;400-403. 8. Richardson C, Jull G, Hodges P, Hides J. Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain-Scientific Basis and Clinical Approach. Churchill Livingston,

Edinburgh 1999. 9. Bergmark A. Stability of the Lumbar Spine. A study in mechanical engineering. Acta Orthop Scand 1989;230(60):20-24. 10. Richardson CA. Course notes from the Bachelor of Physiotherapy (Year 3). St Lucia: University of Queensland Physiotherapy Department 1997. 11. Vleeming A, Mooney V et al. Movement, Stability and Low Back Pain: The essential role of the pelvis. Churchill Livingstone London 1997. 12. Hodges PW, Richardson CA. Neuromotor dysfunction of the trunk musculature in low back pain patients. Proceedings of the World Confederation of Physical Therapists con- gress, Washington USA 1995. 13. Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH. Evidence of lumbar multifidus mus- cle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine 1994;19(2):165-172. 14. Hides JA, Richardson CA, Jull GA. Multifidus inhibition in acute low back pain: recovery is not spontaneous: Proceedings of the 9th biennial conference of the Manipulative Physiotherapists Association of Australia.

Gold Coast, Queensland,

1995;57-60. 15. Snijders CJ, Ribbers MTLM, de Bakker HV et al. EMG recordings of abdominal and back mus- cles in various standing postures: Validation of a biomechanical model on SIJ stability. J.Electromyo-graphy and Kinesiology 1998;8:205-214 16. Steffen JM, Musacchia XJ. Spaceflight effects on adult rat muscle protein, nucleic acids and amino acids. American Journal of Physiology 1986;251:R1059-R1063. 17. Fitts RH, Riley DR, et al. Invited Review: Microgravity and skeletal muscle. Journal of Applied Physiology 2000;89:823-839.

Rachele Quested BPhty, MCSP is a physio- therapy graduate from University of Queensland, Australia and has been work- ing in the UK for over three years. During this time she has worked for the MOD, Sport England and has travelled with several national sporting teams.

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