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Free Content From Structures to Mechanisms: Time to Let Go of Transversus Abdominis

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Medical and healthcare professionals are generally aware that pain is multidimensional and requires a biopsychosocial approach. Yet, even for clinicians who advocate and believe they are applying this, the clinical application of a biopsychosocial approach remains a formidable challenge. Conscious 'isolated' activation of transversus abdominis and multifidus - either as a sole task or alongside movement or activity - is still advocated by many clinicians as an essential strategy for low back pain management. However, this strategy illustrates the challenge of letting go of a biomedical paradigm and truly embracing a biopsychosocial model of patient care.


This is an evidence-based Narrative Review, exploring the neuroscientific and psychological literature investigating pain mechanisms and approaches to management.


Conscious 'isolated' transversus abdominis and multifidus recruitment – whether performed routinely or selectively in patients with low back pain – embodies the biomedical paradigm, potentially to the detriment of patient care. This review proposes innovative ways in which clinicians can embrace a biopsychosocial approach in practice.


'Isolated' TrA and multifidus treatment approaches may reinforce a structural pathology paradigm which is inconsistent with a biopsychosocial approach. Arguably, the contexts for movement and exercise in rehabilitation should instead promote adaptive attitudes, beliefs and associations regarding patients' conditions and recovery.

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Document Type: Research Article

Publication date: June 1, 2015

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  • Pain and Rehabilitation is a peer-reviewed, Bi-annual journal of the Physiotherapy Pain Association and special interest group of the Chartered Society of Physiotherapy. The journal comprises a range of different articles types from orignial articles to systematic reviews and letters around the topic of pain and rehabilitation. The journal is multidisciplinary in its focus and welcomes submissions from all professionals working in this multidisciplinary field. the abstract of all articles will be freely avilable online. Full text articles are available free online to members of the Physiotherapy Pain Association, and access to individual PDF articles can be purchased by non members.
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