忘却からの帰還〜Intelligent Design

A treatment for certain back conditions, Williams flexion exercises, recommended decreasing lordosis as much as possible. It was based on evolutionary theory, specifically that humans evolved from quadrupeds and that back problems are a result of our new upright posture. This treatment protocol often impeded healing and caused great pain. Robin McKenzie's exercises, which recommended restoring normal lordosis (anterior convexity of the spine), are much more effective.

ある種の背部痛の治療法である、Williams屈曲エキササイズは可能な限り、柱前湾を小さくすることを推奨している。これは特に人間が四足歩行から進化し、背部痛が直立歩行姿勢によるものだという、進化論に基づいている。この治療手段は治癒を妨げ、大きな痛みを引き起こした。Robin McKenzieの練習は、柱前湾（背骨の前方への湾曲）を伸ばすもので、はるかに効果がある。

Bergman, Jerry, 2001. Back problems: how Darwinism misled researchers. TJ 15(3): 79-84.

1. Williamsの背部痛の治療法は進化論に基づいていない。健康な人と、背部痛の人の観察に基づいている。彼の理由付けのひとつは、床に座るアフリカやアジア文化圏から人々の方が、椅子に座る西洋人よりも、背部痛が少ないことだった。
   ~さらに、Williamsは、常に柱前湾を小さくするよう推奨していたわけではない。椎間板前部の場合のみである。背骨の通常の湾曲を増やそうが減らそうが、痛みを生じることが分かっている。Bergmanも認めているように、Williams屈曲エキササイズは、脊柱管狭窄症の場合に有益である。
   ~
2. Mackenzieのエキササイズは単純かつ器具を必要としないために、効果的である。なので患者の協力も得やすい。

1. Smythe, Vivienne, 2003. Re:"Back problems: how Darwinism misled researchers" Message-ID 　6mqehv0k68te6rmbpjoobbandfabh1i5hq＠4ax.com　, (17 July)

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これはIndex to Creationist Claims, edited by Mark Isaakの和訳です。

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On Thu, 17 Jul 2003 18:18:25 +0000 (UTC), "Alan Wright"
<alanatya...@giganews.com> uttered:

>"Harlequin" <use...@cox.net> wrote in message
>news:Xns93BADE30A2367usenet123mmcablecom@68.12.19.6...
>>Today's feature at Answers in Genesis is an attack on
>>Darwinism in medicine.
>>
>>
>>"Back problems: how Darwinism misled researchers"
>>by Jerry Bergman, _TJ_ 15(3):79-84 (2001)
>>
>http://www.answersingenesis.org/home/area/magazine... >>p
>>http://tinyurl.com/h6l0~~ >>
>>Anyone have a response? (Besides the obvious fact that AiG
>>has a VERY poor track record.)
>ALAN

>Fine logic:
>
>- TOE says humans evolved from quadrupeds
>- spinal problems in humans may relate to this
>- treatment for spinal problems tried based on this idea
>- treatment fails
>
>- THEREFORE THEORY OF EVOLUTION IS WRONG!
>
>Non sequitur.
As Alan says, the logic is rotten. The premises they are arguing from are also a misrepresentation of spinal therapy. Evolution was not the rationale for spinal treatments that I learned while studying to become a physiotherapist (USA: physical therapist) many years ago.

By the 1980s it was presented as long-known information that the double-S curve of the spine was biomechanically essential for pain-free loadbearing, and that anything which interfered with the normal double-S curve i.e. increased *or decreased* curvature (also asymmetries of course) tended to produce pain/immobility. Depending upon the variation from normal alignment that was producing the pain, the exercises/joint mobilisations were prescribed *as indicated by X-ray and mobility measurements*. Some prescriptions were for flexion, some for extension, some for rotation and side-flexion. It is simply not the case that lumbar flexion exercises were the only ones prescribed for people with lumbar pain due to some evolutionary dogma.

Williams' exercises were, according to one of my old textbooks, especially popular in the USA at one time, and his rationale was that a minimal lumbar lordosis was a healthier spinal posture than an exaggerated lordosis *in cases of posterior disc bulging*. My textbook states that part of his rationale was that African and Asian cultures where people sit on the floor with a curved lower spine experience less back pain than Western cultures where our chairs encourage an exaggerated lordosis. There was no mention of any evolutionary rationale in my textbook (Williams perhaps indulged in some evolutionary speculation as to the reason why African/Asian hypolordotic spines presented with fewer instances of pain/injury, but the authors seemed clear that his initial observations on differences in injury/pain frequency in non-Western cultures were what drove his postural thesis). There book mentions that Williams also prescribed extension exercises where indicated by clinical signs, which would seem to contradict any alleged evolutionary dogma about what the spine ought to look like - his primary goal was to decrease pain. (White and Panjabi, _Clinical Biomechanics of the Spine_, Lippincott 1978 pp.305-6[1])

Mackenzie's lumbar extension exercises made a sensation in the early 1980's certainly, but not because nobody was prescribing extension exercises before then or not performing extension mobilisations/manipulations. Mackenzie's exercises made a sensation because they were a stunningly simple set of exercises requiring no special equipment which a patient could easily follow at home. Therefore patient compliance with home-exercise regimen was greatly increased, with the result that the Mackenzie therapy got greatly superior results in decreasing pain and increasing lumbar function, including a drastic reduction in the number of cases needing to be referred for surgery of doubtful utility.

Also, the recent ability (1970's) to measure _in vivo_ intradiscal pressures during certain exercises showed that the traditional Williams exercises were too severe in some instances (especially situps[2] and HIS EXTENSION EXERCISES )[p.306] and Mackenzie's exercises managed to have beneficial effects on pain and mobility without causing a dangerous rise in intra-discal pressure. Other tests showed that a slightly extended spine showed less activity in paraspinal muscles and a lowered intradiscal pressure, which was the discovery that finally put paid to using Williams flexion exercises in cases of back pain due to disc trauma. It is worth noting however that not a few of Mackenzie's extension exercises are described by him as "modified Williams posture", where he has modified them only to keep any increased intradiscal pressure in safe bounds.

In my own experience, while *hypo*-lordosis as a clinical sign in actual traumatic lifting injuries is a definitive sign of posterior disc injury, it is far more common in gradual onset diffuse lumbar back pain to find that the client is *hyper*-lordotic and requires exercises the diametric opposite of Mackenzie's extension exercises and far more of the ilk of the Williams flexion exercises in order to diminish spasm and pain. Even the AIG article acknowledges that the Williams flexion exercises are of benefit in cases of spinal stenosis.

I have a suspicion also that AIG have looked at figures illustrating "slumping" postural exercises meant to be held for a few minutes at most and misrepresented these as some sort of ideal permanent posture that Williams was advocating.

Summary: they have overstated the reliance upon an alleged "Williams dogma" regarding a perceived need to eliminate the spinal double-S curve, when my textbook from 1978 shows that Williams advocated extension exercises as well as flexion exercises depending upon the clinical signs. They have also overstated the influence of Mackenzie extension exercises - their effect is spectacular in cases of acute traumatic lumbar injury involving disc displacement/rupture, but the Mackenzie extension exercises have no special benefit over flexion exercises (Williams or other) in other cases of back pain, particularly chronic back pain due to degenerative bone/joint changes.

+this was a standard undergraduate and postgraduate text in many medical and paramedical faculties around the world at the time. It is still in publication in updated and revised editions (latest 199?), and Panjabi and White are still researching and publishing other biomechanical treatises, although now they are published by Churchill Livingstone (this may be why there are no more recent editions). Their 2000 book _Biomechanics of the Musculoskeletal System_ is on the reading list of many facculties..
+the discovery of this increase in intradiscal pressure to dangerous levels during straight-leg sit-ups is why gyms nowadays teach people to do situps with knees bent.

Vivienne "the rapist" Smythe


"Usenet is like a herd of performing elephants with diarrhea --massive,difficult to redirect, awe-inspiring, entertaining, and >a source of mind-boggling amounts of excrement when you least expect it." - Gene "spaf" Spafford (1992)

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