Transversus abdominis: a different view of the elephant.

It is good to see that clinical and research hypotheses are debated in the literature. The purpose of science is to challenge ideas and to consider alternative interpretations of observations. Within this, the place for neurophysiological/biomechanical studies in clinical research is not to predict the potential efficacy of a clinical approach, but to try to understand the mechanisms that underlie it. This is helpful as it provides a means to refine, improve, and direct intervention and provides a platform to develop rationales for intervention, particularly when we are faced with complex patients who do not fit the clinical prediction rule or the narrow criteria adopted for inclusion in clinical trials. If we understand the mechanisms we have a powerful tool to rationalise and test interventions. The developing debate about the role of transversus abdominis is healthy for rational consideration of motor control interventions for back pain. I welcome this opportunity to comment on the opinions and interpretations of Allison et al and Cook. As indicated by Allison et al in their paper published in JOSPT, it is not the data that are questioned; it is the interpretation. It seems that we have a recurrence of the issue of the six blind men and the elephant, where we see the same animal, but from different perspectives, and draw different conclusions. There are a number of assumptions that require consideration to challenge the interpretation of Allison et al and the opinion of Cook. A key issue is that to conclude that a single observation from a single task refutes the conclusion of a whole range of different methodologies/tasks seems unfounded.