Abstrakt
A case is presented in which paresis of the back muscles and of the transversus abdominis due to boreliosis prevented the patient lifting her arms when standing freely. She was, however, able to lift her arms normally when seated.. or when standing with a corset supporting her pelvis.
Thanks to the Australian school of physiotherapists and our personal clinical experience with the pelvic floor and the diaphragm we are now well aware of the crucial importance of what may be called the "Deep Stabilisation System". Whereas the deep back muscles and the transversus abdominis are frequently weak, dysfunction of the pelvic floor and the diaphragm is usually accompanied by trigger points (TrPs), which must be palpated (Fig 1, 2).
This is important, as for the stability of the lumbar spine, the back muscles and in front the abdominal cavity with all its walls are essential. Painful TrPs are usually found in the superficial trunk muscles if there is any type of dysfunction in the deep stabilisation system.
The influence of postural function on voluntary movement was admirably shown by Hodges, Richardson and Jull, using EMG. They demonstrated that if a healthy subject raises his arm, the transversus abdominis contracts before the deltoid.
Their findings are almost experimentally confirmed by the following case. The patient J.L., born 1923, female, was first seen by one of us on August 28, 2001, complaining that when standing her "tummy was sticking out" and that when standing she was unable to lift her arms, while sitting she could do so normally.
So unusual was this finding, that the patient was suspected of malingering.