Spinal Stabilization 24 Foundations PDF

Concepts and Spinal progression Stabilization PT6606 D. Dye Content from: Kisner, Borstad & Colby Therapeutic Exercise 8th Ed, 2023 Functional Classification of Muscles Mobilizers – Global – Phasic...

Concepts and Spinal progression Stabilization PT6606 D. Dye Content from: Kisner, Borstad & Colby Therapeutic Exercise 8th Ed, 2023 Functional Classification of Muscles Mobilizers – Global – Phasic Stabilizers – Local – Tonic generates torque – movement tension to control joint alignment producer minimal length change – isometric concentric power continuous activity with shock absorption movement high kinematic input Stabilizer – Global - mix Comerford (2001); Rood, Janda, Sahrmann (1993); Sahrmann (2000, 2001); Bergmark (1989) Function Classification with Spinal Muscles – pg. 439 Mobilizers – Global – Phasic Stabilizers – Local – Tonic More superficial (farther from axis Deep (closer to the axis of motion) of motion) Attach to each vertebral segment Cross multiple vertebral (or joints) Control segmental motion segments Greater percentage of type I Cause compressive loading with muscle fibers – endurance strong contraction function Function Classification with Spinal Muscles – pg. 439 – Table 14.1 Mobilizers – Global – Phasic Stabilizers – Local – Tonic Lumbar spine Lumbar spine Rectus abdominis Transversus abdominis External/internal obliques Multifidus QL QL - deep portion Erector spinae Cervical spine Iliopsoas Cervical spine Rectus capitis anterior and lateralis SCM Longus colli Scalenes Levator Upper trap Erector spinae Spine Stabilizers Consider in the extremities as well https://sportsrehabpa.com/2018/01/02/shoulder-injuries-part-1/shoulder- https://mskneurology.com/causes-hip-pain-how-to-fix/ muscles/ More defined roles with the trunk musculature; extremity muscles may shift their role depending on the task but still some are better designed for stabilizing then others  What is the major global mobilizer for shoulder external rotation??? Question??? Will power strengthening improve the function of the rotator cuff muscles?? How about this statement? FREE WEIGHTS https://www.setforset.com/blogs/news/ how-to-strengthen-stabilizer-muscles Working out with free weights is a guaranteed way to strengthen your stabilizer muscles.  Stability Impairment Regional Impairment Stability Impairment can result from: Joint hypermobility (aka ligamentous laxity) Muscle weakness Impaired postural control Impaired endurance Address joint structures, regional muscles, regional posture, endurance factors Joint hypomobilities?? Often if there is a hypermobility there is a hypomobility above or below Address the hypomobility concurrently as the hypermobility gains control  Hypermobility Excessive movement around a joint Definitions Instability Excessive joint movement without muscular control  Recognition of a common cause of LBP and cervical pain being associated with hypermobility of spinal segments or muscle imbalance Spinal Purpose: actively train the deep “core” musculature Stabilization (abdominal and lumbar muscles and pelvic floor for LB) to provide support in all positions (Ch 16 pp 533-556) Endurance and stabilization is emphasized  Spinal Stabilization (pp 534-535) Guidelines 1. Kinesthetic awareness 1st Make sure there are no mobility restrictions Appropriate posture / position can be attained Can use Biofeedback / Manual cueing or monitoring 2. Activation - Isometric holding Appropriate posture / position can be attained Focus on TrA and multifidus (Mf) Can use Biofeedback / Manual cueing or monitoring 3. Extremity motions -- Progressive Limb Loading Placement/position of the extremities to add difficulty and need for trunk stabilization Progress with movement of the extremities – aka dynamic stabilization 4. Increase endurance and strength 30 – 60 sec up to 3 min Add resistance with extremity movements  Spinal Stabilization (pp 534-535) Guidelines 5. Use manual resistance-alternating isometrics & rhythmic stabilization 6. Develop transition stabilization – ability to stabilize while changing positions Sit to stand Walking Lifting with Bilateral UEs; Lifting overhead 7. Perturbation – higher level balance training (will note during balance interventions) Methods of Activation Use of BP cuff or Stabilizer Lumbar – first find neutral spine then set to 70mmHg; with activation, drop by 6-10 mmHG Hold for 10 sec; work up to 10 reps Cervical – set to 20 mmHG; with activation, progressively increase by 2mmHG up to 30mmHG Hold each level 10 sec; train at final pressure working up to 10 reps Limb loading See table 16.2 Emphasis on Flexors – Cervical Spine Limb loading Emphasis on Extensors - Cervical  Level 2 = knee fall outs Limb Key difference with loading levels 3-5 is what the non- Emphasis moving limb is doing on Flexors Lumbar Level 6 – bilateral movement Limb loading Emphasis on Extension Lumbar Start Quadruped UE then LE then alternate Then Prone 1 LE, then both LEs, then both with upper Progressions – see videos from CH 16 Body positions / Activities Supine; Quadruped; Prone; Plank Sitting, Standing; Lunges; Squats [NOTE: positions are not sequential – for the LB you can/should work progressions in supine, sitting, and prone concurrently once activation is consistent; for the cervical spine you should start in supine once activation is consistent then progress in prone and the to sitting -- standing] Gymnastic balls; foam rollers Unstable surface standing Addition of resistance Addition of perturbations Foundation and Equipment San Francisco Spine Institute Founders Dynamic Lumbar Stabilization Program – 1989 Was a non-profit research organization CORE STIX® Core stabilization through UE resistance Video https://generalmedtech.com/products /scifit-core-stix-fitness-system- functional-trainer-70-0157  Summary Stabilization is necessary to enable efficient muscle performance skill Stable strong trunk “core” musculature enables greater power production of the extremities There is some evidence that core stabilization decreases recurrence of LBP (pg 549) and extensor strength is more often weak; isolating Mf requires a low-intensity focus (pg 554)