Specific Exercise Flexion PDF

Specific Exercise Flexion Category Mohammad Yabroudi, PT, PhD Jordan University of Science and Technology  Directional Preference Identifying Factors - History – Preference for one spinal posture Sitting - Flexion Classification Standing/Wal...

Specific Exercise Flexion Category Mohammad Yabroudi, PT, PhD Jordan University of Science and Technology  Directional Preference Identifying Factors - History – Preference for one spinal posture Sitting - Flexion Classification Standing/Walking - Extension Classification  Specific Exercise Classification Identifying Factors - Examination – Centralization during movement testing Single test movements – Flexion – Extension – Pelvic Translocation Repeated/Sustained movements  Specific Exercise Classification DEFINITIONS – Centralization: A pain, or paresthesia moves centrally, towards the spine A paresthesia which was present is abolished A symptom is diminished or abolished during the movement, and remains so for at least 30 seconds after completion of the movement.  Specific Exercise Classification DEFINITIONS – Peripheralization: A pain, or paresthesia moves distally, away from the spine A paresthesia is produced which was not previously present A symptom present (or produced) increases in intensity, and remains increase for at least 30 seconds after completion of the movement.  Specific Exercise Classification DEFINITIONS – Is Status Quo (ISQ) Neither centralization or peripheralization is produced Occurs when transient increase/decrease in pain is observed during movement.  Flexion Classification Stenotic, Degenerative Spine Postural Syndromes – Flatback --Swayback – Hyperlordotic Special Cases – Spondylolithesis (instability classification) – Adherent Root Syndromes “adverse dural tension” Post-surgical sequelae  Spinal Stenosis AKA: Neurogenic claudication Narrowing of the central canal or lateral intervertebral foramina – Central stenosis – Lateral stenosis Male/ female = 8:1 Older age (>65 yrs) (wear and tear) Neurogenic claudication: Neural compromise due to obstruction of blood flow to the nerve  Subjective Symptoms – Mostly bilateral (3:1) – Localized pain /Numbness and “pins and needles” in legs, calves or buttocks – Walking short distance→ Weakness, tiredness, heaviness of legs→ stop – A decreased endurance for physical activities Agg: extension, prolonged standing or walking, walking downhill, lying flat Ease: Leaning on grocery basket, flexion, sitting or squatting, walking uphill, bike riding  Objective exam/ Stenosis Flat lumbar posture Painful/limited or no extension Central and unilateral PA→ pain and stiffness Peripheral pulses: present Diagnostics: X-ray, CT scan / MRI  Objective exam Bike test – In neutral position→ increase symptoms → claudication – In flexed position→ decreased symptom→ neurological claudication – In flexed position→ no change→ vascular claudication Treadmill test: Pain with normal level or down-hill walking, able to tolerate incline walking  Intervention ADL instruction with a neutral spine Flexion exercises/mobility exercises (William’s flexion) Stretching: Hamstring, hip flex Intermittent Traction Spinal stabilization exercises Joint mobilization (rotation) -Joint mobilization: Increase space, decrease shortening of soft structures, increase segmental mobility  Intervention Abdominal and gluteal muscle strengthening NO extension exercises Medications (NSAIDS) / epidural steroid injections Laminectomy / Fusion  Postural Syndrome Flatback – Increased lumbar flexion with associated posterior pelvic and hip extension Compensations: – Posterior pelvic tilt – Tightness of the Hamstring MM – Weakness of the Hip Flexor MM – Stretched posterior longitudinal ligaments  Postural Syndrome Swayback – Manifestation of lumbar flexion with associated posterior pelvic tilt, hip extension, thoracic kyphosis, and forward displacement of the pelvis Compensations – Stretched anterior hip ligaments, muscles – Compression of the posterior vertebral elements  Postural Syndrome Hyperlordotic – Increased or excessive lumbar lordosis Compensations – Anterior pelvic tilt – Stretched anterior longitudinal ligaments and lower abdominal muscles – Compression of the posterior vertebral elements – Shortening of low back extensors and hip flexor MM  Flexion Classification ❖ AROM Pattern Status Quo or improved with flexion Pain, may peripheralize with extension History suggests preference X for flexion Baseline: LBP  Flexion Classification Symptoms improve with flexion and worsen with extension of lumbar spine. Postural and directional preference for flexion. Typically older in age (> 50 years). Imaging evidence of lumbar stenosis.  Treatment Treatment Program: – Flexion-oriented exercises – Mobilization of lumbar spine – De-weighted treadmill ambulation – Exercises for individual impairments – Avoidance of extension of lumbar spine Unloading