SPINOUS spinal rehabilitation and core stabilization
What is the
conection betwen Low Back Pain and Lumbar Stabilization Exercises?
It has been
estimated that approximately 80% of people in Western countries have
experienced low back pain (LBP) at some point in their lives. Most cases
resolve within 2-4 weeks without any medical intervention. However, within 1
year following the first episode of LBP, 60-80% of patients will have recurring
pain. Current research has reported that in most cases of LBP, certain muscles
of the back that stabilize the spine are reflexively inhibited (shutdown) after
injury. These muscles do not spontaneously recover even if patients are pain
free with a return to normal activity levels. These specific muscles work
together to support and stablize the spine to help prevent LBP.
What Are the
Lumbar Multifidi and Transversus Abdominus?
The lumbar
multifidi are the deepest layer of muscles of the the back. They attach from
the vertebral arches to the spinous processes. Each multifidi connects 1-3
vertebrae, (the vertebrae are the bones of the spine) controlling movement
between the vertebrae.
The transversus abdominus is the deepest of the abdominal muscles and is also a stabilizer of the spine. Support by this muscle is considered to be the most important of the abdominal muscle and has also been found to be in a weakened state in those who have chronic back pain or problems. Its normal action along with the action of the the lumbar multifidus muscles function together to form a deep internal corset that acts to stabilize the spine during movement. This pattern of protection is disrupted in patients with low back pain.
it is uncertain why these muscles become dysfunctional after a low back injury, but specific exercises focusing on the contraction of these two muscles together will improve the protective stabilizing ability of the spinal muscles, reduce pain intensity, and improve activities of daily living as well as improve body awareness and posture.
How does a
Chiropractor treat Low Back Pain?
Chiropractic
treatment for LBP often involves a wide range of techniques including heat
therapy, ultrasound, traction, mobilization, manipulation, exercise, and
education about posture and body mechanics. Stabilizing and strengthening the
lumbar spine (specifically lumbar multifidi and transverse abdominus) through a
lumbar stabilization program is also an important part of a rehabilitation
program for the patient with low back pain.
What Does a Lumbar Stabilization
Program Involve?
The lumbar
stabilization program is a program of back exercises designed to teach patients
strengthening and flexibility in a pain-free range. It not only improves the
patient´s physical condition and symptoms but also helps the patient with
efficient movement. It provides the patient with movement awareness, knowledge
of safe postures, and functional strenghth and coordination that promotes management
of LBP.
Prior to starting a lumbar stabilization program, the patient should first be evaluated by his/her physician (D.C. or M.D.) which will design a comprehensive rehabilitation program with the above mentioned techniques along with a lumbar stabilization program specified to the patient. Since every patient is an individual and presents with different conditions, a physical therapist is needed to design and monitor the rehabilitation program.
Which
exercises focous on Spinal Stabilization?
The initial
phase of stabilization training begins with isolated muscle contractions.
Stabilization training is initiated with the patient being instructed in the
neutral spine position. The neutral spine position is where the spine is in
ideal alignment and is found by envisioning the face of a clock on the abdomen,
with 12:00 at the belly button and 6:00 at the pubic bone. The pelvis is then
alternately tilted so that 12:00 rocks toward the floor and then 6:00 rocks
toward the floor. This is done repeatedly 10 times in each direction gently and
slowly. The neutral position within that range is the point where you identify
is the most comfortable. This position is emphasized and should be maintained
for all movements performed during stabilization activities as well as all
daily activities. As awareness
of the neutral position is demonstrated, isolated transversus abdominus
contraction is then initiated. This muscle is trained by simply pulling your
navel into your spine, and/or exhaling thoroughly, while maintaining the
neutral spine position.
Once these 2 exercises are learned, the following exercises can then be initiated:
Back Stabilization Exercise 1
•Lie on back, left knee bent. Tighten abdominals and buttocks, keeping back in neutral position. Raise right leg 12 inches, knee straight.
•Hold 3 counts
•Lower leg. Repeat 10 times.
•Repeat with left leg.
•Progress to making circles and squares with raised leg.
Back
Stabilization Exercise 2
•Start in kneeling position. Tighten abdominals and buttocks, keeping back in neutral position.
•Hands on hips.
•Raise right foot and place on floor in front of you, kneeling on left knee.
•Lunge forward, moving at hips.
•Hold 3 counts.
•Return to kneeling.
•Repeat 10 times.
•Repeat with the opposite side