Exercises for Lumbar Instability
Introduction• Motion of the lumbar spine is result of a
complex interaction of : bony structures and soft tissues.
• Therefore abnormalities of any of these structures may limit the range of motion of the lumbar spine.
• The loss of motion may be due to pain, muscle spasm, mechanical block, or neurological defect.
Major Diagnostic Possibilities (after trauma)
• Fracture• Ligamentous Injury• Low back strain/sprain• Herniated DiskDuring Fracture & Ligament. injury – (Sx
related to movement/stability) pt. unwilling to move.
LB strain – ROM typically painful Herniated Disk – Flex spine = reproduces leg
symptoms – pain in SLR tests.
Major Diagnostic Possibilities (without
trauma)• Degenerative Disk Disease• Lumbar Arthritis • Infection• Tumors• Spinal DeformitiesLumbar Arthritis esp. ĉ Stenosis– unilateral
leg weaknessSpinal Stenosis – loss of lumbar lordosisLumbar Spondylosis - ↓ lumbar ROM
What is Lumbar Instability?
• Lumbar instability is when there is decreased stiffness (there is a resistance to bending) of a segment. As a result, excessive movement occurs, even under minor loads.
Management • Treatment Aim: to ↓ or
eliminate completely the Sx of the condition rather than getting a bony reunion.
• Depend on condition – “active rest” “total bed rest”.
• Braces – Casts • MOST IMPORTANT
component of management is closely supervised EXERCISE THERAPY.
How to maintain spinal stability?
• Three inter-related systems.• Passive support • Active support • Control centres
• If stability of 1 system ↓ the other systems most compensate.
What can the PT do?• This inter-related system
gives the PT opportunity to ↓ pain and ↑ function by REHABILITATING active lumbar stabilization.
• A 10 wk specific stability programme is shown to be more EFFECTIVE than regular ex’s in the gym, sit – ups, swimming using measures of pain intensity.
• The benefits of this programme have been maintained even after a 30 mnth follow-up (O’Sullivan et. al.1997)
Lumbar Stabilization Programme• Divided into 3 stages and has been
constructed by Richardson and Jull in 1994.
The muscles that function poorly after injury to lumbar spine are the stabilizers (lumbopelvic region): deep abdominals, gluteals, and multifidus.
Signs of msl instability: – msl twitching when pt. shifts weight
to one leg.-pt. shakes or judders while trying to
bend trunk forward.
Phase 1:Begins ĉ abdominal hollowing. Pt. in prone kneeling & spine in mid-pst. Pull abdominal wall in &hold pst. for 2 seconds.Then 5,10, 30 secs. & breathing normally. Build up to 10 reps.
*PT cueing “in and up”/ encouraging *PT tells pt. to contract abdominal
msls hard as possible then relax. PT monitor the ribcage to avoid excessive movement.
*Use visual stimulation*pt focus attention on body part
(umbilicus)
*slow steady movements
Phase 2• Next action = heel slide while maintaining neutral
lumbar position. Hip flexors try to tilt pelvis forward & ↑ lumbar lordosis.
• The abdominal msls work hard to stabilize the pelvis & lumbar spine against pull.
•Bridging actions work abdominals & gluteals combined.
•Side lying movements work quadratus lumborum and trunk side flexors **important stabilizers*
• Dynamic movement and alignment are maintained in this phase
Phase 3
• PT teach patient to draw attention away from spine by use of proprioception to check the stability of the spine so that stability of the spine becomes automatic.
• Resistance Training can be used.
• Balance Board
• Swiss Gym ball
Those are the main points of the exercise
programme for lumbar stability
Thank u!
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