Spinal Stability Program

Why Consider Spinal Stability?

Lumbar stabilization is an active form of exercise used in physical therapy. It is designed to strengthen muscles to support the spine and help prevent lower back pain.


Through a regimen of exercises, and with the initial help of an experienced physiotherapist, a patient is trained to find and maintain her/his "neutral spine" position.


The back muscles are then exercised to teach the spine how to achieve and hold this position, and to safely move out of this position with the coordinated contraction of the prime mover muscles. A "neutral spine" position is just a starting point for development of greater confidence in all other positions that you will need for everyday life.


What Can a Spinal Stability Program Help

The exercise program is designed to help with Low Back Pain relief.


This exercise technique relies on proprioception or the awareness of where one’s joints are positioned. Performed on an ongoing basis, these exercises can help keep the back strong and well-positioned.


Lumbar stabilization is a multi-component program and involves 

 

  • Education/training
  • Strength
  • Flexibility
  • Endurance. 

 

It is generally used during all phases of a back pain episode and may be prescribed after a thorough evaluation of the patient's specific condition. Acute pain often leads to muscles being inhibited and in spasm. The brain may believe there to be a threat and create protective response (even if this is inaccurate). Following an episode of acute pain, it may help to consult a Sports Physician for pain management strategies in order to improve the quality of muscle recruitment and rehabilitation. 


Spinal Stability Program Outcomes

The Spinal Stability Program’s outcomes can include:

  • Reduce the amount of back pain
  • Gain control over the movements of—and forces acting on—the spine during daily activity
  • Promote healing and adaptation of soft-tissue injuries, such as muscle strain and torn ligaments
  • Reduce the chance of back injury due to repetitive motions or sudden movements or stresses
  • Improve confidence and awareness in movement

 

Physiotherapist’s Role in the Lumbar Stabilization Program

Prior to starting a lumbar stabilization exercise program, complex patients with may first be evaluated by Dr Samra.


Each patient will present different problems, and there is no "one-size-fits-all" in lumbar stabilization exercise.


The physiotherapist will then work with Dr Samra and the patient to develop a therapy plan. This process begins with helping the patient find her/his neutral spine through positioning, discussion, and feedback. Good communication is essential to good outcomes. 


During exercise training, the therapist will carefully observe and provide correction to ensure the patient develops a proper technique that then can be used at home, office, or recreation.


Neutral Spine

The first step in the lumbar stabilization exercise process is to find the position of the spine considered neutral. While it may not be completely pain-free, this position is the least painful yet biomechanically sound posture for the lower back.


The benefits of the neutral spine include:

 

  • Decreased tension on the spine-related ligaments and joints
  • Allows the various forces acting on the discs and vertebrae to be distributed in a more balanced manner
  • Keeps the patient's posture near his/her "centre", enabling the patient to react more quickly (either forward or backward) when necessary
  • Provides the greatest functional stability with axial loading

 

Once learned, the lumbar stabilization exercise program is designed to train the muscles to maintain this neutral spine position subconsciously, quickly, and automatically.


Spinal Stability Exercise Program

The lumbar stabilisation exercise program includes a range of exercises that typically progress from beginning to more advanced:

 

  • From static (lying) to dynamic (standing or jumping)
  • From resisting gravity to resisting an additional outside force
  • From predictable to unpredictable movements
  • From individual components of a movement to the complete range of motion in a movement

 

At all times the neutral spine position is maintained.


Progression to the next exercise generally depends on learning to maintain the neutral spine properly during the current exercise. The physical therapist or exercise therapist is trained to help the patient learn the proper technique.


The exercises below are a small subset of those a therapist may recommend. The spine specialist and therapist design each lumbar stabilization exercise program specifically for each patient based on the patient's condition.


Hamstring Stretch

A passive exercise using little muscle effort. Lay on the floor with knees bent and feet on the floor. Find the neutral spine position and maintain it while slowly straightening one leg and lifting the heel toward the ceiling while supporting the back of the thigh with both hands. Hold for 10 to 30 seconds and repeat with other legs. 


Do 3 repetitions. The leg muscles can be made static, too, by using a wall to straighten the leg while resting the leg muscles.


Pelvic Tilt

An active exercise from one position, where the abdominal muscles are isolated and used to move the spine. Lay on the floor with knees bent and feet flat on the floor.


Tighten stomach muscle and pull the lower back to the floor. Hold for 10 seconds.


Do 3 to 5 repetitions.


Arm/Leg Raises

A more dynamic exercise introduces movement of the arms and/or legs to challenge the neutral spine; this exercise is for the hip abductors.


Lie on one side with the lower arm bent under the head and upper arm resting with hand on the floor near the chest. Bend both knees and flex hips and find neutral spine position.


Slowly raise upper leg 8 to 10 inches and lower.


Do 5 to 10 repetitions and repeat on the opposite side.


Exercise Ball Bridges

An advanced stabilization exercise that introduces unpredictable movement that must be responded to (the movement of the ball).


Lay on the floor with both feet propped up on the exercise ball with legs straight and arms relaxed to the sides. Find the neutral spine position and hold while slowly tightening the buttock muscle to lift the buttocks off the floor 2 to 3 inches.


Stretching and Aerobic Conditioning

In addition to strengthening exercises, such as those above, stretching and aerobic conditioning are also an important part of lumbar stabilization physical therapy:

 

  • Flexibility is key to successful lumbar stabilization training because flexibility allows the muscles to assume the neutral position easily.
  • Cardiovascular (aerobic) conditioning is an important part of the total body muscle strength and endurance, and the neurological adaptations that reduce pain, and should be combined with the lumbar spine stabilization program. Walking is a great starting activity as it is controlled and can be titrated easily to the right dose for the patient.
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