The Spine: Exercise Interventions

Copyright © 2013. F.A. Davis Company

Part IV: Exercise Interventions by Body Region

Chapter 16

The Spine: Exercise Interventions


BASIC CONCEPTS OF SPINAL MANAGEMENT WITH EXERCISE


Definition: Exercises or skills that all patients with spinal impairments should learn….at the time of examination and initial intervention– Kinesthetic training– Stabilization training– Functional training of basic body mechanics

Fundamental Interventions


Active Participation Limitations at Each Stage of Healing Safe Self-Management Instruction Prevention

Patient Education


Kinesthetic Awareness Mobility/Flexibility Muscle Performance Cardiopulmonary Endurance Functional Activities

General Exercise Guidelines


KINESTHETIC AWARENESS


Position of Symptom Relief (position of bias)– Cervical spine– Lumbar spine

Effects of Movement on the Spine Blending of Kinesthetic Training, Stabilization

Exercises, and Fundamental Body Mechanics

Elements of Kinesthetic Training: Fundamental Techniques


Use of Reinforcement– Verbal, visual, tactile

Identify Any Need for Postural Support Integrate Awareness of Postural Control– Body mechanics– Functional activities

Progression to Active and Habitual Control of Posture


MOBILITY/FLEXIBILITY


Techniques to Increase Thoracic Extension– Self-stretching

Techniques to Increase Axial Extension (Cervical Retraction): Scalene Muscle Stretch– Manual stretching– Self-stretching

Cervical and Upper Thoracic Region: Stretching Techniques


Techniques to Increase Upper Cervical Flexion: Short Suboccipital Muscle Stretch– Manual stretching– Self-stretching

Traction as a Stretching Technique– Manual traction: cervical spine– Self-traction: cervical spine

Cervical and Upper Thoracic Region: Stretching Techniques (cont'd)


Grading I–V: Definitions Precautions Contraindications

Cervical Joint Manipulation Techniques


Manipulation to Increase Cervical Flexion Manipulation to Increase Cervical Extension Manipulation to Increase Cervical Rotation Manipulation to Increase Cervical Rotation

and Sidebending Manipulation to Increase Cervical Rotation

and Sidebending-Alternate Technique

Cervical Joint Manipulation Techniques (cont'd)


To Increase Craniocervical Flexion To Increase Craniocervical Rotation

Muscle Energy Techniques to Increase Craniocervical Mobility


Techniques to Increase Lumbar Flexion– Self-stretching

Techniques to Increase Hip Muscle Flexibility Traction as a Stretching Technique– Manual traction: lumbar spine– Positional traction: lumbar spine

Mid and Lower Thoracic and Lumbar Regions: Stretching Techniques


Manipulation to Increase Thoracic Spine Extension

Manipulation to Increase Thoracic Spine Flexion Manipulation to Increase Thoracic Spine Rotation Pistol Thrust to Increase Thoracic Spine Mobility Cross-Arm Thrust to Increase Thoracic Spine

Mobility Fall Thrust to Increase Thoracic Spine Mobility

Thoracic and Lumbar Joint Manipulation and HVT Techniques


Rib Manipulation for Inspiratory Restriction Rib Manipulation for Expiratory Restriction Elevated First Rib Manipulation

Thoracic and Lumbar Joint Manipulation and HVT Techniques (cont'd)


Manipulation to Increase Lumbar Spine Extension

Manipulation to Increase Lumbar Spine Rotation

Manipulation to Increase Lumbar Intervertebral Sidebending

HVT Lumbar Roll to Increase Lumbar Rotation



SI Joint Manipulation Technique to Increase Sacral Nutation (Flexion)

SI Joint Manipulation Technique to Increase Sacral Counter-Nutation (Extension)

HVT Posterior Rotation to Innominate



MUSCLE PERFORMANCE:STABILIZATION, MUSCLE ENDURANCE, AND STRENGTH TRAINING


Stabilization Training: Fundamental Techniques and Progressions Guidelines for

Stabilization Training


Cervical Musculature– Deep neck flexors– Lower cervical and upper thoracic extensor – Progression

Deep Segmental Muscle Activation and Training


Lumbar Musculature– Drawing-in maneuver (abdominal hollowing

exercise) for transverse abdominis activation– Abdominal bracing– Posterior pelvic tilt– Multifidus activation and training

Deep Segmental Muscle Activation and Training (cont'd)


Stabilization Exercises for the Cervical Region– Stabilization with progressive limb loading– Variations and progressions in the stabilization

program– Integration of stabilization exercises and posture

training– Progression of isometric and dynamic

strengthening in conjunction with functional activities

Global Muscle Stabilization Exercises


Stabilization Exercises for the Lumbar Region– Stabilization with progressive limb loading– Variations and progressions in the stabilization

program– Quadratus lumborum: stabilization exercises– Progression to dynamic exercises

Global Muscle Stabilization Exercises (cont'd)


Exercise for the Cervical Region– Isometric exercises: self-resistance– Isometric resistance activities– Dynamic cervical flexion– Manual resistance: cervical muscles– Intermediate and advanced training• Transitional stabilization for the cervical and upper

thoracic regions• Functional exercises

Isometric and Dynamic Exercises


Exercise for the Thoracic and Lumbar Regions– Alternating isometric contractions and rhythmic

stabilization– Dynamic strengthening: abdominal muscles• Trunk flexion• Trunk flexion (abdominals): sitting or standing

Isometric and Dynamic Exercises (cont'd)


Exercise for the Thoracic and Lumbar Regions (cont’d) – Dynamic strengthening: erector spinae and

multifidus muscles• Extension exercises in prone or quadriped position• Extension exercises sitting or standing• Trunk side bending (lateral abdominals, erector spinae,

quadratus lumborum)

Isometric and Dynamic Exercises (cont'd)


CARDIOPULMONARY ENDURANCE


Cycling Walking and Running Stair Climbing Cross-Country Skiing and Ski Machines Swimming Upper Body Ergometers Step Aerobics and Aerobic Dancing “Latest Popular Craze”

Common Aerobic Exercises and Effects on the Spine


FUNCTIONAL ACTIVITIES


Goal: Progress to Independence Safely Rolling Supine to Sit/Sit to Lying Down Sit to Stand/Stand to Sit In and Out of a Car Walking

Early Functional Training: Fundamental Techniques


Weight-Bearing Exercises– Modified bridging exercises– Push-ups with trunk stabilization– Wall slides– Partial lunges, partial squats, and steps– Walking against resistance

Preparation for Functional Activities: Basic Exercise Techniques


Transitional Stabilization Exercises– Quadriped forward/backward shifting– Squatting and reaching– Shifting weight and turning

Preparation for Functional Activities: Basic Exercise Techniques (cont'd)


Principles of Body Mechanics: Instruction and Training– Lumbar spine position– Spinal flexion– Spinal extension– Load position

Body Mechanics and Environmental Adaptations


Environmental Adaptations– Home, work, and driving considerations– Sleeping environment

Body Mechanics and Environmental Adaptations (cont'd)


Repetitive Lifting Repetitive Reaching Repetitive Pushing and Pulling Rotation or Turning Transitional Movements Transfer of Training

Intermediate to Advanced Exercise Techniques for Functional Training


Continual Throughout the Rehabilitation Process

Relationships of Posture and Pain Home Exercise Program– Flexibility– Muscle endurance– Strengthening– Cardiopulmonary

Education for Prevention


Critical Thinking and Discussion Laboratory Practice Case Studies

Independent Learning Activities

Documents

The Spine: Exercise Interventions