Basic Concepts of Spinal Management with Exercise
Fundamental Interventions
Exercises all patients should learn regardless of their functional level (Kisner & Colby, p. 440)
Based on
Kinesthetic Training: patient education on safe spinal motions with integration and application to activities of daily living
Stabilization Training: accessing and contracting muscles which provide spinal stability during gross motion
Functional Training: applying principles of body mechanics during everyday activities
Patient Education
Healing continuum and expectations for recovery
Patient-centered goals with direct patient engagement during treatment
Includes instruction in prevention
General Exercise Guidelines
Therapeutic exercises are based on integrating pathology, tissue healing processes, and patient symptoms and limitations. Table 16-2 in your K&C text (p. 442) provides an excellent summary of general exercise applications based on the stage of recovery. This lecture covers the basic interventions, and subsequent lectures will address stabilization and functional progressions.
Elements of Kinesthetic Training
Position of bias = position of symptom relief; a.k.a., resting position
Neutral spine = mid-range of motion in all planes
Emphasis is on bringing the patient's attention to what feels worse/ better and then training them to find and use those positions of relief
Cervical Spine
Facilitated passive ROM with verbal cues with transition to active-assisted and active range of motion. Patient should be positioned according to symptom tolerance (WB vs. non-WB). Supine positioning when first learning these techniques is recommended.
Lumbar spine
Passive positioning into posterior tilt (hooklying) or anterior tilt ( gentle long leg pull in supine); or with towel prop. Hook-lying is ideal for initiating kinesthetic training in pelvic tilt motions.
Progress to active positioning by instruction in pelvic tilt, moving through safe range and finding position of ease
Influences of the extremities on the trunk
limbs moving away from trunk = leads to spinal extension
limbs moving toward trunk = leads to spinal flexion
Bringing patient's attention to the effect of limb
Integrate motions into functional activities: rolling, sit to stand, bending, etc.,
Postural Control
Use of visual (mirror), verbal, and tactile cues for engaging core muscle and controlling dynamic movements to decrease incidence of painful symptoms
Stretching principles
may be contraindicated in inflamed tissue, however; assisted or positional stretching may be used to decrease tissue tension and allow patient to place spine in positions which decrease stress to involved structures.
Traction forces are stretching forces which may be used to decompress inflamed nerve root structures, thus decreasing pain
