Summary of Spine Rehabilitation Progressions

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Approximately 6 minutes

 

Intervention

Early Training; Protection

Basic Training; Controlled Motion

Intermediate to Advance Training; Return to Function

Training in safe movement and postures (kinesthesia/proprioception)

Pelvic tilt; cervical retraction

PROM-AAROM-AROM

Active spinal stabilization in progressively more challenging positions (supine, prone, quadruped); stabilization during functional activities

Integrates spinal stabilization into ADLs/iADLs

Mobility/Flexibility

Stretching in pain-free ranges (spine and extremities); gentle joint mobilization

Gentle motion into mildly painful ranges; limb stretching without activation of spine symptoms

Stretching into limitations, including discomfort

Core Stabilization; muscular strength and power

Passive positioning with isometric and gentle, progressive limb loading

Progressive stabilization with limb loading in dynamic postures; begin abdominal and limb strengthening and endurance training

Progression to dynamic trunk strengthening using challenging surfaces and resistance

Cardiopulmonary Endurance

Limited; work in position of ease and protect affected joints

Low to moderate intensity (RPE) with emphasis on joint protection; target activities that can be performed in position of bias

High intensity -sustained cardio activity consistent with health promotion (30 min, 3+ x week)

Functional Activities

Safe postures; safe and adaptive techniques for rolling/supine to sit

Functional activities that include limb motions while maintaining stable spine (reaching, lifting, bending, squatting, kneeling, etc.)

Practice prevention

Individualized instruction in specific, higher level functions the patient engages in at work/home/sport

 

Active Learning Exercise

 

Fill in the table with interventions you have learned so far that would be consistent with managing subacute / controlled motion spinal symptoms. Then use a 0-5 scale to rate your understanding and confidence in selecting the intervention and delivering clear and evidence-based instruction

Plan of Care

Intervention and Parameters

Self-rating of understanding

Self-rating of confidence

Educate the patient in self-management and how to decrease episodes of pain

 

 

 

Progress awareness and control of spinal alignment

 

 

 

Increase mobility in tight muscles/joints/fascia

 

 

 

Teach techniques to develop neuromuscular control, strength and endurance

 

 

 

Teach techniques of stress relief and relaxation

 

 

 

Teach safe body mechanics and functional adaptations

 

 

 

Now compare your tables for acute and subacute conditions of the spine. How do they differ? Can you see indications for a progression? Would you be able to identify when it is appropriate to progress a patient? Can you provide patient-centered education in the above areas? Use the CAN YOU HELP ME? forum to discuss your findings.