exercise management of the spine patient presented by traci schafer, pt mpt, cert mdt, cmp
TRANSCRIPT
Exercise Management of
the Spine Patient
Presented by Traci Schafer, PT MPT, cert MDT, CMP
I have no financial
disclosures
Objectives • Discuss role of active Physical
Therapy in the treatment of common spine diagnoses
• Discuss importance of posture for ongoing management
• Discuss importance of regular corrective exercise for ongoing management
Role of Physical Therapy
• Evaluate and treat impairments that interfere with patients ability to perform daily occupational and/or recreational activities. Common impairments relating to spine diagnoses include: Facet hypomobility, Internal Disc Displacement, Radicular Symptoms, Myofascial pain, ROM loss, Muscle Tightness and adherent nerve root.
• Research concludes that regular mechanical loading of joints and or tissues (i.e exercise!) is the most effective modality to decrease pain and prevent recurrence of pain.
Role of Posture • Most injuries to the spine are reported in PT as
occurring for “no apparent reason.” In reality, the injury is an effect of repetitive prolonged poor static postures or repetitive dynamic postures performed incorrectly. The result is an accumulation of postural stresses on the spine and supporting structures.
• Standing desks are becoming more popular to improve circulation, improve mood and productivity in the workplace
Effects of Slouched Sitting
• Lower cervical flexion/protrusion• Upper cervical extension • mid range flexion of upper thoracic and lower
lumbar spine• End range flexion of low thoracic and mid lumbar
spine • Posterior pelvic tilt
• End result: Excessive spinal flexion
Posture Correction Good
PosturePoor Posture
Most Common Corrective Exercise for Cervical Spine:
Retraction • Retraction: oUpper cervical end range flexionoMid cervical mid range extension oNecessary to effectively treat the
cervical spine
Retraction
Most Common Corrective Exercise for Thoracic Spine:
Extension
Most Common Corrective Exercise for Lumbar Spine:
Extension
Common Cervical Stretches
• Levator scapula (headaches and neck pain)
• O: TP’s of C1-4 • I: Superior Medial Scapular
Border • Action: Scapular elev, RET,
ROT; cervical ipsi SB and ROT; cervical ext
Common Cervical Stretches
• Upper trapezius (headaches and neck pain)
• O: EOP, medial 1/3 superior nuchal line, ligamentum nuchae and SP of C7
• I: Posterior border of lateral 1/3 of clavicle
• Action on c spine: capital contra ROT; cervical ext
Common Lumbar Stretches
• Piriformis (Sciatica, Adherent Nerve Root) • O: Sacrum, ilium near posterior PSIS, SIJ capsule,
Sacrotuberous ligament • I: Greater Trochanter of Femur, superior border • Action: Hip ER, assists in abd with flexed hip
Common Lumbar Stretches
• Psoas Major (Sciatica, Lumbago)• O: L1-5 inferior border of tp’s; T12-L5 vertebral
bodies and IVD’s via 5 digitations • I: Lesser trochanter of femur • Action: hip flexion/ER; lumbar SB, flexion
Role of Core Strengthening in Preventive Care
• Encourage: activities that focus on both flexion and extension (Yoga); strengthening from the inside, out (Pilates); core strengthening that focus on maintaining more neutral alignment on static and dynamic surfaces (plank/side plank on floor or swiss ball/BOSU)
• Avoid: abdominal crunches, dead lifts, weighted trunk rotation, long sitting (all of which compress the lumbar spine); Cross Fit unless you have keen body awareness and know your limitations
Multifidus Training• Lumbar Multifidus • O: L1-5 Mamillary process• I: Deep fibers between contiguous vertebra;
middle fibers to 2nd or 3rd vertebra above; superficial to 3rd or 4th vertebra above
• Action: Ext, Ipsi SB, Contra ROT
Role of Transverse Abdominis Training
• Controversial evidence supporting the role of TrA training to “stabilize” the lumbar spine
• The ability of intra-abdominal pressure including TrA contraction to unload the lumbar spine as a stabilizer for forward lifting tasks is low
• Definite evidence supporting directional preference movement and centralization vs training the TrA to address acute LBP episodes
• Definite evidence supporting mind/body conditioning such as Pilates and yoga to address chronic LBP
• Recovery of Function, Phase 3 of MDT • Overall physical conditioning and postural
awareness with static and dynamic postures more effective than specific TrA re-education
Plank & Side Plank
Pilates Reformer
References• Arjmand, N., & Shirazi-Adl, A. (2006). Role of intra-abdominal
pressure in the unloading and stabilization of the human spine during static lifting tasks. Eur Spine J, 15(8), 1265-1275. doi:10.1007/s00586-005-0012-9
• Bogduk, N., Macintosh, J. E., & Pearcy, M. J. (1992). A universal model of the lumbar back muscles in the upright position. Spine (Phila Pa 1976), 17(8), 897-913. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1523493
• Calais-Germain, B. (1993). Anatomy of Movement.• Danneels, L. A., Vanderstraeten, G. G., Cambier, D. C.,
Witvrouw, E. E., Bourgois, J., Dankaerts, W., & De Cuyper, H. J. (2001). Effects of three different training modalities on the cross sectional area of the lumbar multifidus muscle in patients with chronic low back pain. Br J Sports Med, 35(3), 186-191. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11375879
References, cont.• Do, Y. C., & Yoo, W. G. (2015). Comparison of the
thicknesses of the transversus abdominis and internal abdominal obliques during plank exercises on different support surfaces. J Phys Ther Sci, 27(1), 169-170. doi:10.1589/jpts.27.169
• Kim, J. S., Kang, M. H., Jang, J. H., & Oh, J. S. (2015). Comparison of selective electromyographic activity of the superficial lumbar multifidus between prone trunk extension and four-point kneeling arm and leg lift exercises. J Phys Ther Sci, 27(4), 1037-1039. doi:10.1589/jpts.27.1037
• MacEwen, B. T., MacDonald, D. J., & Burr, J. F. (2015). A systematic review of standing and treadmill desks in the workplace. Prev Med, 70, 50-58. doi:10.1016/j.ypmed.2014.11.011
References, cont. cont.• McKenzie, R., & McKenzie, R. (2006). The cervical and
thoracic spine: Mechanical diagnosis and therapy vol. 1 (2nd ed.). Raumati Beach, N.Z.: Spinal Publications (N.Z.).
• McKenzie, R., & May, S. (2003). The lumbar spine: Mechanical diagnosis & therapy (2nd ed., Vol. 1). Waikanae: Spinal.
• McKenzie, R., & Kubey, C. (2000). 7 steps to a pain-free life: How to rapidly relieve back and neck pain using the McKenzie method. New York: Dutton
• Rydeard, R., Leger, A., & Smith, D. (2006). Pilates-based therapeutic exercise: effect on subjects with nonspecific chronic low back pain and functional disability: a randomized controlled trial. J Orthop Sports Phys Ther, 36(7), 472-484. doi:10.2519/jospt.2006.2144