Exercises for Lumbar Instability

Introduction• Motion of the lumbar spine is result of a

complex interaction of : bony structures and soft tissues.

• Therefore abnormalities of any of these structures may limit the range of motion of the lumbar spine.

• The loss of motion may be due to pain, muscle spasm, mechanical block, or neurological defect.

Major Diagnostic Possibilities (after trauma)

• Fracture• Ligamentous Injury• Low back strain/sprain• Herniated DiskDuring Fracture & Ligament. injury – (Sx

related to movement/stability) pt. unwilling to move.

LB strain – ROM typically painful Herniated Disk – Flex spine = reproduces leg

symptoms – pain in SLR tests.

Major Diagnostic Possibilities (without

trauma)• Degenerative Disk Disease• Lumbar Arthritis • Infection• Tumors• Spinal DeformitiesLumbar Arthritis esp. ĉ Stenosis– unilateral

leg weaknessSpinal Stenosis – loss of lumbar lordosisLumbar Spondylosis - ↓ lumbar ROM

What is Lumbar Instability?

• Lumbar instability is when there is decreased stiffness (there is a resistance to bending) of a segment. As a result, excessive movement occurs, even under minor loads.

Management • Treatment Aim: to ↓ or

eliminate completely the Sx of the condition rather than getting a bony reunion.

• Depend on condition – “active rest” “total bed rest”.

• Braces – Casts • MOST IMPORTANT

component of management is closely supervised EXERCISE THERAPY.

How to maintain spinal stability?

• Three inter-related systems.• Passive support • Active support • Control centres

• If stability of 1 system ↓ the other systems most compensate.

What can the PT do?• This inter-related system

gives the PT opportunity to ↓ pain and ↑ function by REHABILITATING active lumbar stabilization.

• A 10 wk specific stability programme is shown to be more EFFECTIVE than regular ex’s in the gym, sit – ups, swimming using measures of pain intensity.

• The benefits of this programme have been maintained even after a 30 mnth follow-up (O’Sullivan et. al.1997)

Lumbar Stabilization Programme• Divided into 3 stages and has been

constructed by Richardson and Jull in 1994.

The muscles that function poorly after injury to lumbar spine are the stabilizers (lumbopelvic region): deep abdominals, gluteals, and multifidus.

Signs of msl instability: – msl twitching when pt. shifts weight

to one leg.-pt. shakes or judders while trying to

bend trunk forward.

Phase 1:Begins ĉ abdominal hollowing. Pt. in prone kneeling & spine in mid-pst. Pull abdominal wall in &hold pst. for 2 seconds.Then 5,10, 30 secs. & breathing normally. Build up to 10 reps.

*PT cueing “in and up”/ encouraging *PT tells pt. to contract abdominal

msls hard as possible then relax. PT monitor the ribcage to avoid excessive movement.

*Use visual stimulation*pt focus attention on body part

(umbilicus)

*slow steady movements

Phase 2• Next action = heel slide while maintaining neutral

lumbar position. Hip flexors try to tilt pelvis forward & ↑ lumbar lordosis.

• The abdominal msls work hard to stabilize the pelvis & lumbar spine against pull.

•Bridging actions work abdominals & gluteals combined.

•Side lying movements work quadratus lumborum and trunk side flexors **important stabilizers*

• Dynamic movement and alignment are maintained in this phase

Phase 3

• PT teach patient to draw attention away from spine by use of proprioception to check the stability of the spine so that stability of the spine becomes automatic.

• Resistance Training can be used.

• Balance Board

• Swiss Gym ball

Those are the main points of the exercise

programme for lumbar stability

Thank u!