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The Spine: Exercise Interventions Chapter 16 Part IV: Exercise Interventions by Body Region Copyright © 2013. F.A. Davis Company BASIC CONCEPTS OF SPINAL MANAGEMENT WITH EXERCISE Copyright © 2013. F.A. Davis Company Fundamental Interventions 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 Copyright © 2013. F.A. Davis Company Patient Education Active Participation Limitations at Each Stage of Healing Safe Self-Management Instruction Prevention Copyright © 2013. F.A. Davis Company General Exercise Guidelines Kinesthetic Awareness Mobility/Flexibility Muscle Performance Cardiopulmonary Endurance Functional Activities Copyright © 2013. F.A. Davis Company KINESTHETIC AWARENESS Copyright © 2013. F.A. Davis Company Elements of Kinesthetic Training: Fundamental Techniques 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 Copyright © 2013. F.A. Davis Company Progression to Active and Habitual Control of Posture Use of Reinforcement – Verbal, visual, tactile Identify Any Need for Postural Support Integrate Awareness of Postural Control – Body mechanics – Functional activities Copyright © 2013. F.A. Davis Company MOBILITY/FLEXIBILITY Copyright © 2013. F.A. Davis Company Cervical and Upper Thoracic Region: Stretching Techniques Techniques to Increase Thoracic Extension – Self-stretching Techniques to Increase Axial Extension (Cervical Retraction): Scalene Muscle Stretch – Manual stretching – Self-stretching Copyright © 2013. F.A. Davis Company Cervical and Upper Thoracic Region: Stretching Techniques (cont'd) 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 Copyright © 2013. F.A. Davis Company Cervical Joint Manipulation Techniques Grading I–V: Definitions Precautions Contraindications Copyright © 2013. F.A. Davis Company Cervical Joint Manipulation Techniques (cont'd) 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 Copyright © 2013. F.A. Davis Company Muscle Energy Techniques to Increase Craniocervical Mobility To Increase Craniocervical Flexion To Increase Craniocervical Rotation Copyright © 2013. F.A. Davis Company Mid and Lower Thoracic and Lumbar Regions: Stretching Techniques 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 Copyright © 2013. F.A. Davis Company Thoracic and Lumbar Joint Manipulation and HVT 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 Copyright © 2013. F.A. Davis Company Thoracic and Lumbar Joint Manipulation and HVT Techniques (cont'd) Rib Manipulation for Inspiratory Restriction Rib Manipulation for Expiratory Restriction Elevated First Rib Manipulation Copyright © 2013. F.A. Davis Company 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 Copyright © 2013. F.A. Davis Company Thoracic and Lumbar Joint Manipulation and HVT Techniques (cont'd) SI Joint Manipulation Technique to Increase Sacral Nutation (Flexion) SI Joint Manipulation Technique to Increase Sacral Counter-Nutation (Extension) HVT Posterior Rotation to Innominate Copyright © 2013. F.A. Davis Company MUSCLE PERFORMANCE: STABILIZATION, MUSCLE ENDURANCE, AND STRENGTH TRAINING Copyright © 2013. F.A. Davis Company Stabilization Training: Fundamental Techniques and Progressions Guidelines for Stabilization Training Copyright © 2013. F.A. Davis Company Deep Segmental Muscle Activation and Training Cervical Musculature – Deep neck flexors – Lower cervical and upper thoracic extensor – Progression Copyright © 2013. F.A. Davis Company Deep Segmental Muscle Activation and Training (cont'd) Lumbar Musculature – Drawing-in maneuver (abdominal hollowing exercise) for transverse abdominis activation – Abdominal bracing – Posterior pelvic tilt – Multifidus activation and training Copyright © 2013. F.A. Davis Company Global Muscle Stabilization Exercises 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 Copyright © 2013. F.A. Davis Company Global Muscle Stabilization Exercises (cont'd) 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 Copyright © 2013. F.A. Davis Company Isometric and Dynamic Exercises 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 Copyright © 2013. F.A. Davis Company Isometric and Dynamic Exercises (cont'd) 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 Copyright © 2013. F.A. Davis Company 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) Copyright © 2013. F.A. Davis Company CARDIOPULMONARY ENDURANCE Copyright © 2013. F.A. Davis Company Common Aerobic Exercises and Effects on the Spine Cycling Walking and Running Stair Climbing Cross-Country Skiing and Ski Machines Swimming Upper Body Ergometers Step Aerobics and Aerobic Dancing “Latest Popular Craze” Copyright © 2013. F.A. Davis Company FUNCTIONAL ACTIVITIES Copyright © 2013. F.A. Davis Company Early Functional Training: Fundamental Techniques 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 Copyright © 2013. F.A. Davis Company Preparation for Functional Activities: Basic Exercise Techniques Weight-Bearing Exercises – Modified bridging exercises – Push-ups with trunk stabilization – Wall slides – Partial lunges, partial squats, and steps – Walking against resistance Copyright © 2013. F.A. Davis Company Preparation for Functional Activities: Basic Exercise Techniques (cont'd) Transitional Stabilization Exercises – Quadriped forward/backward shifting – Squatting and reaching – Shifting weight and turning Copyright © 2013. F.A. Davis Company Body Mechanics and Environmental Adaptations Principles of Body Mechanics: Instruction and Training – Lumbar spine position – Spinal flexion – Spinal extension – Load position Copyright © 2013. F.A. Davis Company Body Mechanics and Environmental Adaptations (cont'd) Environmental Adaptations – Home, work, and driving considerations – Sleeping environment Copyright © 2013. F.A. Davis Company Intermediate to Advanced Exercise Techniques for Functional Training Repetitive Lifting Repetitive Reaching Repetitive Pushing and Pulling Rotation or Turning Transitional Movements Transfer of Training Copyright © 2013. F.A. Davis Company Education for Prevention Continual Throughout the Rehabilitation Process Relationships of Posture and Pain Home Exercise Program – Flexibility – Muscle endurance – Strengthening – Cardiopulmonary Copyright © 2013. F.A. Davis Company Independent Learning Activities Critical Thinking and Discussion Laboratory Practice Case Studies Copyright © 2013. F.A. Davis Company