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C H A P T E R
14
Exercise Prescription
for Flexibility and LowBack Function
Wendell Liemohn
Chapter 14
Basic Spinal Anatomy
• Motion segment
• 2 vertebrae and the disc between the two
• Facet joint
• Junction of the superior and inferior articular
processes of two vertebrae
• Ligaments
• All have pain receptors
(continued)
Figure 14.2
Basic Spinal Anatomy (continued)
• Discs
• Allow increased mobility in vertebrae
• Contain a central nucleus
• Surrounded by connective tissue fibers (contain pain
receptors)
• Spacers are shock absorbers
• Avascular
Figure 14.3
Normal Curvatures of the Spine
• Lordotic (concave)
• Cervical and lumbar
• Kyphotic (convex)
• Thoracic
Presence of both assist disc in cushioning
compressive forces; balance of the curves
is called neutral spine
Functional Versus Structural Curves
• Functional
• Can be removed by assuming a posture that takes away
the force responsible for the curve
• Structural
• Remain even when the force responsible for the
curve is taken away
• Commonly caused by unhealthy posture over
extended time
• Can make some exercises difficult (e.g., curl-ups)
• Exaggerations may increase stress in low back
Spinal Movement
• Flexion
• Occurs with straightening of the lumbar spine (each
lumbar vertebra rotates to a neutral position)
• After it straightens, no further spinal flexion takes place
• Extension
• Movements are not as common as spinal flexion
• Greater loss in ROM with aging versus flexion
• Prolonged sitting often results in loss of normal
lordotic curve (greater compressive force on discs)
(continued)
Spinal Movement (continued)
• Lateral flexion and rotation
• Movements that combine bending and rotation
• Avoid ballistic movements while performing these
movements
Lateral Curvature (Scoliosis)
• Small, lateral deviations may occur
• Sometimes due to hand dominance
• Major lateral curves
• Not generally correctible with therapeutic exercise
• Inappropriate exercise RX can worsen scoliosis
• Bracing is generally used in treating young adults
• Internal fixation is generally required in adults
Mechanics of the Spine and Hip Joint
• Sacrum is the foundation of the 24 vertebrae
• Pelvic position is important to spinal integrity
• Tightness in muscles crossing hip joint may
interfere with abdominal muscular control of
pelvic position
Figure 14.6
Low-Back Problems:
Adults Versus Youth
• Adults
• Acute pain is commonly caused by damage to discs
• Disc injury is usually microtraumatic and occurs over time
• Preventing LBP: maintaining fitness, strengthening trunk
musculature
• Youth
• LB problems are not usually disc related
• LB problems usually originate in vertebral articular
processes
(continued)
Low-Back Problems:
Adults Versus Youth (continued)
• Spondylolysis—stress fracture in part of vertebra
• Spondylolisthesis—complete fracture on both sides
of a spinous process
• Often results in anterior displacement (slippage) over the
vertebra below
• Most likely cause of LBP in those <26 years of age
Core Stability (Spinal Stabilization)
• Trunk musculature stabilizes the core
• Vertebrae, discs, rib cage, pelvis, and associated
connective tissue
• Spinal (erector spinae, multifidus, quadratus
lumborum) and abdominal (rectus abdominis,
internal and external obliques, transversus abdominis)
musculature contribute to core stability
• Enhances athletic and work-related
activities
Common CS Exercises
• Quadruped
• Low compression force on discs
• Likely improves endurance more than it does
strength
• Horizontal isometric bridge
• Little compressive pressure on discs
• Emphasizes strength and endurance
• Incorporates quadratus lumborum, lateral
abdominals
(continued)
Common CS Exercises (continued)
• Roman chair
• Higher compressive force on discs
• Develops extensor muscles of spine
• Modified equipment exists for those with acute LBP
or other LB issues
• Generally, normal limits of lordosis should not be
exceeded
Exercises Involving Abdominal Wall
• Rectus abdominis directly controls the tilt
of the pelvis
• Emphasized in crunch-type activities
• Higher compressive forces on the discs
• Lateral abdominal muscles
• Transversus abdominis, internal and external
obliques
• Brace the trunk to prevent undesired rotation
• Diagonal crunches, side bridge