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Not all back patients need to do dead bug exercises. Difficulty with these exercises means poor stabilization. Exercises should be part of the program until performed correctly. This progression includes trunk stabilization in supine, quadruped, standing, and functional activities.
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Dead Bug Exercises Not all back patients need to do dead bug exercises. Difficulty with these exercises means poor stabilization. Exercises should be part of the program until performed correctly. Only the extremities move during exercise.
Dead Bug Exercise Substitutions Hips are allowed to roll. Patient rolls from side to side. Lumbar spine moves. Abdominal and gluteal muscles do not remain tense. Pelvic neutral is not maintained.
Dead Bug Exercise Progression • Trunk stabilization in supine with arm or leg movement, then both • Trunk stabilization in quadruped with arm or leg movement, then both • Trunk stabilization in standing with arm or leg movement, then both • Trunk stabilization during functional activities
Core Stability Also known as: • Pelvic stability • Spinal stability • Trunk stability • Lumbar stability
Systems of Support for Stability • Inert tissues offer passive support. • Contractile tissues provide active support. • Neural tissues coordinate sensory feedback. • One or more systems may compensate for another system’s deficiencies, but increased stresses can result.
Added Sources of Stabilization • Thoracolumbar fascia • Quadratus lumborum • Latissimus dorsi • Gluteus maximus and medius
Stabilization of Lumbar Spine Abdominal muscles • Superficial (rectus abdominis): prime movers of trunk flexion, not stabilizers • Deep (transverse abdominis): primary stabilizers • Not often well conditioned • Primary stabilizers of trunk during overhead and lower-limb activity • Assistance from obliques
Stabilization Spine patients should be assessed for posture Stabilization requires strength of: Transverse abdominis Internal obliques Multifidus Lateral and posterior hip muscles Core muscles
Pelvic Stabilization • During sports: abdominal muscles and back extensors—essential for trunk stabilization to serve as base of support for arm and leg movement • In rehab: trunk stability before trunk muscle performance
Other Factors • Just as trunk stabilization serves as a platform for arm and leg activities, hip stabilization serves as a platform for trunk movement. • Consider hip extensors, abductors, and adductors in rehab.
Lumbar Neutral • Refers to overall movement of the lumbar spine, not movement between vertebrae • Lumbar neutral = midway between full flexion and full extension via anterior-posterior pelvic tilting • Basic to stabilization • Places minimal stress on tissues • Best position from which trunk functions
Finding Pelvic Neutral • Start in sitting, supine, or standing. • Fingers on anterior superior iliac spine (ASIS). • Roll pelvis as far as possible forward. • Roll pelvis as far as possible backward. • Rock from each extreme to find the middle of the motion.
First Exercise to Hold Pelvic Neutral • Start in supine hooklying position. • Place blood pressure cuff under lower lumbar spine. • Find pelvic neutral. • Inflate cuff to 40 mmHg. • Tighten gluteal muscles. • Tighten abdominal muscles. • Cuff inflation should remain steady throughout exercises
Exercise Cues to Facilitate Multifidus • Keep pelvic neutral position. • Tighten pelvic floor muscles: Tighten as if stopping urination midflow.
Exercise Cues to Facilitate Transverse Abdominis • Pull navel to spine. • Keep pelvic neutral position. • Place hand on ASIS or sternum or belly for feedback. • Pull in stomach harder as arm or leg moves away from body’s center. • Stop when position is lost.
Early Exercise • Start with feet off floor, hips and knees flexed. • Lower one foot, then the other. • Gradually land foot away from buttock.
Early Quadruped Exercise • Lift one leg, opposite arm. • Can add resistance.
