The Spine: Exercise Interventions

1. The Spine: Exercise Interventions Chapter 16

2. Basic concepts of spinal management with exercise

3. 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

4. Patient Education • Active Participation • Limitations at Each Stage of Healing • Safe Self-Management Instruction • Prevention

5. General Exercise Guidelines • Kinesthetic Awareness • Mobility/Flexibility • Muscle Performance • Cardiopulmonary Endurance • Functional Activities

6. KINESTHETIC AWARENESS

7. 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

8. 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

9. Mobility/flexibility

10. 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

11. 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

12. Cervical Joint Manipulation Techniques • Grading I–V: Definitions • Precautions • Contraindications

13. 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

14. Muscle Energy Techniques to Increase Craniocervical Mobility • To Increase Craniocervical Flexion • To Increase Craniocervical Rotation

15. 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

16. 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

17. Thoracic and Lumbar Joint Manipulation and HVT Techniques (cont'd) • Rib Manipulation for Inspiratory Restriction • Rib Manipulation for Expiratory Restriction • Elevated First Rib Manipulation

18. 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

19. 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

20. Muscle performance:stabilization, muscle endurance,and strength training

21. Stabilization Training: Fundamental Techniques and Progressions • Guidelines for Stabilization Training

22. Deep Segmental Muscle Activation and Training • Cervical Musculature • Deep neck flexors • Lower cervical and upper thoracic extensor • Progression

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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)

29. Cardiopulmonary Endurance

30. 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”

31. Functional Activities

32. 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

33. 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

34. Preparation for Functional Activities: Basic Exercise Techniques (cont'd) • Transitional Stabilization Exercises • Quadriped forward/backward shifting • Squatting and reaching • Shifting weight and turning

35. Body Mechanics and Environmental Adaptations • Principles of Body Mechanics: Instruction and Training • Lumbar spine position • Spinal flexion • Spinal extension • Load position

36. Body Mechanics and Environmental Adaptations (cont'd) • Environmental Adaptations • Home, work, and driving considerations • Sleeping environment

37. Intermediate to Advanced Exercise Techniques for Functional Training • Repetitive Lifting • Repetitive Reaching • Repetitive Pushing and Pulling • Rotation or Turning • Transitional Movements • Transfer of Training

38. Education for Prevention • Continual Throughout the Rehabilitation Process • Relationships of Posture and Pain • Home Exercise Program • Flexibility • Muscle endurance • Strengthening • Cardiopulmonary

39. Independent Learning Activities • Critical Thinking and Discussion • Laboratory Practice • Case Studies