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.

• Fracture • Ligamentous Injury • Low back strain/sprain • Herniated Disk During 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 (after trauma)

Major Diagnostic Possibilities (without trauma) • Degenerative Disk Disease

• Lumbar Arthritis • Infection • Tumors • Spinal Deformities Lumbar Arthritis esp. ĉ Stenosis– unilateral leg weakness Spinal Stenosis – loss of lumbar lordosis Lumbar 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.

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

How to maintain spinal stability?

• 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 Programmehas been • Divided into 3 stages and
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 abdomina ls & 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!