Transcript Therapeutic Exercise: Foundations and Techniques, 6th Edition

The Spine: Exercise
Interventions
Chapter 16
Part IV: Exercise Interventions by Body
Region
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BASIC CONCEPTS OF SPINAL
MANAGEMENT WITH EXERCISE
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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
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Patient Education
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Active Participation
Limitations at Each Stage of Healing
Safe Self-Management Instruction
Prevention
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General Exercise Guidelines
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Kinesthetic Awareness
Mobility/Flexibility
Muscle Performance
Cardiopulmonary Endurance
Functional Activities
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KINESTHETIC AWARENESS
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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
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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
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MOBILITY/FLEXIBILITY
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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
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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
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Cervical Joint Manipulation
Techniques
 Grading I–V: Definitions
 Precautions
 Contraindications
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Cervical Joint Manipulation
Techniques (cont'd)
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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
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Muscle Energy Techniques to
Increase Craniocervical Mobility
 To Increase Craniocervical Flexion
 To Increase Craniocervical Rotation
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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
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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
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Thoracic and Lumbar Joint Manipulation
and HVT Techniques (cont'd)
 Rib Manipulation for Inspiratory Restriction
 Rib Manipulation for Expiratory Restriction
 Elevated First Rib Manipulation
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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
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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
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MUSCLE PERFORMANCE:
STABILIZATION, MUSCLE
ENDURANCE, AND STRENGTH
TRAINING
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Stabilization Training: Fundamental
Techniques and Progressions
 Guidelines for
Stabilization Training
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Deep Segmental Muscle Activation
and Training
 Cervical Musculature
– Deep neck flexors
– Lower cervical and upper thoracic extensor
– Progression
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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
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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
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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
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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
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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
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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)
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CARDIOPULMONARY ENDURANCE
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Common Aerobic Exercises and
Effects on the Spine
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Cycling
Walking and Running
Stair Climbing
Cross-Country Skiing and Ski Machines
Swimming
Upper Body Ergometers
Step Aerobics and Aerobic Dancing
“Latest Popular Craze”
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FUNCTIONAL ACTIVITIES
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Early Functional Training:
Fundamental Techniques
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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
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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
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Preparation for Functional Activities:
Basic Exercise Techniques (cont'd)
 Transitional Stabilization Exercises
– Quadriped forward/backward shifting
– Squatting and reaching
– Shifting weight and turning
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Body Mechanics and
Environmental Adaptations
 Principles of Body Mechanics: Instruction and
Training
– Lumbar spine position
– Spinal flexion
– Spinal extension
– Load position
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Body Mechanics and Environmental
Adaptations (cont'd)
 Environmental Adaptations
– Home, work, and driving considerations
– Sleeping environment
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Intermediate to Advanced Exercise
Techniques for Functional Training
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Repetitive Lifting
Repetitive Reaching
Repetitive Pushing and Pulling
Rotation or Turning
Transitional Movements
Transfer of Training
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Education for Prevention
 Continual Throughout the Rehabilitation
Process
 Relationships of Posture and Pain
 Home Exercise Program
– Flexibility
– Muscle endurance
– Strengthening
– Cardiopulmonary
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Independent Learning Activities
 Critical Thinking and Discussion
 Laboratory Practice
 Case Studies
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