!"#$%& ()*+%, (-%$*,*.

%/0+ 123&%)4 56786789:

12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

9
!"#$%&'()"&(* (),
-%./#0'12"#*#3"&(* 4'%#/1
5)'()&%, 61 7%2%(/&' 58",%)&%
! Ceiiifed Manual Plysical Tleiapisi (CMPT) iliougl
ile Noiil Ameiican Insiiiuie of Oiilopedic Manual
Tleiapy (NAIOMT).

! Masiei of Science in Plysical Tleiapy (MSPT)
Univeisiiy of Souil Daloia
! BA in Biology Augusiana College

! To Defne Biomeclanical Types of Spinal Siabiliiy
and Insiabiliiy.
! To Discuss Evaluaiion]Assessmeni Findings foi
Siabilizaiion Tieaimeni.

! To Discuss Tle Role of ile Neuiomusculai
Sysiem in Spinal Siabilizaiion.
! To Review Peiiineni Anaiomy.

! To Discuss Siabilizaiion Tleiapy ] Exeicises.
Biomeclanical
Defniiions of Spinal
Siabiliiy and
Insiabiliiy
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

7
Passive
Siabilizeis
Aciive
Siabilizeis
Moioi
Coniiol
Bones, }oinis, Ligamenis, Disc.

Piovides siiness, mosily ai end
iange of moiion
Muscles and Tendons.

Coniiibuie io siiness iliougloui
iange of moiion
Neivous Sysiem coniiol of aciive
siabilizeis.

Cooidinaies conceniiic and,
ecceniiic coniiaciions along wiil
isomeiiic co-coniiaciions of
muscles.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

:
"Tle funciional iniegiaiion of ile
passive spinal column, aciive spinal
muscles, and ile neuial coniiol unii in
a mannei ilai allows ile individual io
mainiain ile inieiveiiebial neuiial
zones wiilin plysiological limiis,
wlile peifoiming aciiviiies of daily
living." (Liemoln ei al. :oo)
Ligamenious laxiiy, spondylolysis,
spondylolisilesis, degeneiaiive disc
disease (DDD) and ]oi degeneiaiive
joini disease (D}D) ilai pioduces
excessive (non-plysiological)
movemeni of ile spine.
! Evidence on imaging.
! MD diagnosis.

Posiiive Clinical Examinaiion
Signs of Insiabiliiy.



Hisioiy Findings:
! Episodic LBP
Ofien piogiessively woisening. Bui may be fisi episode.
! Subjeciive Ciepiius, Clunl, oi "Giving Away" wiil Bending oi
Twisiing.
! Gieaiei Pain Reiuining Fiom Flexion, Tlan Wiil Flexion.
! Diculiy Clanging Posiiions (Caicling, Locling, Pain):
Rolling in bed, supine io sii, sii io siand, eic.
! Discomfoii Oi Pain Wiil Unsuppoiied Siiiing Oi Susiained Posiiions.
! Inciease Pain Wiil Sudden oi Mild Movemenis.
! Piioi good bui sloii ieim ielief wiil manipulaiion.
Fiequenily Feeling Need io "Ciacl oi Pop" Bacl.
! Relief wiil immobilizaiionbiacing.




!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

5
Dieieniial Diagnosis ] Scanning Examinaiion
Findings:
! (+)Abeiiani Spinal Moiion wiil AROM Tesiing.
Gowei's Sign: walling up iligls.
! (+) Excessive ROM and ]oi Pain ai End Noimal ROM.
! (+) H 8 I Tesis: Combined Movemeni]Quadiani Tesis.
! (+) Objeciive Ciepiius oi Clunl Wiil ROM oi Oilei Tesis.
! (+) Pione PA Piessuies: Piovocaiive noi Hypomobile.
! (+) Pione Insiabiliiy Tesi (PA + PA wiil exiensoi coniiaciion).
! (+]-) Piimaiy (Geneial) Siiess Tesis:
Tiaciion, Compiession, Toision.
! (+]-) Diieciional Piefeience oi Ceniializaiion:
Ofien insiabiliiy pain wiil susiained posiiions.



(+) Biomeclanical Examinaiion Insiabiliiy Findings.

i. Passive Plysiological Iniei-Veiiebial Movemenis (PPIVM)
oi Passive Plysiological Movemenis (PPM) in peiipleial
joinis

:. Passive Accessoiy Iniei-Veiiebial Movemenis (PAIVM)
oi Passive Accessoiy Movemenis (PAM) in peiipleial
joinis---GLIDES

. Secondaiy Siiess Tesi (Segmenial oi }oini Siabiliiy Tesis).



(+) Biomeclanical Examinaiion Insiabiliiy Findings.
! If PPIVM oi PPM Tesis aie Negaiive (-) foi
lypomobiliiy, ilen joini movemeni is noimal OR
! If PPIVM oi PPM Tesis aie (-) bui moiion is feli io
be excessive (wlicl is ofien diculi io assess) oi
ciepiius is pieseni ilen a joini insiabiliiy oi
lypeimobiliiy is suspecied.
! PAIVM oi PAM would be also be (-) oi excessive.
! Secondaiy (Segmenial oi }oini Siabiliiy) Siiess
Tesis aie needed.
(+) Biomeclanical Examinaiion Insiabiliiy Findings.
! (+) Secondaiy (Segmenial]}oini Siabiliiy) Siiess Tesis:
i) Anieiioi Sleai (plus Iliolumbai Ligameni Siiess Tesi).
:) Posieiioi Sleai
) Lefi and Rigli Toision
() Laieial Sleai

! (+) = Excessive Moiion (diculi io feel).
Incieased Pain and]oi Muscle Guaiding.
Caicling]Clicling]Clunling]Ciepiius.

Ofien feli wiil PPIVM(PPM) and]oi PAIVM(PAM).
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

F
! Tiaciion.
! Specifc Exeicise:
Diieciional Piefeience]Ceniializaiion.

! Manipulaiion (Noi Manual Tleiapy]Mobilizaiions).
! Siabilizaiion.
(oiiginal: Deliiio ei al iqq; Updaied Fiiiz ei al :ooy)

(+) TBC foi Tiaciion (pievalence q%).
! Slould noi be Widely Used (Fiiiz ei al :ooy).
! Coniciing Evidence (D Raied) Suppoiiing Iis Use
}OSPT LBP Clinical Guidelines.

! Can considei Tiaciion if :
i) sympioms of neive iooi compiession and
:) no movemenis ceniialize sympioms.
(+) TBC foi Specifc Exeicise]Diieciional Piefeience]
Ceniializaiion: (pievalence iy-(y%; oi y(-Sq%)
! Diieciional Piefeience Exiension:
i) Sympioms disial io buiiocl.
:) Sympioms ceniialize wiil exiension.
) Sympioms peiipleialize wiil exion.
! Diieciional Piefeience Flexion:
i) Oldei ilan o y]o.
:) Imaging evidence of lumbai spinal sienosis.
) Sympioms deciease]ceniialize wiil exion.
! Laieial Slifi:
i) Visible fionial plane deviaiion (slouldei vs pelvis).
:) Sympioms deciease]ceniialize wiil slifi coiieciion.

(+) TBC foi Manipulaiion (NOT oilei manual ileiapy).
Manipulaiion CPR: (+) (]. (pievalence :-q%)
! No sympioms disial io lnee.
! Receni onsei of sympioms (<i6 days).
! Low FABQW (<iq).
ALL PROGNOSTIC
! Hyomobiliiy of lumbai spine: BIOMECHANICAL.
! Hip IR > in ai leasi one lip.
HIP and]oi SI SCREEN?

some jusi using ilese : ciiieiia----REALLY?
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

G
Piesences of a Fixaiion Hypomobiliy:
! (+) Hisioiy
! (+) Scanning Exam: Resiiicied ROM ] Hypomobiliiy:
AROM, Quadiani Tesis (H 8 I), 8 PA.
! (+) Biomeclanical exam: Hypomobiliiy:
PPIVM, PAIVM, 8 fxaiion endfeel.

! AND (-) coniia-indicaiions foi manipulaiion.
! Lumbai, Tloiacic, 8 Sacioiliac }oinis Assessed.

Manual Tleiapy "CPR": Piesense of a Capsulai Hypomobiliiy:
! (+) Hisioiy
! (+) Scanning Exam: AROM, quadiani iesis, 8 PA: lypomobile.
! (+) Biomeclanical exam: PPIVM, PAIVM, 8 capsulai endfeel.
! AND (-) coniia-indicaiions foi manual ileiapy.
OR Piesence of a Myofascial Hypomobiliiy:
! (+) Hisioiy
! (+) Scanning Exam: AROM, quadiani iesis, 8 PA: lypomobile.
! (+) Biomeclanical exam: PPIVM, PAIVM, 8 myofascial endfeel.
! AND (-) coniia-indicaiions foi manual ileiapy.
(+) TBC foi Siabilizaiion Tleiapy
Siabilizaiion CPR = (+) ]( (pievalence i-:6%)
! Youngei Age (<(o yeais old).
! Gieaiei Geneial Flexibiliiy:
Aveiage SLR ROM >qi Degiees; Posipaiium.
! "Insiabiliiy Caicl" oi Abeiiani Movemenis Duiing
Lumbai Flexion]Exiension ROM.
! (+) Pione Insiabiliiy Tesi.
(Hicls ei al :oo]Fiiiz ei al :ooy)
A Compaiison of Seleci Tiunl Muscle Tliclness Clange
Beiween Subjecis Wiil Low Bacl Pain Classifed in ile
Tieaimeni Based Classifcaiion Sysiem and Asympiomaiic
Coniiols. }OSPT Oci :ooy. Kiesel ei al.
! All iieaimeni based classifcaiions lave
neuioplysiological wealness of lumbai siabilizeis:
Tiansveise Abdominis (TiA) and Lumbai Muliifdus (LM).
! TiA and LM wealness is signifcani wlen compaiing LBP
paiienis io asympiomaiic coniiols, bui noi dieieni
beiween subjecis in dieieni iieaimeni based caiegoiies.
! Moioi coniiol defciis may, in paii, be caused by pain,
iiiespeciive of ile souice.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

H
Evaluaiion of a iieaimeni-based classifcaiion algoiiilm foi
low bacl pain: A cioss-seciional siudy. Plys Tlei. :oii; qi:
(q6-oq. Sianion TR ei al.
! Impoiiani foi conieni validiiy of TBC foi ileie io be
exlausiiveness (all fi) and muiual exclusiviiy (inio only i).
! :% of paiienis did noi mei TBC ciiieiiaFAIL.
! :% of paiienis meei moie ilan one TBCFAIL.
! o% of paiienis mei ciiieiia foi one TBC.
! Hieiaicly io assisi wiil >i TBC being mei
(oi muliimodal PT piomoiion)
! No TBC mei: Add new TBCs; iefne exisiing TBC ciiieiia
(Manual Tleiapy, Eldeily, Clionic)
Wlai Claiacieiizes People Wlo Have an Uncleai
Classifcaiion Using a Tieaimeni-Based Classifcaiion
Algoiiilm foi LBP? A Cioss-Seciional Siudy. Plys Tlei.
:oi; q:(-. Sianion TR ei al.
! Uncleai classifcaiion foi appioximaiely (:.y% (q%
Acuie]subacuie and 6:.y% Clionic) of people wiil
LBP.TBC Failuie.
! People wiil uncleai classifcaiion appeai io be less
aecied by LBP (less disabiliiy and fewei feai
avoidance beliefs), despiie iypically laving a longei
duiaiion of LBP (clionic ] > monils duiaiion).
! Add classifcaiions]iefne exisiing TBC.
Reliabiliiy of a iieaimeni-based classifcaiion sysiem foi
subgiouping people wiil low bacl pain. }OSPT. Sepi :oi:;
(:(q): yqy-So. Heniy SM ei al.
! Inieiiaiei ieliabiliiy is modeiaie io good.
! Tlis does noi mean ilai ile iieaimeni will woil; jusi ilai
PT's can caiegoiize paiienis faiily well.
! Conicis beiween siabilizaiion and manipulaiion TBC.
! Conicis beiween specifc exeicise and siabilizaiion TBC.
! Clinical Realiiy: Muliimodal PT needed.
Nevei is ii going io be as simple a CPR.
Vaiiables associaied wiil level of disabiliiy in woiling
individuals wiil non-acuie LBP: A cioss-seciional
invesiigaiion. }OSPT. Feb :oi; ((:): qy-io(.
Davis DS ei al.
! Evidence does noi suppoii use of impaiimeni based
iieaimenis foi non-acuie LBP.
(Tiue Clionic Pain Paiienis)
! Evidence does noi suppoii ile use of iieaimeni based
classifcaiion sysiems foi non-acuie LBP.
(Tiue Clionic Pain Paiienis)
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

I
! "Paiienis wiil low bacl pain ofien fi inio moie ilan i
impaiimeni ] funciion-based caiegoiy, and ile mosi
ielevani impaiimeni of body funciion, piimaiy
inieiveniion siiaiegy, and ile associaied
impaiimeni ] funciion-based caiegoiy(-ies) aie
expecied io clange duiing ile paiieni's episode of
caie" (}OSPT LBP Guidelines :oi:).

! Hieiaicly Of TBC: (Tiaciion), Specifc Exeicise,
Manipulaiion, Siabilizaiion.
! SI joini pain is noi ile same iling as SI joini
dysfunciion: can lave pain wiil]wiiloui dysfunciion
and can lave dysfunciion wiil]wiiloui pain.
! SI }oini Scanning Exam: Piimaiy Siiess (Piovocaiive)
Tesis.
! SI }oini Biomeclanical Exam: Moiion]Kineiic Tesis
(WB 8 NWB), Posiiion Tesis (Sianding and Supine),
PAM]endfeels]glides, 8 Secondaiy Siiess
(Ligamenious]}oini Siabiliiy) Tesis.
! SI }oini Pain CPR: (+) ] Piovocaiive Tesis.
! Hip 8 Tloiacic Spine Examinaiions aie Paii of Tle
Lowei Quaiiei Scanning Examinaiion.
! Hip and Tloiacic Deiailed Biomeclanical
Examinaiions if Waiianied.
! Regional Meclanical Inuences Can Impaci Injuiy
and Recoveiy (Causaiions and Complicaiions).
Siabilizaiion Siiengil ] Enduiance Tesiing.
LBP Clinical Guidelines :oi: }OSPT: Abdominal Tesis:
! Tiunl Flexois:
Double Siiaigli Leg Loweiing wiil Posieiioi Pelvic Tili.
Measuie disiance fiom leel io iable wlen PPT is losi.
! Tiansveisus Abdominis:
Pione ovei a piessuie biofeedbacl unii inaied io yo
mmHg. Insiiuciions io diaw in abdominal wall x io
seconds and max deciease in piessuie is iecoided.
! Laieial Abdominals:
Timed iiial of side planl fiom lnees.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

J
Siabilizaiion Siiengil ] Enduiance Tesiing.
Oilei Abdominal Tesis:
! Abdominal Biacing:
Time iiial of lold iiunl exion ai 6o degiees.
! Ciuncl:
Reps] i minuie.
! Planl Enduiance:
Time iiial of planl posiiion.
! Side Planl Enduiance:
Time iiail of side planl posiiion (on feei noi lnees).
Siabilizaiion Siiengil ] Enduiance Tesiing.
LBP Clinical Guidelines :oi: }OSPT: Lumbai Exiensois:
! Tiunl Exiensois:
Time iiial of pione clesi lifi (lumbai exiension) io
appioximaiely o degiees.

Siabilizaiion Siiengil ] Enduiance Tesiing.
Oilei Lumbai Exiensoi Tesis:
! Roman Claii Enduiance ] Soiensen Tesi:
Time iiial of paiallel posiiion io ooi being leld.
! Roman Claii Enduiance ai Vaiiable Angles.
Time iiial of non-paiallel posiiions being leld.
! Roman Claii Repeiiiions ] Minuie.
! Pione Double Siiaigli Leg Raise.
Time iiial
! Quadiuped Alieinaiion UE]LE lifis.
Obseive coniiol wiil UE, LE, and UE]LE lifis.


Failuie of ile aciive siabilizeis and
moioi coniiol sysiem io mainiain
spinal movemeni in ile "neuiial zone".

! A muscle oi piopiiocepiive defcii is
pieseni.
! Sympioms of insiabiliiy pieseni.
! Funciional insiabiliiy can lead io
siiuciuial insiabiliiy.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

98
Tle siabilizaiion sysiem of ile spine. Paii II. Neuiial zone
and insiabiliiy lypoilesis. } Spinal Disoid. iqq:; : qo-q6;
discussion qy. Panjabi MM.

! A loss of moioi coniiol ovei mid-ROM of ile joini wleie
ineii siiuciuies play no iole in movemeni consiiainis.
! Ii is caused by pain oi ieex inlibiiion and may piogiess
io lypeimobiliiy oi end-zone (aiiiculai oi ligamenious)
insiabiliiy wiil poieniial pain and dysfunciion iesuliing.
! Tlis occuis as meclanoiecepiois become damaged by
abusive movemeni paiieins.
! Tleie will be a loss of segmenial muscle bull, pooi
segmenial muscle aciivaiion, and pooi global movemeni
coniiol.
! Neuiial Zone Insiabiliiy migli noi be sympiomaiic.
! May lave clinical insiabiliiy wiiloui funciional oi
siiuciuial insiabiliiy.

! May lave funciional insiabiliiy wiiloui clinical
insiabiliiy oi siiuciuial insiabiliiy fndings.

! May lave siiuciuial insiabiliiy fndings on imaging
wiil oi wiiloui clinical insiabiliiy fndings and be
funciionally siable.
Tle siabilizaiion sysiem of ile spine. Paii i. Funciion,
dysfunciion, adapiaiion, and enlancemeni. } Spinal
Disoid. iqq:; : S-Sq; discussion qy. Panjabi MM.

! Tle siabiliiy of ile spine is noi solely dependeni on
ile basic moiplology of ile spine, bui also ile
coiieci funciioning of ile neuiomusculai sysiem.
! If ile basic moiplology of ile lumbai spine is
compiomised ile neuiomusculai sysiem may be
iiained io compensaie and io piovide dynamic
siabiliiy of ile spine duiing ile demands of daily
living.

! Funciional siabiliiy is ielaiive.

! Ailleie veisus consiiuciion woilei
veisus oce woilei.
! :o yeai old veisus (o yeai old veisus
6o yeai old.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

99
Appiopiiaie Use of Diagnosiic Imaging in Low Bacl Pain:
A Remindei Tlai Unnecessaiy Imaging May Do as Mucl
Haim as Good. }OSPT. Novembei :oii. Flynn, TW ei al.

! Oveiuiilizaiion of lumbai imaging coiielaies wiil, and
lilely coniiibuies io, a :- io - fold inciease in suigical
iaies ovei ile lasi io yeais.
! Paiieni's lnowledge of imaging abnoimaliiies can aciually
deciease self-peicepiion of lealil and may lead io feai-
avoidance and caiasiioplic belaviois ilai may piedispose
people io clioniciiy.
! Rouiine imaging and oilei iesis usually cannoi ideniify
ile piecise cause of pain; do noi impiove paiieni
ouicomes; and incui addiiional expenses.
! Tleie is no compelling evidence ilai abnoimal
fndings on imaging indicaies a piolonged couise of
impaiimeni oi disabiliiy.
! Musi fiequenily clange ile paiieni's belief ilai ileii
LBP will noi impiove unless ile imaging impioves.

! Wiil ligl feai-avoidance beliefs, ileie is a need io
bieal ile cycle of inaciiviiy, disuse, and incieased
disabiliiy.
(Flynn ei al :oii)
Spinal Muscle Evaluaiion Using ile
Soiensen Tesi: A Ciiiical Appiaisal of
ile Liieiaiuie. }oini Bone Spine.
y (:oo6): (-o. Demoulin, C ei al
Can Disciiminaie Clionic LBP
Paiienis Fiom Healil Individuals.
May Be Piediciive of Occuiience of
LBP Wiilin a Yeais Time.
! Soiensen Tesi: In Many Siudies Enduiance Time was
Signifcanily Decieased in Paiienis wiil Clionic LBP.
! Clionic LBP Paiienis aie Associaied wiil Decieased
Isomeiiic Enduiance of Tiunl Exiensoi Muscles.
! Less ilan S seconds lold lave x incieased iisl of
LBP veisus lold iime gieaiei ilan io( seconds.
! Less ilan iy6 seconds moie lilely io lave LBP wiilin
a yeai.
! Gieaiei ilan iqS seconds less lilely io lave LBP.
(Demoulin. :oo6)
! o-6o seconds pooi; i-: minuies faii; :- minuies good;
gieaiei ilan minuies noimal.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

97
Scieening ile Lumbopelvic Muscles foi a Relaiionslip
io Injuiy of ile Quadiiceps, Hamsiiings, and Adducioi
Muscles Among Ausiialian Fooiball League Playeis.
}OSPT. Ociobei :oii. Hides, }A ei al.
! Muscle asymmeiiy (ielaiive io ile piefeiied licling
leg) and abdominal funciion (diawing-in maneuvei)
ai ile siaii and end of pieseason iiaining weie noi
ielaied io injuiy.
! Muliifdus muscle size slowed a signifcani
ielaiionslip wiil pieseason injuiy.
! Resulis indicaie ilai playeis wlo susiained a seveie
lamsiiing, gioin, oi quadiiceps injuiy duiing ile
pieseason iiaining lad signifcanily smallei
muliifdus muscles ai ile siaii and end of ile
pieseason compaied wiil playeis wiil no injuiy.
! Baseline cioss seciional aiea of ile muliifdus muscles
ai ile L level piedicied lamsiiing, gioin, oi
quadiiceps injuiy in S.% of cases.
(Hides, }A ei al :oii)
! Example of Neuiial Zone Insiabiliiy.
! Pooi siiengil and moioi coniiol (delayed aciivaiion)
of muliifdus leading io exiia demands (compensaioiy
movemenis) of lowei exiiemiiy muscles io siabilize
ile pelvis?
! Ceniial]peiipleial sensiiizaiion]faciliiaiion:
Adduciois (L:-), Quadiiceps (L-(), Hamsiiings (L-
Si) iesuliing in lypeiioniciiy ("iigliness" and
uliimaiely wealness) piedisposing muscles foi
siiains?
Eecis of siabilizaiion iiaining on muliifdus muscle
cioss-seciional aiea among young eliie ciicleieis wiil
LBP. }OSPT. Maicl :ooS. S(); ioi-ioS. Hides } ei al.
! Despiie iigoious iiaining piogiam, eliie ailleies wiil
lisioiy of LBP may coniinued io lave impaiimenis of
ile muliifdus muscle (decieased CSA).
! Specifc siabilizaiion exeicises incieased ile CSA of
ile muliifdus muscle ai L.
! Muliifdus aiioply and pain ielaied io LBP can be
ieveised using specifc siabilizaiion exeicises.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

9:
4'% 7#*% #9 :'%
-%./#$.2&.*(/
;12:%$ ")
;0")(* ;:(6"*"<(:"#)
! Conceniiically sloiien io piovide mobiliiy
! Ecceniiically lengilen io piovide coniiol of moiion
iliougl deceleiaiion
! Isomeiiically lold foi siabilizaiion
! Piovide piopiiocepiive inpui io ile ceniial neivous
sysiem foi cooidinaied movemeni
=> ?.2&*% 4#)%@;:"A)%22B
Muscle spindle sysiem coniiol of
slow iwiicl fbei coniiaciion.

! Inciease segmenial siiness and
coniiol excessive iniei-segmenial
moiion ] iianslaiion wiil muscle ione
iesisiance.



C> D#E&#):/(&:"#)B
Agonisi and aniagonisi muscle co-
coniiaci on eiilei side of spine aci as
"iension spiings" io coniiol moiion of
spine joinis.
! Tlis involves isomeiiic coniiaciion wiil
small conceniiic]ecceniiic coniiol
plases foi eacl spinal segmeni's moiion.

!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

95
F> G%%,6(&H /%20#)2%B
Ligameni]muscle Reex.
Neuiological inpui fiom iecepiois
in muscles] ligamenis] discs]
joinis of spine lelp iegulaie
muscle aciiviiy.

! Pioieciive iesponse io peiiuibaiions
and wlen appioacling end iange of
moiion.
I> G%%,9#/J(/, /%20#)2%B
Aniicipaioiy iesponse in many
diieciions piioi io funciional
loading of ile spine.

! Posiuial muscles coniiaci piioi io
limb muscles, pioviding a siable
spine]iiunl duiing exiiemiiy
movemeni.
A Magneiic Resonance Imaging Invesiigaiion of ile
Tiansveisus Adominis Muscle Duiing Diawing-in of ile
Adominal Wall in Eliie Ausiialian Fooiball League
Playeis Wiil and Wiiloui Low Bacl Pain. }OSPT. }an
:oio; (o(i): (-io. Hides, }A ei al.

! Tle piesence of LBP alieied ile abiliiy of fooiballeis
io do ile ADIM compaied io ilose wiiloui LBP.
! Reexive iesponses (feed foiwaid and feedbacl) enlance
muscle siiness wiiloui ile meiabolic cosi of sole ieliance
on ile iniiinsic meclanisms and piolonged co-aciivaiion.
! Wiil an appiopiiaie muscle spindle gain seiiing and iiunl
muscle co-aciivaiion level piioi io peiiuibaiion (feed
foiwaid), only minimal ieex iesponses (feedbacl) aie
needed io mainiain dynamic iiunl siabiliiy.
! Tle dynamic iiunl siabiliiy level ilai exisis piioi io
peiiuibaiion and ile ieexive iesponse ilai occuis
following peiiuibaiion combine io inuence composiie
dynamic iiunl siiness and siabiliiy.
(Smiil ei al :ooS)
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

9F
K> L):/(E(6,#$")(* 0/%22./% $#,.*(:"#)>

! Incieased iniia-abdominal piessuie las a diuse
eeci on spinal siabiliiy.
! Incieased iniia-abdominal piessuie occuis as a feed-
foiwaid conscious posiuial siiaiegy duiing lifiing oi
oilei voliiional ligl-loading iasls.
! Can also occui as a ieexive feedbacl iesponse io
sudden ligl loading evenis.

6. Remaining coniinuously aciive
(siabilizing ile spine) iiiespeciive
of ile diieciion of moiion.

! Enduiance is moie impoiiani ilan
siiengil.

! Laige amounis of foice aie NOT needed foi
aciiviiies of daily living oi even geneial, low level
ailleiic aciiviiy--walling, jogging eic. (Beiglund :oio)
! -io% abdominal maximal voliiional isomeiiic
coniiaciion (MVIC) and as low as :% spinal
exiensoi MVIC needed io maximally siabilize ile
spine (Kiblei WB. Spoiis Med :oo6, Smiil ei al :ooS).
! Piolonged aciivaiion ai liglei ampliiudes may
adveisely inciease compiession foices (Smiil ei al :ooS)
! Tleiefoie, do noi need io iiain wiil maximum
(leavy) iesisiance.
! Biomeclanical adapiaiions associaied wiil neuiomusculai
faiigue and spinal muscle siiness may inuence bacl
injuiy iisl.
! Faiigue negaiively inuences muscle spindle belavioi
associaied wiil feedbacl ieexive iesponses.
! Because of ile plysiological cosis associaied wiil an
incieased spinal load and ile peiipleial neuiomusculai
faiigue cieaied by excessive oi piolonged muscle co-
aciivaiion, ile non-impaiied sysiem ielies less on pie-
aciivaiion (feed foiwaid) and moie on ieaciion (feedbacl)
meclanisms io mainiain dynamic siabiliiy.
(Smiil ei al :ooS)
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

9G
! Spinal siabiliiy decieases and iiunl muscle aciivaiion
ampliiudes incieases as iasl iniensiiy incieases.
! Feedbacl delay is a desiabilizing facioi in neuiomusculai
coniiol sysiems and gieaiei linemaiic eiiois fiequenily
occui ai fasiei movemeni velociiies.
! Decondiiion, inlibiiion, oi dysfunciion of muscles
negaiively inuence dynamic iiunl siabilizaiion.
(Smiil ei al :ooS)
! Passive siabilizei injuiy (spiain, leiniaiion, fiaciuie,
DDD]D}D) negaiively inuences spinal siabilizaiion and
puis incieased demand on ile neuiomusculai
componenis.
Swing Kinemaiics in Slilled Male Golfeis Following
Puiiing Piaciice. }OSPT. }uly :ooS; S(y):(:-(.
Evans K ei al.
! Golf swing linemaiics clanges weie obseived
following (o minuies of puiiing poieniially ielaied io
spinal faiigue.
! Soiensen iesi enduiance scoies weie signifcanily
ieduced following (o minuies of puiiing.
! Golfeis wiil liglei BMI weie leasi aecied by puiiing
piaciice faiigue.
! Lumbai Spinal Siabilizaiion ("Coie" Muscles)
! Box of muscles suiiounding ile spine
! Tiansveisus abdominis and inieinal obliques in fioni
! Sloii paiaspinals (muliifdus) and gluieals (gluieus
maximus piimaiily) in bacl
! Pelvic ooi and lip giidle muscles (funciional lip
exieinal ioiaioisPiiifoimis, Glui Max) ile ooi
! Diapliagm is ile ioof
! Psoas: Oiigin on anieiioi suiface of iiansveise
piocesses, veiiebial bodies, disc Ti:-L.
! To avoid excessive segmenial aiiiculai micio-
movemeni.
! To mainiain segmenial neuiial zones.
! To piovide piopiiocepiive inpui io neuiomusculai
sysiemione, co-coniiaciions, feedbacl iesponse,
feed-foiwaid iesponses.
! To ieduce ile compiessive oveiloads.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

9H
Laigei muscles ilai cioss muliiple
spinal segmenis.
Long paiaspinals ]Eiecioi Spinae
Recius abdominis
Exieinal obliques
Uppei]Lowei Exiiemiiy Musculaiuie.
! Piime moveis of ile iiunl and exiiemiiies
! Balance exieinal loads io minimize spinal foices:
Fuiilei ieduce compiessive foices along wiil local
siabilizei muscles.
! Piovide geneial iiunl siabilizaiion (noi segmenial)
! Piovide foices needed foi aciiviiies of daily living
(lifiing, pusling, pulling eic) and ailleiics
! Siabilizaiion exeicises cooidinaies global and local muscle
ieciuiimeni and inuence iniiinsic and ieexive
meclanisms io mainiain ile "neuiial zone" duiing
funciional movemenis.
! Wiil piopei iiaining, spinal siabiliiy can iely less on pie-
aciivaiion]feed foiwaid meclanisms and moie on
ieexive feedbacl meclanism io mainiain dynamic iiunl
siabiliiy.
! Siabilizaiion iiaining is esseniial given ile desiabilizing
inuence and linemaiic eiiois associaied wiil fasiei
ailleiic movemeni, ligl-load iasl.
(Smiil C ei al :ooS)
! Siabilizaiion exeicises aie also esseniial in ile piesence of
passive siiuciuie desiabilizaiion (injuiy]degeneiaiion).
! People wiil LBP aie unable io peifoim ile abdominal
diawing in maneuvei eeciively.
! In ile piesence of LBP, ileie aie muscle subsiiiuiion
paiieins wleie laige ioique pioducing syneigisis lile ile
iecius abdominis occuis piioi io oi wiiloui ile aciivaiion
of local (deep) siabilizing muscles lile ile iiansveius
abdominis.
! Dieieni foims of exeicise can piefeieniially aciivaie and
iiain dieieni muscles wiilin ile abdominal complex.
! Specifc exeicises can aliei muscle aciivaiion ieciuiimeni
paiieins (iaiios) duiing iiunl-loading iasls.
(O'Sullivan ei al iqqS)
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

9I
Passive
Siabilizeis
Aciive
Siabilizeis
Moioi
Coniiol
LBP Guidelines :oi: }OSPT "A" Raied Tieaimenis.
! Specifc Exeicises:
Ceniializaiion and Diieciional Piefeience.
! Manual Tleiapy:
Manipulaiion and Non-iliusi Mobilizaiion.
! Siabilizaiion Exeicises
! Piogiessive Enduiance Exeicise and Fiiness Aciiviiies:
Global siabilizaiion.
LBP Guidelines :oi: }OSPT.
! "Clinicians slould considei uiilizing iiunl
cooidinaiion, siiengilening, and enduiance exeicises
io ieduce low bacl pain and disabiliiy in paiienis wiil
subacuie and clionic low bacl pain wiil movemeni
cooidinaiion impaiimenis and in paiienis posi-
lumbai miciodisceciomy."
Moioi Coniiol Exeicise foi Peisisieni, Nonspecifc LBP: A
Sysiemic Review. Plys Tlei. :ooq; Sq:q-:. Macedo G ei al.

! Moioi coniiol exeicise is moie eeciive ilan minimal
inieiveniion and adds benefi io oilei foims of
inieiveniions in ieducing pain and disabiliiy foi people
wiil peisisieni, nonspecifc LBP.
! Moioi coniiol exeicise alone oi as a supplemeni io
anoilei ileiapy, is eeciive in ieducing pain and disabiliiy
in paiienis wiil peisisieni, nonspecifc LBP.
! Tley did noi fnd convincing evidence ilai moioi coniiol
exeicise was supeiioi io manual ileiapy, oilei foims of
exeicise, oi suigeiy.

!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

9J
Moioi Coniiol Exeicise foi Clionic LBP: A Randomized
Placebo-Coniiolled Tiail. Plys Tlei. :ooq; Sq: i:y-S6.
Cosia L ei al.

! Moioi coniiol exeicise pioduced sloii-ieim
impiovemenis in global impiession of iecoveiy,
funciional aciiviiy levels, and ieduced iecuiieni]episodic
pain, bui noi pain iniensiiy, foi people wiil clionic LBP.
! Mosi of ile eecis obseived in ile sloii ieim weie
mainiained ai ile 6- and i:-monil follow-ups.
! Small clinical impiovemeni obseived, bui compleie
iecoveiy is unlilely in ile clionic, nonspecifc populaiion,
wlo lave aspecis associaied wiil pooi ouicomes.
Giaded Exeicise foi Recuiieni LBP: A Randomized,
coniiolled iiial wiil 6-, i:-, and 6-monil follow ups. Spine.
:ooq: (: ::i-S. Rasmussen-Baii ei al.

! Paiienis wiil iecuiieni LBP did a giaded exeicise
inieiveniion emplasizing siabilizaiion exeicises oi a
geneial walling piogiam.
! Tle siabilizaiion exeicise gioup oui peifoimed ile
walling gioup: % vs :6% mei ciiieiia foi success.
! Siabilizaiion exeicises seems io impiove peiceived
disabiliiy and lealil paiameieis ai sloii and long ieims in
paiienis wiil iecuiieni LBP.
Long-Teim Eecis of Specifc Siabilizaiion Exeicise foi
Fiisi Episode of LBP. Spine. :ooi; :6. Hides ei al.

! Paiienis wiil fisi episode of LBP given ( weel
exeicise piogiam emplasizing lumbai muliifdus and
iiansveisus abdominis muscle gioups.
! Tle siabilizaiion exeicise gioup iepoiied iecuiience
iaies of o% ai i yeai and % ai yeais, compaied io
S(% ai i yeai and y% ai yeais foi ile advice and
medicaiion coniiol gioup.
Evaluaiion of Specifc Siabilizaiion Exeicise in ile
Tieaimeni of Clionic Low Bacl Pain Wiil Radiologic
Diagnosis of Spondylolysis oi Spondylolisilesis. Spine.
Dec iqqy. O'Sullivan, PB ei al.
! Paiienis wiil clionic LBP and spondylolysis oi
spondylolisilesis slowed a siaiisiically signifcani
ieduciion in pain iniensiiy and funciional disabiliiy
levels, wlicl was mainiained ai o monil follow-up.
! Tle coniiol gioup slowed no signifcani clange in
ilese paiameieis afiei inieiveniion oi ai follow-up.

!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

78
Ecacy of dynamic lumbai siabilizaiion exeicise in
lumbai miciodisceiomy. } Relabil Med. }ul :oo; (():
i6-y. Yilmaz F ei al.
! Dynamic lumbai siabilizaiion exeicises aie an
ecieni and useful ieclnique in ile ielabiliiaiion of
paiienis wlo lave undeigone miciodisceciomy.
! Dynamic lumbai siabilizaiion exeicises ielieve pain,
impiove funciional paiameieis, and siiengilen iiunl,
abdominal and low bacl muscles.
An iniensive, piogiessive exeicise piogiam ieduces disabiliiy
and impioves funciional peifoimance in paiienis afiei
single-level lumbai miciodisleciomy. Plys Tlei. :ooq;
Sq:ii(-y. Kulig K ei al.
! An iniensive, piogiessive exeicise piogiam combined wiil
educaiion ieduces disabiliiy and impioves funciion in
paiienis wlo lave undeigone a single-level lumbai
miciodisleciomy.
! Educaiion and siabilizaiion exeicise gioup lad
signifcanily gieaiei ieduciion in disabiliiy (ODI),
impioved walling peifoimance ( minuie wall, o fooi
wall), and lumbai exiension siiengil]enduiance
(modifed Soiensen iesi).
! Iniensive siiengilening and enduiance piogiam of iiunl
and lowei exiiemiiies is safe and eeciive.
Relabiliiaiion afiei lumbai disc suigeiy (Review). Tle
Cocliane Collaboiaiion. :oio, issue :.
! Exeicise piogiams siaiiing (-6 weels posi-suigeiy seem io
lead io a fasiei deciease in pain and disabiliiy ilan no
iieaimeni.
! Higl iniensiiy exeicise piogiams seem io lead io a fasiei
deciease in pain and disabiliiy ilan low iniensiiy
piogiams.
! Tleie is no signifcani dieience beiween supeivised and
lome exeicises foi pain ielief, disabiliiy, oi global
peiceived eeci.
! Tleie is no evidence ilai aciive piogiams inciease ile ie-
opeiaiion iaie afiei fisi-iime lumbai suigeiy.

Alieied Abdominal Muscle Reciuiimeni in Paiienis Wiil
Clionic Bacl Pain Following a Specifc Exeicise
Inieiveniion. }OSPT. Feb iqqS; :y(:); ii(-:(.
O'Sullivan P ei al.
! Paiienis wiil clionic LBP lave a liglei level of iecius
abdominis aciiviiy duiing double leg iaise in ile coniiol
gioup and a gieaiei level of aciiviiy of ile inieinal oblique
in ile specifc (siabilizaiion) exeicise gioup.
! Tleie was a ielaiive inciease in iecius abdominis aciiviiy
in ile coniiol gioup and a ielaiive deciease in ile specifc
(siabilizaiion) exeicise gioup following inieiveniion.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

79
Segmenial Siabilizaiion and Musculai Siiengilening in
Clionic LBP: A Compaiaiive Siudy. Clinics. Oci :oio; 6(io):
ioi-iy. Fianca F ei al.
! Paiienis wiil clionic LBP did segmenial siabilizaiion
exeicise (TiA, LM) vs supeifcial siiengilening exeicises
(iecius, obliques, eiecioi spinae).
! Boil iieaimenis weie eeciive in ielieving pain and
impioving disabiliiy.
! Segmenial siabilizaiion lad signifcani gains foi all
vaiiables compaied io supeifcial siiengilening.
! Segmenial siabilizaiion impioved TiA aciivaiion and
supeifcial siiengilening did noi.
Ecacy of Tiunl Balance Exeicises foi Individuals Wiil
Clionic Low Bacl Pain: A Randomized Clinical Tiail.
}OSPT. Augusi :oii. Gaiii, R ei al.
! Foi paiienis wiil clionic LBP, iiunl balance exeicises
combined wiil exibiliiy exeicises weie found io be
moie eeciive ilan a combinaiion of siiengil and
exibiliiy exeicises in ieducing disabiliiy and
impioving ile plysical componeni of qualiiy of life.
Ecacy of Segmenial Siabilizaiion Exeicise foi Lumbai
Segmenial Insiabiliiy in Paiienis wiil Meclanical LBP:
A Randomized Placebo Coniiolled Ciossovei Siudy.
N Am } Med Sci. Ociobei :oii. Kumai.
! Foi paiienis wiil meclanical LBP, segmenial
siabilizaiion exeicise ileiapy was moie eeciive ilan
placebo inieiveniion in iieaimeni of sympiomaiic
lumbai segmenial insiabiliiy.
Tle eecis of siabilizing exeicises on pain and disabiliiy
of paiienis wiil lumbai segmenial insiabiliiy. } Bacl
Musculoslelei Rlabil. :oi:; :(): i(q-. }avadian Y ei
al.
! Lumbai siabilizaiion exeicise iesulied in ieduced pain
iniensiiy, incieased funciion, and incieased muscle
enduiance compaied io iouiine exeicise alone foi
paiienis wiil segmenial insiabiliiy.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

77
Eecis of musculai siieicling and segmenial
siabilizaiion on funciional disabiliiy and pain in
paiienis wiil clionic LBP: A iandomized, coniiolled
iiial. } Manipulaiive Plysiol Tlei. May :oi:; (():
:yq-S. Fianca F ei al.

! Boil ieclniques impioved pain and ieduced
disabiliiy, bui siabilizaiion exeicises was supeiioi io
siieicling foi measuied vaiiables associaied wiil
clionic LBP.
! Passive Siabilizeis: Bones, Ligamenis, Discs
! Abdominal Musculaiuie: Supeifcial,
Inieimediaie, Deep, Posieiioi Abdominal
Wall.
! Pelvic Flooi
! Bacl Musculaiuie: Supeifcial,
Inieimediaie, Deep.
! Hip Siabilizei Musculaiuie.
Passive
Siabilizeis
Aciive
Siabilizeis
Moioi
Coniiol
! (+) Biomeclanical Examinaiion Insiabiliiy Findings.
! (+) Siabilizaiion Tieaimeni Based Caiegoiizaiion ]
Clinical Piedicioi Rules.
! (+) Lumbai Siabilizaiion Muscle Wealness.
! S]P Lumbai (Micio-) Disceciomy.
! Afiei Manual Tleiapy Tieaimeni foi Hypomobiliiy of Lumbai
Spine oi Sacioiliac (SI) }oini.
! Eveiyone wiil Low Bacl Pain?
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

7:
Eveiyone Wiil Low Bacl Pain?
A Compaiison of Seleci Tiunl Muscle Tliclness Clange
Beiween Subjecis Wiil Low Bacl Pain Classifed in ile
Tieaimeni Based Classifcaiion Sysiem and Asympiomaiic
Coniiols. }OSPT Oci :ooy. Kiesel ei al.
! All iieaimeni based classifcaiions lave
neuioplysiological wealness of lumbai siabilizeis:
Tiansveise Abdominis (TiA) and Lumbai Muliifdus (LM).
! TiA and LM wealness is signifcani wlen compaiing LBP
paiienis io asympiomaiic coniiols, bui noi dieieni
beiween subjecis in dieieni iieaimeni based caiegoiies.
! Moioi coniiol defciis may, in paii, be caused by pain,
iiiespeciive of ile souice.
! Avoidance of excessive ROM by paiieni
! Posiuie and Body Meclanics Coiieciion
! Reduce siiess fiom adjaceni joinis : iieai suiiounding
lypomobiliiies including lips, iloiacic and lumbai
spine, SI }oinisBiomeclanical examinaiion.
! Anii-inammaioiy modaliiies if necessaiy
! Biacing if necessaiy
(Siiuciuial]Clinical Insiabiliiy)
! Remove oi deciease pain]ieex inlibiiion if necessaiy
! Siabilizaiion ileiapy]exeicises

i. Pelvic Flooi.
:. Abdominal Muscles: Tiansveisus Abdominis,
Inieinal]Exieinal Obliques, Recius Abominis.
. Muliifdus.
(. Hip Siabilizeis if needed.

. Psoas if needed (Noi Coveied Today).
6. Diapliagm if needed (Noi Coveied Today).
Pelvic Flooi: if signifcanily weal and
ileie is a need io go beyond Kagel
exeicises and basic insiiuciion ]
cueing, ilen seel a women's lealil
specialisi.

Can palpaie jusi medial io isclial
iubeiosiiy (wiil cauiion) io cue.

!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

75
Tiansveisus Abdominis (TiA):
Funciions io lold in abdominal conienis.
TiA coniiaciion coniiibuies io a ieduciion of
lumbai loidosis wlicl iigliness ile
iloiacolumbai fascia (TLF) and
supiaspinous ligameni eic.
If TLF iigliens eeciively ii can be used io
lelp siabilize an unsiable spine.
If TLF is unable io iiglien eeciively ilen ile
ielabiliiaiion piognosis is woise. Tlen
need io iiy io "bull" ile muliifdus io
iiglien ile TLF. (Cole ei al, :oio)

Tiansveisus Abdominis (TiA):
! TiA aciivaiion is delayed]inlibiied wiil LBP and
needs io be ieiiained.
! Remission of LBP does noi necessaiily iianslaie inio
iesioied TiA aciivaiion bui ii can be iiained wiil
specifc exeicise.
! TiA feed foiwaid aciivaiion can be unilaieial and is
diieciionally specifc. (Allison G ei al :ooS)
! TiA siabilizing funciion may be moie sensoiy
(piopiiocepiive]cogniiive) and moioi coniiol based
ilan meclanical (coisei).
(Allison G ei al :ooS)
Recius abdominis:
Recius abdominis siiengilening can be lelp iiglien
ile linea alba wlicl is ile inseiiion siie of ile
iiansveisus abdominis (ceniial suppoii siiuciuie).

Inieinal and Exieinal Obliques:
Inieinal obliques aie consideied gieai spinal
siabilizeis and aie paii of deep abdominal
musculaiuie along wiil iiansveisus abdominis.
Exieinal Obliques along wiil iecius abdominis aie
moie global siabilizeis.
Compaiison of ile Sonogiaplic Feaiuies of ile Abdominal Wall
Muscles and Conneciive Tissues in Individuals Wiil and Wiiloui
Lumbopelvic Pain. }OSPT. }an :oi. ((i); ii-iq. Wliiialei }L, ei al.
! Tleie may be alieied loading of ile abdominal conneciive
iissue and linea alba secondaiy io io an alieied siiaiegy
involving a ieduced coniiibuiion of ile iecius abdominis (RA).
! Tley found less ioial abdominal muscle iliclness, ilinnei RA,
iliclei conneciive iissue, and a widei inieiiecii disiance in
people wiil LBP.
! Insucieni coniiibuiions of ile RA (ilinnei]aiioplied) iesulis
in an incieased iole of conneciive iissue (iliclei) io dissipaie
iiunl loads.
! Tley found no dieience in exieinal oblique, inieinal oblique,
and iiansveius abdominis iliclness beiween gioups.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

7F
! Tloiacolumbai fascial iigliening iliougl abdominal
muscle aciivaiion eeciively iniioduces iension
iliougloui ile sysiem, incieasing aciivaiion eciency.
! Tle fascial sysiem is closely associaied wiil ile iegulaiion
of iiunl and exiiemiiy posiuie, musculai biomeclanics,
moioi coniiol and piopiiocepiion.
! Axioappendiculai muscles sucl as ile laiissimus doisi and
gluieus maximus fuilei coniiibuie io ile dynamic
siabiliiy and movemeni iliougl ileii iloiacolumbai
fascial aiiaclmenis.
(Smiil ei al :ooS).
Clanges in Deep Abdominal Muscle Tliclness Duiing
Common Tiunl-Siiengilening Exeicises Using
Uliiasound Imaging. }OSPT. Oci :ooS; S(io): q6-6o.
Teylen, DS ei al.
! Tiansveisus Abdominis and Inieinal Oblique
musculai iliclness clanges measuied wiil US
imaging fiom gieaiesi io leasi:
! Hoiizonial side suppoii (side planl) > Abdominal
ciuncl > Abdominal Diawing-in Maneuvei >
Quadiuped Opposiie Uppei and Lowei Exiiemiiy
Lifi > Supine Lowei Exiiemiiy Exiendei (PPT Level
wiil beni lnees) > Abdominal Sii-bacl.
Tle use of lumbai spinal siabilizaiion ieclniques
duiing ile peifoimance of abdominal siiengilening
exeicise vaiiaiions. } Spoiis Med Plys Fiiness. Maicl
:oo; ( (i): S-(. Baineii F ei al.
! Suiface EMG of TiA, inieinal obliques (IO), and
uppei iecius abdominis (RA).
! Abdominal diawing in maneuvei (ADIM) is an
eeciive meilod foi piefeieniially seleciing voluniaiy
coniiaciion of TiA]IO piioi io uppei RA duiing
ciuncles.
Eleciiomyogiaplic Analysis of Tiansveisus Abdominis and
Lumbai Muliifdus Using Wiie Eleciiodes Duiing Lumbai
Siabilizaiion Exeicises. }OSPT. Nov :oio; (o(ii): y(-o.
Olubo, YU ei al.
! Wiie eleciiodes in TiA and LM along wiil suiface
eleciiodes on iecius abdominis, exieinal obliques, and
eiiecioi spinae.
! Planl wiil alieinaiing UE]LE lifis lad gieaiesi aciivaiion
of TiA.
! Abdominal muscles geneially moie aciivaied in pione
posiiion exeicises.
! Asymmeiiical (lefi vs iigli) aciivaiion of TiA and oilei
muscles was seen wiil ile suppoii side being moie
aciivaied.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

7G
Tiucl muscle aciiviiy duiing lumbai siabilizaiion
exeicises on boil a siable and unsiable suiface. }OSPT.
}une :oio; (o(6): 6q-y. Imai A ei al.
! Wiie eleciiodes in TiA and LM along wiil suiface
eleciiodes on iecius abdominis, exieinal obliques,
and eiiecioi spinae.
! Siabilizaiion exeicises on an unsiable suiface
enlanced ile aciiviiy of siabilizaiion muscles excepi
foi biidges.
! Global siabilizei muscles sucl as ile exieinal obliques
weie moie aciive wiil unsiable suiface exeicises.
Coie muscle aciivaiion duiing Swiss ball and iiadiiional
abdominal exeicises. }OSPT. May :oio; (o(); :6-y6.
Escamilla, RF ei al.
! Suiface EMG of uppei iecius abdominis (RA), lowei RA,
exieinal oblique (EO), inieinal oblique (IO), laiissimus
doisi (lais), iecius femoiis, and lumbai paiaspinals.
! Pione Swiss ball exeicises weie as eeciive oi moie
eeciive in geneiaiing coie muscle aciiviiy compaied io
iiadiiional ciuncl and beni lnee sii-up wiil feei fxaied.
! IO (and lilely TiA) liglesi aciivaiion wiil Swiss ball pile,
ioll-oui, lnee-up, and sliei.
! Recius femoiis (and lilely psoas]iliacus) liglesi aciivaiion
wiil beni lnee sii-up wiil feei fxaied and Swiss ball sliei,
pile, siiiing maicl, lip exiension.
! No single spinal siabilizaiion (coie) muscle can be ideniifed as
ile mosi impoiiani foi lumbai spinal siabiliiy.
! Lumbai siabilizaiion exeicises may be mosi eeciive wlen iley
involve ile eniiie spinal musculaiuie undei vaiious spine
loading condiiions.
! Ii slould be emplasized ilai exeicises ilai demand ligl spinal
siabilizaiion muscle aciiviiy noi only enlance spinal siabiliiy
bui also geneiaie liglei spinal compiessive loading wlicl may
lave adveise eecis in individuals wiil lumbai spine pailology.
! Mainiaining a neuiial lumbosacial spine migli be moie opiimal
foi spinal condiiions ilai slould noi be exed (some disl
pailologies, osieopoiosis, eic) oi exiended (facei D}D, laieial]
foiaminal sienosis, ceniial]spinal sienosis, sponylolisilesis,
spondylolysis, eic).
(Escamill, RF ei al)
! Deep Abdominals: ADIM, PPT Level i- (Level i-S).
! Deep 8 Supeifcial: Ciuncl, Oblique Ciuncl
! Global Siabilizaiion: Side Planls, Planls.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

7H
! Planls may be ioo aggiessive in ile piesence of
clinical and ] oi siiuciuial insiabiliiy.
! Wiil segmenial insiabiliiy ile facei joini may become
ile piimaiy iesiiaini againsi anieiioi iianslaiion
(sleai).
! May be pain piovoling if facei D}D is pieseni.
! Woise ielabiliiaiion piognosis if unable io planl.
! Sianding piogiession. Dynamic Piogiam. Balance.

! Eveiyiling becomes a "coie" spinal siabilizaiion
exeicise.

! Diagonals wiil medicine balls, iubing, cable sysiems.

! Body blades, Bosu ball, Exeicise (Swiss) ball, Plyoballs
wiil ieboundei, eic.

Muliifdus: Funciions io siabilize ile lumbai
spine duiing foiwaid leaning befoie ile
iloiacolumbai fascia iigliens. Ii also
pioduces exiension and counieis ioiaiion
pioduced by abdominals.

Muliifdi aie noi ile spinal siabilizaiion
sysiem bui iley aie ile besi indicaioi of
low well ile segmenial siabilizaiion sysiem
is funciioning. (Cole ei al :oio).

! Muliifdi aie dense in muscle spindles -feedbacl
coniiol of spine (Niiz, A}. Am Suig. iqS6).
! Muliifdi aie segmenially inneivaied and aie
inlibiied wiilin minuies io louis upon a
discogenic lesion.
! Tlose wiil LBP lave a loss of dynamic spinal
siabiliiy due io muliifdus inlibiiion
--Tley lose coniiol of ile "neuiial zone".
! Tle muliifdus does noi auiomaiically ieiuin io
iis pie-inlibiied siaie.bui ii can be iiained.
(Cole ei al :oio, Hides } ei al :ooS, Smiil ei al :ooS)
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

7I
Tle ielaiionslip of iiansveisus abdominis and lumbai
muliifdus aciivaiion and piognosiic faciois foi clinical
success wiil a siabilizaiion exeicise piogiam: a cioss-
seciional siudy. Acl Plys Med Relabil. }an :oio; qi(i):
yS-S. Hebeii }}, ei al.

! Examined ile piognosiic faciois foi ile siabilizaiion
clinical piedicioi iule and ile degiee of TiA and LM
muscle aciivaiion assessed by ielabiliiaiive US imaging.
! Decieased LM aciivaiion, bui noi TiA is associaied wiil
ile siabilizaiion CPR faciois.
Suiface EMG Analysis of ile Low Bacl Muscles Duiing
Relabiliiaiion Exeicises. }OSPT. :ooS; S(i:); y6-y(.
Elsiiom R; Osboin R; Hauei P.

! Abdominal lollowing in quadiuped does noi pioduce
any signifcani aciiviiy in muliifdus muscles.
! Maximum Voluniaiy Isomeiiic Coniiaciion (MVIC)
measuied wiil suiface EMG.
! Bilaieial Muliifdus Coniiaciion.
i. Biidge io neuiial spine posiiion wiil slouldeis on
exeicise ball and feei on ooi: S% MVIC.
:. Biidge io neuiial spine posiiion: q% MVIC.
. Biidge io neuiial spine posiiion wiil lnees
exiended and feei on gymnasiic ball: ((% MVIC.
(. Bilaieial lowei exiiemiiy lifis io neuiial fiom
pione posiiion wiil iiunl iesiing ovei an exeicise
ball; lands in pusl up posiiion: (q% MVIC.
. Aciive bacl exiension wlile lips ovei an exeicise
ball and feei on ooi: o% MVIC.
! Unilaieial Muliifdus Coniiaciion.
i. Maximum iesisiance io unilaieial lamsiiing wiil
lnee exed ai ( degiees: :% MVIC.
:. Aciive iiunl sidebending wiil feei siabilized; lying
on coniialaieial side: % MVIC.
. Sidebiidge io neuiial posiiion wlen lying on
ipsilaieial side (side planl): % MVIC.
(. Maximum iesisiance io sidebending wlen lying on
ile coniialaieial side and feei siabilzed: q% MVIC.
. Opposiie aim and leg lifis in quadiuped: (i% foi side
of ile leg lified; :q% foi ile side of ile aim lified.
6. Opposiie aim and leg lifis in pione: (% foi side of
aim being lified; (o% foi leg being lified.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

7J
! Bilaieial Muliifdus Coniiaciion.
i. Siiiing iiunl exiension wiil ile pelvis
meclanically siabilized againsi elasiic iubing and
isomeiiic lold ai end iange of moiion: 6:% MVIC.
:. Slow aciive siiiing iiunl exiension againsi elasiic
iubing wiiloui pelvis siabilized: 6:% MVIC.
. Pione iiunl exiension io neuiial spine ai io iep max
iniensiiy wiil ile LE's siabilized: 6y% MVIC.
(. Pione iiunl exiension wiil UE and LE exiended
(Supeiman lifi): yy% MVIC.
. Pione slow aciive iiunl exiension againsi elasiic
iubing wiil ile pelvis siabilized: yS% MVIC.
! Bilaieial Muliifdus Coniiaciion.
i. Maximum iesisiance io pione iiunl exiension in
neuiial spine posiiion wiil ile LE's siabilized:
So% MVIC.
:. Pione iiunl exiension io end iange wiil io iep
max iniensiiy weigli leld againsi ile clesi wiil
ile LE's siabilized: q:% MVIC.
. Maximum iesisiance io pione exiension ai end
iange of moiion wiil LE's siabilized: qS% MVIC.
Eleciiomyogiaplic Analysis of Tiansveisus Abdominis
and Lumbai Muliifdus Using Wiie Eleciiodes Duiing
Lumbai Siabilizaiion Exeicises. }OSPT. Nov :oio;
(o(ii): y(-o. Olubo, YU ei al.
! Wiie eleciiodes in TiA and LM along wiil suiface
eleciiodes on iecius abdominis, exieinal obliques,
and eiiecioi spinae.
! Lumbai exiensoi muscles geneially moie aciivaied in
supine posiiion exeicises.
! Asymmeiiical (lefi vs iigli) aciivaiion of LM and
oilei muscles was seen wiil ile suppoii side being
moie aciivaied.
! Eaily Muliifdus
! Biidges: Bilaieial, Unilaieial, Supine Ball: lnees
exiended, lnees exed, lamsiiing cuils.
! Quadiuped and Pione: ADIM, UE lifi, LE lifi,
Alieinaiing UE]LE lifi.
! Pione Ball: Bilaieial LE lifi, Alieinaiing UE]LE lifi,
Spinal exiension wiil iow.
! Roman Claii: lold and iepeiiiions.
! Sianding: Windmills, UE iubing, LE iubing,
Alieinaiion of UE]LE iubing.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

:8
! Sianding piogiession. Dynamic Piogiam. Balance.
! Eveiyiling becomes a "coie" spinal siabilizaiion
exeicise.

! Combined movemeni wiil iubing ] cable sysiem---
diagonals.
! Body blades, Bosu ball, Exeicise (Swiss) ball, Plyoballs
wiil ieboundei, eic.


Hip Siabilizaiion Siiengilening (if needed):
! Exieinal Roiaiois: ecceniiic lengilening io
coniiol inieinal ioiaiion duiing gaii.

! Abducioisgluieus medius: leep pelvis
siable in ile fionial plane.

! Exiensoisgluieus maximus: siabilize pelvis
via iensioning iloiacolumbai fascia; also a
funciional lip exieinal ioiaioi.
Developmeni of Aciive Hip Abduciion as a scieening iesi foi
ideniifying occupaiional low bacl pain. }OSPT; Sepi :ooq:
q(q): 6(q-y. Nelson-Wong, E ei al.
! Tle aciive lip abduciion (AHAbd) iesi was ile only
clinical assessmeni iool ilai slowed dieiences beiween
pain developeis and non-pain developeis.
! Individuals wlo scoies : oi gieaiei wiil AHBbd iesi weie
.S iimes moie lilely io develop LBP duiing : loui
sianding woil iasl.
! Decieased lip and pelvis coniiol poieniially piedisposes
people io lumbai injuiy and io develop LBP.
Wlicl Exeicises Taigei ile Gluieal Muscles Wlile
Minimizing Aciivaiion of ile Tensoi Fascia Laia?
Eleciiomyogiaplic Assessmeni Using Fine-Wiie Eleciiodes.
}OSPT. Feb :oi; ((:): (-6. Sellowiiz DM ei al.
! Gluieus Medius: Sidelying lip abduciion > Hip Hile.
! Supeiioi Gluieus Maximus: Clam > Unilaieial Biidge.
! Tensoi Fascia Laia (TFL): Sidelying lip abduciion > Hip
Hile (same as Gluieus medius).
! Besi Gluieal io TFL Aciivaiion Raiio: Clam > Laieial band
walling > Unilaieial biidge > QP Hip exiension wiil
lnee exiended oi lnee exed.
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

:9
! Sidelying: Clam, Hip abduciion.
! Sianding: Laieial band walling, Squais, Loop ER:
open clain wiil laieial lunges, Tubing closed clain
ER, Tubing closed clain lip abduciion (lip lile).
! Balance: Single leg siance, Single lnee siance, Single
Leg Squai.
i. Laige muscle siiengilening
:. Enduiance iiaining
. Funciional iiaining: ADL, woil, spoii
specifc exeicise piogiam.
Body Meclanics: Lifiing, squaiiing,
iunning, jumping.
! Muscle imbalances: If global siabilizaiion muscles aie
oveipoweiing oi aciivaied piioi io local (coie) spinal
siabilizaiion muscles ilen ileie will be an inciease in
iianslaioiy moiion (sleaiing) ai ile spinal segmeni.
! Tlis will lead io moie funciional insiabiliiy, moie
pain, moie muscle inlibiiion]wealness eic.
! Pain is noi always ile siaii of ile pioblem.
(Beiglund, :oio)
! Lool foi poieniial culpiiis foi a paiieni's pain by
doing a iloiougl dieieniial diagnosis evaluaiion and
biomeclanical examinaiion.
! Do noi jusi iieai painful aiea unless oilei poieniial
culpiiis lave been invesiigaied.
(Eil Peiiman]NAIOMT)
!"#$%& ()*+%, (-%$*,*.%/0+ 123&%)4 56786789:
12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
B*-20"- 3C)&3;; B&*D3+ )3&#*;;*0+ 0< -23 %"-20&E

:7
! Neuiologic Wealness slould also be consideied.
i. Tiue Conduciion Loss ] Palsy.
:. Pain Inlibiiion.
. Hypeiioniciiy via Ceniial oi Peiipleial
Sensiiizaiion] Faciliiaiion.
(. Axoplasmic Flow Disiupiion.
. Axonal Tianspoii Disiupiion.


Specifc Exeicise

Manual Tleiapy Piogiessive Fiiness]Aeiobics

Siabilizaiion

Home Piogiam (Gym Piogiam)
Pioblem if oilei caiegoiies aie noi addiessed fisi:
! Pain inlibiied oi lypeiionic siabilizaiion muscles aie
less eeciively siiengilened.

! Segmenial siabilizaiion moie eeciive if segmenial
moiion is iesioied fisi.

! Spinal siabilizaiion exeicises aie noi a panacea ]
cuie all.
! Spinal siabilizaiion exeicises aie peifoimed as paii of
a compiessive ielabiliiaiion piogiam based on
dieieniial diagnosis examinaiion (medical scieening
examinaiion if waiianied) and biomeclanical
examinaiion.
! PT Goals: Reduce pain]ceniialize sympioms, iesioie
mobiliiy, and ilen funciionally siabilize.
! Acuie LBP PT Goals: Reduce fiequency and iniensiiy
of exaceibaiions 8 Pieveni Clioniciiy.
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12*; *+<0&#%/0+ *; -23 )&0)3&-4 0< (-3=3 (>2+3*?3&@ A1 %+? ;20",? +0- $3 >0)*3? 0& 0-23&B*;3 ";3?
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::
Clinical
Evidence
Relevani
Reseaicl
Evidence
Paiieni
Beliefs
Ideal Tieaimeni
! Pain can iemain clionically foi i io i. yeais bui funciional
impiovemenis can be made.
! Piogiess fiom local siabiliiy iiaining io enduiance iiaining
ilen siiengilen io individual paiieni's demands.
! If pain levels limiiing piogiess wiil ielabiliiaiion ilen
MD managemeni ]consuliaiion needed. Medicaiion,
Injeciions, eic.
! If siiuciuial insiabiliiy ioo gieai io funciionally manage
wiil neuiomusculai iiaining, ilen suigical inieiveniion
maybe waiianied, especially if iadiculai sympioms peisisi.