The Spine Exercise Interventions Chapter 16 Part IV

BASIC CONCEPTS OF SPINAL MANAGEMENT WITH EXERCISE Copyright © 2013. F. A. Davis Company

Fundamental Interventions § Definition: Exercises or skills that all patients with spinal impairments should

Patient Education § § Active Participation Limitations at Each Stage of Healing Safe Self-Management

General Exercise Guidelines § § § Kinesthetic Awareness Mobility/Flexibility Muscle Performance Cardiopulmonary Endurance Functional

KINESTHETIC AWARENESS Copyright © 2013. F. A. Davis Company

Elements of Kinesthetic Training: Fundamental Techniques § Position of Symptom Relief (position of bias)

Progression to Active and Habitual Control of Posture § Use of Reinforcement – Verbal,

MOBILITY/FLEXIBILITY Copyright © 2013. F. A. Davis Company

Cervical and Upper Thoracic Region: Stretching Techniques § Techniques to Increase Thoracic Extension –

Cervical and Upper Thoracic Region: Stretching Techniques (cont'd) § Techniques to Increase Upper Cervical

Cervical Joint Manipulation Techniques § Grading I–V: Definitions § Precautions § Contraindications Copyright ©

Cervical Joint Manipulation Techniques (cont'd) Manipulation to Increase Cervical Flexion Manipulation to Increase Cervical

Muscle Energy Techniques to Increase Craniocervical Mobility § To Increase Craniocervical Flexion § To

Mid and Lower Thoracic and Lumbar Regions: Stretching Techniques § Techniques to Increase Lumbar

Thoracic and Lumbar Joint Manipulation and HVT Techniques § Manipulation to Increase Thoracic Spine

Thoracic and Lumbar Joint Manipulation and HVT Techniques (cont'd) § Rib Manipulation for Inspiratory

Thoracic and Lumbar Joint Manipulation and HVT Techniques (cont'd) § Manipulation to Increase Lumbar

Thoracic and Lumbar Joint Manipulation and HVT Techniques (cont'd) § SI Joint Manipulation Technique

MUSCLE PERFORMANCE: STABILIZATION, MUSCLE ENDURANCE, AND STRENGTH TRAINING Copyright © 2013. F. A. Davis

Stabilization Training: Fundamental Techniques and Progressions § Guidelines for Stabilization Training Copyright © 2013.

Deep Segmental Muscle Activation and Training § Cervical Musculature – Deep neck flexors –

Deep Segmental Muscle Activation and Training (cont'd) § Lumbar Musculature – Drawing-in maneuver (abdominal

Global Muscle Stabilization Exercises § Stabilization Exercises for the Cervical Region – Stabilization with

Global Muscle Stabilization Exercises (cont'd) § Stabilization Exercises for the Lumbar Region – Stabilization

Isometric and Dynamic Exercises § Exercise for the Cervical Region – Isometric exercises: self-resistance

Isometric and Dynamic Exercises (cont'd) § Exercise for the Thoracic and Lumbar Regions –

Isometric and Dynamic Exercises (cont'd) § Exercise for the Thoracic and Lumbar Regions (cont’d)

CARDIOPULMONARY ENDURANCE Copyright © 2013. F. A. Davis Company

Common Aerobic Exercises and Effects on the Spine § § § § Cycling Walking

FUNCTIONAL ACTIVITIES Copyright © 2013. F. A. Davis Company

Early Functional Training: Fundamental Techniques § § § Goal: Progress to Independence Safely Rolling

Preparation for Functional Activities: Basic Exercise Techniques § Weight-Bearing Exercises – Modified bridging exercises

Preparation for Functional Activities: Basic Exercise Techniques (cont'd) § Transitional Stabilization Exercises – Quadriped

Body Mechanics and Environmental Adaptations § Principles of Body Mechanics: Instruction and Training –

Body Mechanics and Environmental Adaptations (cont'd) § Environmental Adaptations – Home, work, and driving

Intermediate to Advanced Exercise Techniques for Functional Training § § § Repetitive Lifting Repetitive

Education for Prevention § Continual Throughout the Rehabilitation Process § Relationships of Posture and

Independent Learning Activities § Critical Thinking and Discussion § Laboratory Practice § Case Studies

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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 Copyright © 2013. F. A. Davis Company

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 Copyright © 2013. F. A. Davis Company

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 Copyright © 2013. F. A. Davis Company

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 Copyright © 2013. F. A. Davis Company

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 Copyright © 2013. F. A. Davis Company

Cervical Joint Manipulation Techniques (cont'd) Manipulation to Increase Cervical Flexion Manipulation to Increase Cervical Extension Manipulation to Increase Cervical Rotation and Sidebending § Manipulation to Increase Cervical Rotation and Sidebending-Alternate Technique § § Copyright © 2013. F. A. Davis Company

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 Copyright © 2013. F. A. Davis Company

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 Copyright © 2013. F. A. Davis Company

Thoracic and Lumbar Joint Manipulation and HVT Techniques (cont'd) § Rib Manipulation for Inspiratory Restriction § Rib Manipulation for Expiratory Restriction § Elevated First Rib Manipulation Copyright © 2013. F. A. Davis Company

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 Copyright © 2013. F. A. Davis Company

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 Copyright © 2013. F. A. Davis Company

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 Copyright © 2013. F. A. Davis Company

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 Copyright © 2013. F. A. Davis Company

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 Copyright © 2013. F. A. Davis Company

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 Copyright © 2013. F. A. Davis Company

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 (abdominals): sitting or standing Copyright © 2013. F. A. Davis Company

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) Copyright © 2013. F. A. Davis Company

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” Copyright © 2013. F. A. Davis Company

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 Copyright © 2013. F. A. Davis Company

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 Copyright © 2013. F. A. Davis Company

Preparation for Functional Activities: Basic Exercise Techniques (cont'd) § Transitional Stabilization Exercises – Quadriped forward/backward shifting – Squatting and reaching – Shifting weight and turning Copyright © 2013. F. A. Davis Company

Body Mechanics and Environmental Adaptations § Principles of Body Mechanics: Instruction and Training – Lumbar spine position – Spinal flexion – Spinal extension – Load position Copyright © 2013. F. A. Davis Company

Intermediate to Advanced Exercise Techniques for Functional Training § § § Repetitive Lifting Repetitive Reaching Repetitive Pushing and Pulling Rotation or Turning Transitional Movements Transfer of Training Copyright © 2013. F. A. Davis Company

Education for Prevention § Continual Throughout the Rehabilitation Process § Relationships of Posture and Pain § Home Exercise Program – Flexibility – Muscle endurance – Strengthening – Cardiopulmonary Copyright © 2013. F. A. Davis Company