Lumbar Stabilization

Question 1

3 subsystems that stabilize LS

Answer 1

1. Neuron control subsystem
   - ACTIVE
   - determines amount of stability needed & tells which muscles to contract w/ what force
2. Osteoligamentous subsystem
   - PASSIVE stability: bones, ligaments, joint capsules, etc
   - LIMITS neutral zone & STABILIZES elastic zone
3. Muscle subsystem
   - ACTIVE stability
   - controls ELASTIC zone

Question 2

Neutral Zone

Answer 2

region around a neutral spine in the first few degrees of motion

very little resistance from passive structures and muscles

can think of it as Grade I and II mobs

Question 3

Elastic Zone

Answer 3

end of neutral zone to the end of physiologic range

motion in this zone occurs w/ considerable internal resistance

think of it as Grade III and IV

Question 4

Instability

Answer 4

Displacement under load (nonlinear relationship between load & displacement)
Greater displacement w/ prolonged load (sitting for long period of time)

Greater displacement w/ injury to the passive structures meaning an increase in the neutral zone and overactivation of the muscles

• -> increase in neutral zone = instability
• -> decrease in stiffness (aka elastic zone) = instability (hypermobility)

Question 5

Motor Training in Patients w/ Instability

• what is it
• four elements
• 3 phases

Answer 5

Minds attempt to teach the body conscious control of a specific movement/muscle

high reps w/ step by step progressions using cues and feedback

Four elements:

1. proprioceptive and kinesthetic awareness
2. dynamic stability
3. preparatory and reactive muscle characteristics
4. conscious and unconscious functional motor patterns

3 phases:

1. static stabilization
2. transitional
3. dyanamic

Question 6

Underlying factors leading to failure of stabilization training (4)

Answer 6

1. Negative prone instability test
2. Absence of aberrant motions
3. Absence of lumber hypermobility
4. Score of 9 or higher of FABQ

Question 7

Two types of instability

Answer 7

1. Structural (dysfunction of passive structures)

2. Functional (related to dysfunction of muscle or neural subsystem)

Question 8

Items for predictive success w/ stabilization training (4)

Answer 8

1. Age less than 40
2. presence of abberant motions
3. positive prone instability test
4. average SLR (no neurological symptoms)

Must have 3 or more of these to have a 67% probability of success w/ stabilization training

Question 9

Leg Load Tests - biofeedback (supine)

Answer 9

Testing for appropriate contraction of the TrA w/o spine movement

1. patient is supine w/ cuff inflated to 40 mmHg under lumbar spine
2. Draw abdominal wall in w/o moving spine or pelvis
3. Hold for 10 seconds & breath normally
4. Progress to marching & heel slides

Correct response: Pressure remains same

Incorrect response: pressure increases due to posterior pelvic tilt, or pressure decreases w/ marching due to anterior tilt

Question 10

Prone Leg Load Test - biofeedback

Answer 10

1. patient is prone w/ cuff inflated to 70 mmHg under abdomen
2. draw abdominal wall up w/o moving the spine or pelvis
3. Hold for 10-15 seconds, breathing normally

Correct response: Pressure will decrease 6-10mmHg

Incorrect response: Pressure increases due to trunk flexion, ant pelvic tilt, or depressing rib cage OR no drop in pressure (less than 2) which would be a poor result and poor contraction of TrA