Spine Stabilization + Local vs. Global Approaches

Question 1

According to the Treatment Based Classification system, what patients would benefit from a lumbar stabilization program?

Answer 1

Those with: age<40, + prone instability test, aberrant motions, greater SLR ROM (>91), hypermobility with PA mobilizations, large amount of LBP episodes

Question 2

According to O’Sullivan’s Movement Coordination Deficits classification of back pain, would those that benefit from spinal stabilization fall under a movement impairment or control impairment grouping?

Answer 2

control impairment

Question 3

Describe O’Sullivan’s “control impairment” group and the characteristics of an individual placed into that group.

Answer 3

• Impairment in the control of the painful segment in direction of pain
• Loss of functional control in neutral zone
• Repetitive strain, excessive loading
• Painful arc or pain in variety of directions
• Movement and postures adopted worsen symptoms
• Decreased proprioceptive awareness
• Fear of movement, anxiety
• Mal-adaptive

Question 4

What are some aberrant movements that might be seen? (3)

Answer 4

lumbopelvic reversal, gowers sign, and favoring one side

Question 5

What screening tool/test can be used to assess local and global spinal stabilizing systems?

Answer 5

active straight leg raise

Question 6

What is the goal of dynamic lumbar stabilization?

Answer 6

to eliminate repetitive injury to discs, facet joints, and related structures

Question 7

What is dynamic lumbar stabilization?

Answer 7

When the core muscles (i.e. diaphragm, pelvic floor, rectus abdominus/transverse abdominus, and multifidi/rotatores) dynamically control lumbar spine forces during movements

Question 8

Bones, joints, ligaments are the [form closure/force closure] components of stability.

Answer 8

form closure

Question 9

Muscles and tendons are the [form closure/force closure] components of stability.

Answer 9

force closure

Question 10

What component of stability are coordination, timing, and sequencing?

Answer 10

neuromotor control

Question 11

[Local/Global] stabilizers are deep, small, control intersegmental motion, and tonic

Answer 11

local stabilizers

Question 12

[Local/Global] stabilizers are superficial, large, spine motion and load transfer, and phasic

Answer 12

Global stabilizers

Question 13

[Local/Global] stabilizers include the transverse abdominis, intertransversrii, interspinales, lumbar multifidus, QL, IO, ES, pelvic floor, and diaphragm.

Answer 13

local stabilizers

Question 14

[Local/Global] stabilizers include the erector spinae, quadratus lumborum, external oblique, internal oblique, and rectus abdominis

Answer 14

global stabilizers

Question 15

What do local or motor control exercises emphasize?

Answer 15

specific training exercises for local muscles

Question 16

What do global or general exercises emphasize?

Answer 16

exercises for global muscles, not just one important muscle, with contribution being dependent upon the magnitude and direction of trunk loading

Question 17

How should you progress specific stabilization in the clinic? (3)

Answer 17

from specific localized to general trunk, to function training!

Question 18

Global stabilization is better for those with [lower/higher] pain & [lower/higher] initial strength.

Answer 18

lower pain and higher initial strength

Question 19

T/F You often want to combine local and global stabilization approaches.

Answer 19

True