Stability Flashcards
Spinal Stability
Characterized by bx of spinal column and coordination of surrounding muscles
Static Stability
Stability when the person is still
Dynamic Stability
With perturbation the spine behaves as it did in undisturbed state (stable)
Kinematic bx changes with disturbance (unstable)
Clinical Instability
Changes in dynamic functional control of spinal segment vs. radiographic changes
Muscle changes not talking about radiographic changes
Impaired muscle control at the segmental level
Classification of instability
LBP with movement coordination impairment
Panjabi’s Interdependent Subsystems
Active - muscles
Passive - bone, ligaments, disc
Neural - patient awareness of body in space, the control, can be neuromuscular control
Neutral Zone
Midrange of the spine
A zone of high flexibility around the neutral position of the spinal segment
Size of NZ determined by
Pasive restraints, active control, and control by CNS
Size of NZ can increase
micro trauma, injury, lack of segmental muscle control
maybe muscle is overlengthened
Larger NZ = more potential for injury, IVD degeneration
In neutral zone we count on ____ versus flex/ext position
In neutral zone passive structures are NOT involved so we count on the segmental structures for control
End range flex and ext there is something that stops us but not in neutral zone
Global Muscle System
Act on trunk and spine without being directly attached to it
Large torque producing
Provide general trunk stability
Eccentrically decelerate momentum
Control gross spinal rotation
Attach on pelvis and thoracic cage
No direct segmental influence on the spine
Global Stabilizers
Rectus Abdominis
IO and EO
Quad Lum (lat fibers)
Thoracic iliocostalis
Local Muscle System
Deeo muscles attached to lumbar vertebrae or pelvis
Directly control lumbar segments and SIJ
- provide segmental stability
- provides stiffness effect on spine for dynamic stability with limb movement
- control neutral zone
Local Muscles
Lumbar Multifidus Transversus Abdominis Quad LUmborum (medial fibers) Lumbar portion iliocostalis/longissimus thoracic
Transversus Abdominis
Capable of tonic acitivty regardless of trunk position (fires with any trunk pos)
First trunk muscle to activate with movement initiation
Lumbar Multifidus
Greatest potential to provide dynamic control of motion segment
Greatest control of neutral zone
- Bracing Mechanims
Bracing Mechanism
Act as guide wires; loss of tension can result in unstable buckling of the spine
Deep Corset mechanism
TA forms cylinder, pelvic floor and diaphragm for base and lid; inta-abdominal pressure –> spinal support
LBP - Transversus Abdominis
Activation threshold is increased (takes longer to contract)
Delayed contraction
Loss of independent control (hard to control muscle in isolation without global muscles helping)
Multifidus - LBP
Decrease in size in symptomatic level on involved side in acute LBP and post surgical
Remains atrophied after acute episode subsides - important to educate because susceptible to re-injury
Recovered size and firing with specific retraining
Subjective History
LBP recurrent, constant, catching, locking
Repeated unprovoked episodes of feeling unstable with minor provocation
Inconsistent sx
- sustained postures, sudden mvmt, return to upright from flexion, minor ache after episode of “give way”, click/clunk noises
Objective Examination
Skin creases Lumbar spine segmentally fixed Spinal angulation upon ROM Inability to recover from full ROM Excessive AROM
If erector spinae won’t turn off - cant relax them…
chances are the multifidus isn’t firing well
Clinical Tests
Farfans Torsion Test Test of Ant Lumbar Spinal Instability Posterior Shear (POSH) Prone Stability Test Segmental Stability Test/Muscular Control
Segmental Tests of Muscle COntrol
Monitor compensations by global stabilizers TA Multifidus Activation Pelvic floor activation Diaphragm activation
Global muscle activity
Aberrant Movement
Contours of the abdominal wall
Excessive back extensor activity
Global Muscle Activity - Aberrant Movement
Post pelvic tilt - they are using EO if they go into post tilt
Flexion of the TL junction
Contours of the abdominal wall - GLobal muscle activity
Patient unable to voluntarily relax
EO contraction
Test Item Cluster: for patients likely to benefit from lumbar stabilization exercises
50% of greater reduction in disability following stabilization ex program Age 91 degrees Positive prone instability test Aberrant movement present with AROM 3 of 4 factors met +LR = 4
Principles of Stability Rehab
Proximal stability before distal mobility Control of neutral zone Retrain dynamic control Rehab global stabilizers through range Lengthen or inhibit overactive muscles
Strategies
Extremity Loading - upper and lower
Rhythmic Stabilization: apply various low forces with slow alternations while pt maintains neutral spine
Unstable base
Functional movements
