Stability

Question 1

Spinal Stability

Answer 1

Characterized by bx of spinal column and coordination of surrounding muscles

Question 2

Static Stability

Answer 2

Stability when the person is still

Question 3

Dynamic Stability

Answer 3

With perturbation the spine behaves as it did in undisturbed state (stable)
Kinematic bx changes with disturbance (unstable)

Question 4

Clinical Instability

Answer 4

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

Question 5

Classification of instability

Answer 5

LBP with movement coordination impairment

Question 6

Panjabi’s Interdependent Subsystems

Answer 6

Active - muscles
Passive - bone, ligaments, disc
Neural - patient awareness of body in space, the control, can be neuromuscular control

Question 7

Neutral Zone

Answer 7

Midrange of the spine

A zone of high flexibility around the neutral position of the spinal segment

Question 8

Size of NZ determined by

Answer 8

Pasive restraints, active control, and control by CNS

Question 9

Size of NZ can increase

Answer 9

micro trauma, injury, lack of segmental muscle control
maybe muscle is overlengthened
Larger NZ = more potential for injury, IVD degeneration

Question 10

In neutral zone we count on ____ versus flex/ext position

Answer 10

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

Question 11

Global Muscle System

Answer 11

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

Question 12

Global Stabilizers

Answer 12

Rectus Abdominis
IO and EO
Quad Lum (lat fibers)
Thoracic iliocostalis

Question 13

Local Muscle System

Answer 13

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

Question 14

Local Muscles

Answer 14

Lumbar Multifidus
Transversus Abdominis
Quad LUmborum (medial fibers)
Lumbar portion iliocostalis/longissimus thoracic

Question 15

Transversus Abdominis

Answer 15

Capable of tonic acitivty regardless of trunk position (fires with any trunk pos)
First trunk muscle to activate with movement initiation

Question 16

Lumbar Multifidus

Answer 16

Greatest potential to provide dynamic control of motion segment
Greatest control of neutral zone
- Bracing Mechanims

Question 17

Bracing Mechanism

Answer 17

Act as guide wires; loss of tension can result in unstable buckling of the spine

Question 18

Deep Corset mechanism

Answer 18

TA forms cylinder, pelvic floor and diaphragm for base and lid; inta-abdominal pressure –> spinal support

Question 19

LBP - Transversus Abdominis

Answer 19

Activation threshold is increased (takes longer to contract)
Delayed contraction
Loss of independent control (hard to control muscle in isolation without global muscles helping)

Question 20

Multifidus - LBP

Answer 20

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

Question 21

Subjective History

Answer 21

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

Question 22

Objective Examination

Answer 22

Skin creases
Lumbar spine segmentally fixed
Spinal angulation upon ROM
Inability to recover from full ROM
Excessive AROM

Question 23

If erector spinae won’t turn off - cant relax them…

Answer 23

chances are the multifidus isn’t firing well

Question 24

Clinical Tests

Answer 24

Farfans Torsion Test
Test of Ant Lumbar Spinal Instability
Posterior Shear (POSH)
Prone Stability Test
Segmental Stability Test/Muscular Control

Question 25

Segmental Tests of Muscle COntrol

Answer 25

Monitor compensations by global stabilizers
TA
Multifidus Activation
Pelvic floor activation
Diaphragm activation

Question 26

Global muscle activity

Answer 26

Aberrant Movement
Contours of the abdominal wall
Excessive back extensor activity

Question 27

Global Muscle Activity - Aberrant Movement

Answer 27

Post pelvic tilt - they are using EO if they go into post tilt
Flexion of the TL junction

Question 28

Contours of the abdominal wall - GLobal muscle activity

Answer 28

Patient unable to voluntarily relax

EO contraction

Question 29

Test Item Cluster: for patients likely to benefit from lumbar stabilization exercises

Answer 29

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

Question 30

Principles of Stability Rehab

Answer 30

Proximal stability before distal mobility
Control of neutral zone
Retrain dynamic control
Rehab global stabilizers through range
Lengthen or inhibit overactive muscles

Question 31

Strategies

Answer 31

Extremity Loading - upper and lower
Rhythmic Stabilization: apply various low forces with slow alternations while pt maintains neutral spine
Unstable base
Functional movements