Stability and trunk control exercises Flashcards
What is the rationale behind using this treatment (Pain/Increase ROM/Strengthen)?
strengthen the key muscles in trunk stability
What are the physiological effects of the treatment?
increased muscle strength
improved muscular activation patterns which can enhance postural stability
enhanced stability to the spine and pelvis
reduced risk of spinal misalignment and postural deviations which can reduce associated pain
improved balance and proprioception
reduced risk of low back pain due to increase in core strength
prevention of falls and injuries
improved breathing mechanics
What structures are affected by the technique?
diaphragm, mulitfidis, transversus abdominus, pelvic floor muscles
vertebrae
pelvis
dorsal column (proprioception)
What principles are used in carrying out the technique?
use another physio for support
progress and regress
Precautions and contraindications?
acute and severe pain
recent spinal surgery-would need to speak with consultant
severe instability of pelvis
unhealed fractures and injuries
What muscles are global?
abdominals-rectus abdominals, internal and external obliques
quadratus lumborum
If you see abnormal movements how can you tell which muscles are working or not?
use palpation
use eyes to assess the movement
facilitation-for example at region where muscles are to encourage them working
use ultrasound
EMG- place pads on area so can take a reading and see muscle activity occurring in real time
What muscles are local in trunk stability?
multifidis
transversus abdominis-side of the barrel
pelvic floor muscles-lower margins
diaphragm-upper margins
How to assess the key muscles when someone is unable to sit up against gravity?
diaphragm: cant palpate so assess using breathing control, ask model to breathe comfortably making sure they fill the lungs and should maintain a conversation without breaking to breathe, can place hand on chest to feel.
multifidus: ask model to expose top, ask model to arch their back and palpate multifidis whilst they are doing them, then ask them to close the gap an push against plinth and you should feel multifidis moving.
pelvic floor-cant palpate, easy way to do this is to imagine you are going to the toilet and trying to stop in the middle.
transversus abdominis: palpate ASIS move in an inch and move down an inch and ask the model to cough and you should feel this move
How would you exercise the key muscles used to sit up against gravity?
palpate and ask model to lift knee up to hand, e.g. hip 90 flexed and knee flexed to 90 and fell this movement under fingers to ensure transversus abdominis is being engaged, use alternating legs.
To regress the movement put the towel under the heel, and instead of lifting they slide their foot backwards towards the hip.
hand still palpate TA, but knees are bent and knees and feet are together, then ask them to drop out comfortably, also show them how to palpate TA themselves so they can feel for contraction and do it on their own. For example, if you don’t feel the muscle contract of the legs drop you have gone too far.
How do we strengthen muscles of trunk control if the patient is able to sit up against gravity?
can have 2 people there for safety
one hand on front of the chest and the other on the lumbar spine. Get the patient to sit as straight as possible and then slouch back down. The physio can help tilt the pelvis during this mvmt.
How to challenge the BOS when the patient is able to sit up against gravity and how to progress even further?
push the pt gently away and then ask themselves to bring themselves back to the original position, having arms on shoulders to move them out of the central position.
then try to move the patient and try and get them to resist this so that they stay in the position they are in. -progress and regress this by varying the amount of force applied.
progress even further by making them move out of their BOS, for example, get the model to reach and touch my hand with their opposite hand to make them reach across their body which brings in rotation. Progress this by increasing the reach and keeping the feet on the floor for sturdy BOS.
How to use a gym ball to help progress movements even further and also weights?
the model sits on the gym ball, making sure they are next to the plinth to stabilise and having another physio behind- this challenges the BOS to make it unstable
can also use weights in hands to make it harder for them to keep the posture straight
can also change the BOS to make it harder by raising feet off the floor to make it smaller.
