Spine Stabilization Powerpoint

Core Strengthening Spine Exercises
in Rehabilitation
Eric Shamus,PhD, DPT

Miami, Florida, USA
Introduction
Eric Shamus, PT, PhD, CSCS
Role of Core Training
Importance to stability
Types of contraction
 Ability of muscles to work together
Types of exercises
Research on the role of the
abdominal muscles in
stabilization
Contraction of the transverse abdominis is
significantly delayed in patients with low back
pain during all movements. This delay
indicates a deficit of motor control and is
hypothesized to result in inefficient muscular
stabilization of the spine
Central nervous system
The central nervous system deals with
stabilization of the spine by contraction
of the abdominal and multifidus muscles
in anticipation of reactive forces
produced by limb movement
EMG activity of all trunk muscles preceded that of
the muscle responsible for limb movement (thus
contributing to the feed-forward postural response)
in control subjects. In subjects with LBP, EMG onset
of transverse abdominis was delayed with
movement in each direction; while EMG onsets of
rectus abdominis, erector spinae, and oblique
abdominal muscles were delayed with specific
movement directions. This result provides evidence
of a change in the postural control of the trunk in
people with LBP (Hodges & Richardson, 1998).
Early activation of transverse abdominis and internal
obliques occurred in the control group with fast and
intermediate speed movement. Subjects with low
back pain failed to recruit either muscle group in
advance of limb movement during fast movement;
and no activity of the abdominal muscles was
recorded in the majority of intermediate speed trials.
The results of this study indicate that the mechanism
of preparatory spinal control is altered in people with
lower back pain for movement at a variety of speeds
(Hodges & Richardson, 1999).
In control subjects, reaction time of deltoid and the
superficial abdominal muscles increased with task
complexity, but reaction time of transverse
abdominis was constant. In subjects with LBP, the
reaction time of the transverse abdominis increased
with increased task complexity. While inhibition of
the descending motor command cannot be
excluded, it is more likely that the change in
recruitment of the transverse abdominis represents
a more complex change in organization of the
postural response (Hodges, 2001).
Participants with LBP had a significantly
smaller increase in transverse
abdominis thickness and less EMG
activity during isometric leg tasks
compared with controls. The results of
this study reinforce evidence for
changes in automatic control of
transverse abdominis in people with
LBP (Ferreira, et al., 2004).
Principles

i. Breathing
ii. Concentration
iii. Control
iv. Precision
v. Centering
vi. Flow
Breathing
Proper breathing using full inhalation
and exhalation to control each
movement of the exercise.
Concentration
Concentration is necessary for the
mind-body connection.
Control
Each exercise is performed with
absolute muscle control.
Precision
Every movement has a purpose.
Centering
Exercises originate from the
powerhouse that consists of the
abdominal, low back, pelvic floor, and
gluteal musculature.
Flow
Exercises are performed with a flowing
motion that originates from the center.
Neutral Spine Position
Neutral spine is alignment of the ASIS
and pubic symphysis in the same
horizontal plane (normal lumbar
curvature)
Equipment and Exercises
Chatanooga Stabilizer Cuff
Types of Pilates Exercises
and Equipment
(1) Matwork
(2) Reformer
(3) Cadillac
(4) Chair and Barrel
Types of Pilates Exercises
and Equipment
Certification
Polestar
a. http://www.polestarpilates.com
b. Certification involves completing the course
series, assignments and short quizzes, as well as
a number of hours of observation, self-mastery,
assistant teaching, and practical teaching. Full
certification is granted once the final written and
practical exam is passed – pass mark is 80%.
Certification open to all, but special rehab
certification for health care professionals.
Certification
The Professional Health and Fitness Institute
a. http://www.prohealthandfitness.com
b. Certification is broken into one mat and
two equipment courses (weekend courses,
approximately 18 hours each), followed by
100 practical hours (on your own), and a
written exam for each.
c. Certification only for healthcare
professionals.
Certification
The Pilates Method Alliance
a. http://www.pilatesmethodalliance.org
b. Is working towards a National
Certification “Requirement”.
Hosts International Education
Conference annually
(November 3-6, 2005).
Core Strengthening and
Pilates in Rehabilitation
Lumbar Spine
Spinal stabilization exercises are essential for
prevention and rehabilitation of an injury to
the lumbar spine. In patients with low back
pain, contraction of the transverse abdominis
is significantly delayed, resulting in inefficient
muscular stabilization of the spine.
Pilates mat exercises
All of the Pilates mat exercises target
the transverse abdominis (and
subsequently, the multifidus), and many
of these are appropriate in the treatment
of low back pain.
Indicated exercises covered in
lab will include:
The Hundred
Single Leg Stretch
Double Leg Stretch
Single Straight Leg Stretch
Double Straight Leg Stretch
Contraindicated?
The following exercises may be
contraindicated and should be used with
caution because they involve extension
beyond the neutral spine position.
Neck Roll
Double Leg Kick
Swimming
Swan Dive
Posterior pelvic tilt
These following exercises are performed in a
posterior pelvic tilt and involve rolling onto the
spinous processes of the vertebra. This could
place additional stress on all vertebral
structures, including the pars interarticularis
and are contraindicated for spinal fusion and
possibly herniated disks.
Rolling Like a Ball
Seal
Open Leg Rocker
Upper Extremity
If the scapula is not stabilized sufficiently, the
glenoid may become poorly positioned. This
decreases the subacromial space, and may
lead to impingement. Weakness of the
serratus anterior can alter the normal muscle
firing patterns of the rotator cuff, resulting in
inflammation of the rotator cuff tendon and/or
tendon of the long head of the biceps.
Shoulder impingement can lead to tendonitis,
bursitis, and rotator cuff tears.
Shoulder stabilizers
Several Pilates exercises target the
shoulder stabilizers. Indicated
exercises covered in lab include:
Leg Pull Up
Leg Pull Down
Side Press
Push Ups
The following advanced exercises place a
majority of the body weight on the neck and
shoulders, and should be used with caution:
Roll Over
Scissors
Bicycle
Jack Knife
Boomerang
Lower Extremity
A 2004 study by Leetun, demonstrated hip
external rotation strength as a predictor of injury
status in collegiate track runners, and suggested
core stability has an important role in injury
prevention. A 2000 study by Fredericson et al
demonstrated weakness in hip abduction
strength in long distance runners with ITBS
compared to the unaffected leg and unaffected
long-distance runners. Symptom improvement
was related to improvement in hip abductor
strength.
Pilates position
The Pilates position is used in most mat
exercises, and involves external rotation
of the hips and ankle plantarflexion. A
neutral positioning can be used if
piriformis or gastroc tightness is an
issue. The Magic Circle can be added
to many exercises to target hip
abductors or adductors as needed.
Sidelying series
The sidelying series in matwork targets
the hip musculature. Indicated
exercises covered in lab include:
Side Kicks: Up/Down
Side Kicks: Front/Back
Side Kicks: Small Circles
Side Kicks: Double Leg Lift
THE HUNDRED
THE HUNDRED
THE HUNDRED
THE HUNDRED
SINGLE LEG STRETCH
SINGLE LEG STRETCH
SINGLE LEG STRETCH
SINGLE LEG STRETCH
DOUBLE LEG STRETCH
DOUBLE LEG STRETCH
DOUBLE LEG STRETCH
DOUBLE LEG STRETCH
SINGLE STRAIGHT LEG
STRETCH
SINGLE STRAIGHT LEG
STRETCH
SINGLE STRAIGHT LEG
STRETCH
DOUBLE STRAIGHT LEG
STRETCH
DOUBLE STRAIGHT LEG
STRETCH
DOUBLE STRAIGHT LEG
STRETCH
DOUBLE STRAIGHT LEG
STRETCH
LEG PULL DOWN
LEG PULL DOWN
LEG PULL DOWN
LEG PULL DOWN
LEG PULL UP
LEG PULL UP
LEG PULL UP
LEG PULL UP
PUSH UP
PUSH UP
SHOULDER BRIDGE
SHOULDER BRIDGE
SHOULDER BRIDGE
SIDE BEND
SIDE BEND
SIDE BEND
SIDE BEND
SIDE KICK SERIES:
FRONT/BACK
SIDE KICK SERIES:
FRONT/BACK
SIDE KICK SERIES:
FRONT/BACK
SIDE KICK SERIES: BACK
SIDE KICK SERIES:
UP/DOWN
SIDE KICK SERIES: UP
SIDE KICK SERIES: DOWN
SIDE KICK SERIES: SMALL
CIRCLES
SIDE KICK SERIES: SMALL
CIRCLES
SIDE KICK SERIES: SINGLE
LEG LIFT
SIDE KICK SERIES: SINGLE
LEG LIFT
SIDE KICK SERIES: DOUBLE
LEG LIFT
SIDE KICK SERIES: DOUBLE
LEG LIFT
FEEDBACK CUFF
EXERCISES
FEEDBACK CUFF
EXERCISES
FEEDBACK CUFF
EXERCISES
FEEDBACK CUFF
EXERCISES

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Core Strengthening Spine Exercises

Eric Shamus,PhD, DPT

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