Self correction techniques for biomechanical problems related to spine

self correction techniques used for the spinal biomechanical problems

1. SELF CORRECTION TECHNIQUES FOR SPINAL BIOMECHANICAL PROBLEMS MAHVISH QAISER MPT CARDIOPULMONARY FINAL YEAR

2. It is discovered that core stability exercise promotes improvement in tonic core muscle strength and endurance whereas muscular stretching does not in CLBP rehabilitation . 1 The core also known as lumbo-pelvic-hip complex is attached to local (postural, tonic) muscles which are responsible for providing segmental stability and directly controlling of the lumbar segments during movement. Weakness and/or tightness of these groups of muscles will cause many disorganized movements that leads to lower back injury. 1

3. This approach will offer a more biomechanical efficient for the entire kinetic chain of the lumbo-pelvic-hip complex thus allowing the body to decelerate gravity, ground reaction forces and momentum at the right joint, in the right plane and at the right time. 2 Increased stability of the trunk will enable the individual to maintain the spine and pelvis in the most comfortable & acceptable mechanical position that control the forces of repetitive micro trauma and protect the structures of the back from further damage.

4. ADIM (Abdominal drwaing in manuever) side-bridge quadrupe d exercises can be used. 2 For the ADIM , 3 sets of 10 contractions, with a 10 second hold and 15 second rest, can be used. (Figure 1). Core-stability: Transverse abdominus muscle

5. Transverse abdominis ADIM Exercise

6. For the side-bridge exercise , the patient will start by lying on their right side, with the weight-bearing elbow flexed and both knees flexed. 2 The position w ill be held for 10 seconds, with a 15-second rest. 3 sets of ten contractions can be performed. ( Figure 2). Core-stability: Transverse abdominus muscle

7. Transverse abdominis Side-bridge exercise

8. Lastly, for the quadruped exercise , the patient will adopt quadruped position . Keeping a flat back, the patient will perform the ADIM, holding the contraction for 10 seconds with 15 seconds rest between contractions. 2 (Figure 3). Core-stability: Transverse abdominus muscle

9. Transverse abdominis Quadruped exercise

10. In a supine position, the subject placed a ball below the neck, bent the knees, and crossed and bent 90° the arms so that the crossed arms came to the eye level. While breathing out, the subject slowly raised each lower limb in turn. The subject performed the motion of bending the hip joint and the knee joint 90° five times, for 10 seconds each time . 3 Core-stability: Multifidus muscle

11. In a supine position, the subject placed a ball below the pelvis, bent the knees, and crossed and bent 90° the arms so that the crossed arms came to the eye level. The subject performed the motion of pressing the ball below the pelvis slowly five times, for 10 seconds each time . 3 Core-stability: Multifidus muscle

12. In a crawling position, the subject placed a ball below one knee and kept the toes away from contact with the floor. The subject balanced first to stabilize the posture and slowly raised the other lower limb. This exercise was performed in turn for the two lower limbs 10 times, for 10 seconds each time . 3 Core-stability: Multifidus muscle

13. After assuming a prone position, the subject placed a ball in front of the pelvis and raised both lower limbs. As if kicking, the subjects repeatedly raised and lowered the two lower limbs alternately. The subject performed this exercise 10 times, for five sets, taking a rest of at least 15 seconds between each set. 3 Core-stability: Multifidus muscle

14. Stretching is widely used in physical therapy which helps in alleviat ing CLBP by progressively stretching the muscle groups which are assumed to be too short, especially the lumbar spinal muscle and the hip flexors and extensor .6,7 Stretching

15. Self stretching techniques to increase lumbar flexion 5,6 ,7 : Hamstrings stretch Lumbar erector spinae muscle and tissue posterior to the spine

16. Jack-knife stretch is a useful active static stretching technique to efficiently increase flexibility of tight hamstrings. One set consisted of 5 repetitions, each held for 5 s. (4weeks). 6 Jack-knife stretch

17. Active stretching to the hamstrings, quadriceps, and triceps surae muscle reduce muscle tightness in paediatric patients with lumbar spondylolysis.One set of 5 repetition with 10seconds hold. 7 Quadriceps stretch Triceps slae muscle

18. Self stretching techniques to increase lumbar extension : 5 Self stretching of the soft tissue anterior to the lumbar spine and hip joint with the patient (A) prone and (B) standing.

19. Self-slump stretching home exercise program . Patient Position- long sitting, feet against a wall to maintain neutral dorsiflexion angle, trunk flexed to enhance dural elongation, active neck flexion with overpressure from their hands until the onset of symptoms. Five repetitions of 30- second holds . 8 Self-slump stretching

20. Self stretch techniques to increase lateral flexibility of the spine Patient with a right thoracic left lumbar curve. Patient actively stretches thoracic curve by reaching upward on side of concavity and downward on side of convexity.

21. Self stretch techniques to increase lateral flexibility of the spine Heel-sitting position with patient reaching the arms overhead and then walk the hands toward the convex side. Side-lying with a rolled towel at the apex of the convexity

22. Self stretching techniques to increase thoracic extensio n : A) Touchdown position B) With the shouldes abducted and laterally rotated . C) Adducting the scapula and extending the thoracic spine against the back of the chair.

23. Positional Traction: Lumbar spine Patient position: Side lying, with the side to be stretched uppermost. A rolled blanket or thick towel is placed under the spine at a level where the traction force is desired. Side bending over a 6 to 8 inch roll causes longitudinal traction to the segments on the upward side.

24. Rotation is added to isolate a distraction force to the desired level. Flex the patient's upper most thigh, again palpating the spinous processes until flexion of the lower portion of the spine occurs at the desired level. The segment at which two opposing forces meet now has maximum positional distraction forces. Side bending with rotation adds a distraction force to the facets on the upward side .

25. Self Traction: Cervical spine Patient Position: Siting or lying down. Have the patient place his or he hands behind the neck with the fingers interlocking. The patient then gives a lifting motion to the head. The head and spine maybe placed in flexion, extension, side bending or rotation for more isolated effects. He or she may apply the traction intermittently or in a sustaied manner. Recommendations varies from few min to 40 minutes. 15-30seconds hold with 5-10 seconds rest. Saunders et al advised 8-10min of spinal traction in disc protrusion whereas Hickling et al advised 20-40min of spinal traction in disc protrusion. 19,20

26. Self Traction: Cervical spine

27. Shih-Lin Hsu et al in their study found that exercises for the transverse abdominis, multifidus, diaphragm, and pelvic floor muscles helps to improve core strength. Core strength training 1. T ransverse abdominis and multifidus muscle , H and-knee bird dog exercise with draw-in can be performed for 30 s ×10 sets .

28. 2. D iaphragm muscle A bdominal inspiratory exercises with a 3-kg weight resting on the abdomen was performed for 10 min .

29. 3. P elvic floor muscles E xercise requiring maximal contraction of the perineal muscles in a sitting position against a towel between the thighs was performed 15 times × 2 sets.

30. Spine stabilization 10,11,12 A series of studies showed that 3 forms of exercise produced stabilizing patterns, specifically for flexion dominant challenges using a form of the curl-up, frontal plane challenges using the side-bridge, and extensor dominant challenges using the birddog. 10,11 Specific transverse abdominis and multifidus training are not as effective as multimuscle therapeutic exercises. More recently, Suni et al showed that the position of the spine (neutral in this case) when performing exercise resulted in better outcome. 12

31. Fritz et al showed that those patients with stiff backs did better with mobilizing approaches, whereas those with unstable backs did better with stabilization exercise. 13 Hicks et al16 have shown that testing for shear instability (using the test described by Magee17) was a good predictor of those who would do well with stabilization exercise approaches. 14

32. Spine stabilization 14,15

33. Spine stabilization 15,16

34. U pslip and Downslip Ilium are patterns of sacroiliac joint (SIJ) dysfunction (SIJD) that are commonly described in the literature . 15 An ‘upslip’: 1. may co-exist with a ‘rotational malalignment’ and/or an ‘outflare/inflare’ 2. occurs considerably less often than ‘rotational malalignment’. Common signs for left Upslip : 16 Functionally shorter leg length on the left Left Iliac crest superior vs. right Left PSIS superior vs. right Iliac Crest Height left superior to righ t SACROILIAC JOINT DYSFUNCTION

35. A unilateral ‘downslip’ occurs rarely and the diagnosis is frequently delayed or missed altogether. 16 Typically, there is a history of excessive traction on an extremity . In posterior innominate rotation, the anterior superior iliac spine is carried superior and posterior, the posterior superior iliac spine is carried anterior and inferior, and the ischial tuberosity is carried anterior and inferior

36. Common signs for right a nterior Innominate : Functionally longer leg length on the right Anteriorly rotated ilium (Right ASIS appears inferior) Right PSIS superior vs. left .. ASIS Height Right inferior to le ft

37. Treatment of Upslip : 1. trigger point release to the quadratus lumborum 2. Muscle energy technique to the Quadrautus Lumborum 3. Isolated strengthening of right Quadratus Lumborum via right hip hike (approximation). Treatment of anterior innominate: 1. trigger point release to the hip flexors 2. Muscle energy technique to the Quadrautus Lumborum 3. Isolated strengthening of the Right Gluteus Max via single leg floor bridge. Common trigger point (QL) Trigger points for TFL and Rectus Femoris

38. Self corrective techniques for upslip 16 Self myofascial release to quadratus lumborum: Once t ender spot is located lean back in to the ball with moderate pressure and hold for 30-60 seconds. M yofascial release tools such as a Thera-Cane or Backnobber can be used to release the QL.

39. 2. Static self stretching of the quadratus lumborum. Self corrective techniques for upslip 16

40. Isolated strengthening of right Quadratus Lumborum via right hip hike (approximation): Stand on a 6-12” box or step, with the right leg hanging off and weight shifted over the left leg. Slowly pull up or hike the right leg. The right iliac crest should move toward the right 12th rib. Hold the up position for 2 seconds and slowly return to the starting position. Repeat for 10-15 repetitions. For increased intensity, add a cuff weight to the ankle. Self corrective techniques for upslip 16,17

41. Self Myofascial Release to the right Rectus Femoris and right TFL via foam roll: R ectus femoris : lie flat on the foam roll, the roll should be perpendicular to the front of the thigh. Begin at the hip and slowly roll toward the knee. Hold the tender spot for 30-60 seconds. Self corrective techniques for Anterior Innominate 16 Foam Roll Rectus Femoris

42. TFL :lie down on the foam roll and rotate to approximately 45 degrees to the side, so that the TFL is on the foam roll (near the area of the front pocket). Once the tender spot is found hold pressure on the spot for 30-60 seconds. Foam Roll TF L Self corrective techniques for Anterior Innominate 16

43. 2. Static self stretching of the rectus femoris and TFL . Self corrective techniques for Anterior Innominate 16 Rectus femoris stretch Tensor fascia lata stretch

44. Self corrective techniques for Anterior Innominate 16 Isolated strengthening of the Right Gluteus Max via single leg floor bridge: single leg floor bridge

45. Correction techniques for Inflare and outflare 17 A) MET INFLARE TECHNIQUE B) MET OUTFLARE TECHNIQUE

46. Self corrective techniques for Inflare 18

47. Ebby Waqqash, Rahmat Adnan, Sarina Md Yusof, Shariman Ismadi Ismail. fficacy of core stability exercise and muscular stretching on chronic lower back pain. Proceedings of the International Colloquium on Sports Science, Exercise, Engineering and Technology 2014 (ICoSSEET 2014). Noelle M. Selkow, , Molly R. Eck , Stephen Rivas . TRANSVERSUS ABDOMINIS ACTIVATION AND TIMING IMPROVES FOLLOWING CORE STABILITY TRAINING: A RANDOMIZED TRIAL. IJSPT. The International Journal of Sports Physical Therapy | Volume 12, Number 7 | December 2017 | Page 1048-56. DOI: 10.16603/ijspt20171048. SinHo Chung, JuSang Lee, JangSoon Yoon. Effects of Stabilization Exercise Using a Ball on Mutifidus Cross-Sectional Area in Patients with Chronic Low Back Pain. Journal of Sports Science and Medicine (2013) 12, 533-541. REFERENCES

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