Therapeutic Exercises for Spinal Segmental Stabilization in Low Back Pain: Scientific Basis and Clinical Approach

200 Pages·1998·17.29 MB·English

by  Carolyn Richardson PhD BPhty(Hons)

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SpinaSle gmentSatla bilization
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CarolyRni chardson
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EDINBURGHL ONDON NEW YORK PHILADELPHISAY DNEYA ND TORONTO 1999
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permittriensgt riccotpeydi Inngt heU niteKdi ngdoims sued
byt heC opyriLgihcte nsAignegn clyi d9,0 T ottenham
CourRto adl.o ndonW.1 P OlP.
Ther igohftC arolRyinc hardsGowne,n dalJeunl Pla,u l
Hodgesa ndJ uliHei detso b ei dentiafsit ehdea uthoorfst his
Workh asbe en assertbeydt hemi na ccordanwciett hh e
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Britilsihb raCrayt aloguiinPn ugb licatDaitoan
A catalogrueec orfdot rh ibso oki sa vailafbrloetm h eB ritish
Library.
LibraorfyC ongresCsa talogIinnP gu blicaDtaitoan
A catalroegc orfdot rh ibso oki sa vailafbrloetm heL ibraorfy
Congress.
Note
Medickanlo wledigsce o nstancthlayn giAnsgn .e w
informabteicoonm easv ailable, cihnta rnegaetsm ent,
procedureesq,u ipmeanntd t heu seo fd rugbse come
necessaTrhye.a uthoarnsd t hep ublishhearvsea ,s f aars i t
isp ossibtlaek,e cna rteo e nsurteh atth ei nformagtiivoenin n
thitse xitsa ccuraatnedu pt od ateH.o weverre,a dearrse
stronagdlvyi steodc onfitrhma tth ei nformateisopne,c ially
witrhe gartdod ruugs agec.o mpliweist lha telsetg islation
ands tandarodfps r actice.
Printientd h eU niteKdi ngdom
Contents
Forewovridi 7.O vervioeftw h per inciopfcl leisn ical
managemoefnt thd ee empu scslyes tem
Prefaicxe fosre gmensttaalb iliz9a3 tion
Acknowledgemxie nts SECTION4 Thec linical app1r0o3a ch
8.C linitceaslto iftn hgle o cmauls cles:
SECTION1 Introduct1i on
practeixcaamli naotfmi ootno srk il1l05
1.T her easfooncr h ang3e
9.A nalyasnidts r eatmoefmn ott or-control
problienmt sh leo cmauls cloefts h e
SECTION2 Thes cientbiafsiics9
lumboperlevgiico1 n25
2.B acpka iann dl umbopesltvaibci lization:
10.I ntegrianttidooy nn amfiucn cti1o45n
thcea sfeo trh leo cmauls cslyes te1m1
11.P ractaiscpaelic ntt sr temae nptl annainndg
3.T raditviioenwoasflt hfeu nctoifto hne
delive1r57y
muscloefts h leo csatla bilsiyzsitnoegfmt he
spin2e1
SECTION5 Futurdei rectio1n6s5
4.A newp erspeocntti hvseet abilirzoaltei on
12.F utudrier ectiinro ensse aarncdch l inical
oft hter ansvaebrdsoums in4i1 s
practi16c7e
5.L ocmauls cdlyes funcitnli oowbn a cpka in
61 Reference1s7 3
SECTION3 Applyisncgi entcoep racti7c7e Index1 85
6.G enercaoln siderianmt oitooncrso ntarnodl
joisntta bilitzhabeta isooinfsa: s sessment
ande xerctiesceh niq7u9e s
Foreword
Youa lhla vhee artdh set oorfyf oubrl inmedn thaec tulaola dtsow hicthh sep iniess ubjected
whow erea sketdoe xamiannee lephaTnhte. ind aillyi vitnhge,i mportaonfct eh es pinal
onet ouchtihnlege gssa itdh aittw ast hter unkm usclaensdt heciorn tbreoclo moebsv ious.
ofa treTeh.e o thewrh,o h eltdh ee lephant'Tsh ea uthoorfts h ibso ohka vper oducaet de xt
truniknh ish andwsa,s c erttahianit tw asa thafto cusoents h es pinmauls clsepse,c ifically
rubbheors Teh.e t hiorndef etlhtse h arbpr istloenst hepiort enttois atla bitlhisezp ei ncaoll umn.
oft htea ainld p ronounictte obd e a b ottlebrTuhsehr.ie s s ignifibciaonmte chanliictaelr ature
Thef ourwthho,w ast ouchtihnegl argeea rs,d escritbhiern ogl oefv arioaunsa tomciocma­l
thougthhte tmo b ef anTsh.u asl flo udre scrippo­nenotnst hes tabiolfit thyes pincaoll umn,
tiownesr ter uthbfuutl niodneen ttihfaein eidm alb.u tt hiissn ott hec asfeo rt hem usclTehse.
Cliniscpailni anls tabiisll iiktaeyne lephanstt.u diaebso utth er oloef m uscloens s pinal
Evetnh ougwhe knowi tmsa nifestasttiiolsnlts a,b ialrieft eyw T.h eraer ien herdeinftf iculties
we do notf ululnyd erstiatnA.dn engineeirns tudytihnbegi omecharnoilocefam lu scliens
thinokfsi ta sa mechanisctarlu ctthuarhtea s vivTo.h ea uthohrasvm ea des ignifriecsaenatr ch
becommee chaniucnasltlayAb nloe r.t hopaecdoinct ribuitnti hoifnsis e Ilndt. h itse xtth,e nyo t
surgehoansa diffevrieenwtp oSihneto .r h e onlpyr esetnhteo iwrn a ndo therress'e aornc h
thinokfsi ta sa mechanisctarlu ctthuarhtea s thep otentfioatrlh es pinmauls claensdt heir
lositt asb iltiotm ya inttahienn ormaplh ysion­eurcaoln trtoosl t abitlhiesz pei nbeu,ta lso
logipcata tle mosfm otiorne,s ulitnic nlgi niccalle arplrye setnhteh ypotheosfti hse s pinal
symptoomfps a iann d/noeru rolodgyiscfauln cs­tabilsiyzsitneagmn ,dm ,o sitm portatnhteliyr,
tioAn .p hysitchaelr apmiasytd iagnotshee clineixcpaelr iiennh ceel pitnhgle o wb acpka in
problaesmt hed eficiientn hcemy u sculpaarr t patibeynu ts intgh emiert hodology.
oft hes pinsatla bilsiyzsitneWgmh .i lae m ore Thitse xtto,m y knowledigsae f,i rosfti ts
sevecroen ditmiaoyrn e quicroem pleetlei mink­intdh aatt temtpots sy nthetshieaz vea ilable
atioofnm otiaotnt hsei gohfti njuorrdy y sfunci­nformaatbioountt h ed ynamisct abilization
tiobnyf usisounr getrhyle,e ssienrs tabmialyi toyf t hes pincaoll umbny s pinmauls culature,
be suitably wtirtehma utsecdl ael teratieosnpse ciaasli ltry e lattoet sh el owb acpka in
leaditnodg e creasspeidnm aolt ioTnh.eh uman probleTmh.eb ooki sa well-concberiivdegde
spinies a remarkasbtlreu ctpuerref,o rmibnegt wetehnbe a sriecs eaarncdch l inpircaaclt ice.
seemingly cofnufnlcitcictoainrnsrg:y lianrgg eI ts houbledo fs ignificantto p ihnytseirceaslt
spinal allolaodwmsio,nt gi oinnms u ltippllaen esa ndo ccupational atnhdeo rtahpepirrs ot­s
betwebeond pya rtasn,dp rotectthidene gl icaftees siownhaocl lsi nidceaalwlli ytt hh per oblems
spincaolra dn dn ervreo otMse.c hansitcaabli liotfty h,le o wb acIkt.m a ye vehne lbpe ttiedre ntify
botsht ataincdd ynamiicsn, e edetdop erformt haen imoafcl l iniincsatla bility.
these fundafmuenncttaiAlos n st.h eo st eo­
ligamenstpoiuncsea nc arroyn lay f ractoifo n1 998 M.M.P
Preface
Therapeeuxteircct iors ees tmoursec fluen ctioonfa n ewt ypoefe xercfiostreh m ea nagement of
isa ni ntegrpaatreotfdt heb odoyf k nowledgleo wb acpka isnu fferwehrisci,hsp resenitne d
whiccho nstipthuytseistc haelr aIpnty h.pe a sitt thibso okS.p inasle gmentsatla biliziasta ino n
mayh avbee esna itdh atth erapeeuxteircct ios ei nnovatmievteh oodf d elivetrhienrga peutic
restmoursec lfeu nctiinob na cpka isnu ffereerxse rctiots heep atieInnmt a.n yw aysi ti st he
wasm oroef a na rtw,h erter eatmweansgt i vena ntithteots riasd iteixoenracmlie steh osdusc ahs
ona triaanlde rrboars wiist nho c leuanrd er­strenagntdhe ndurance twrhaiicnhhia nvge,
standoifnw gh ys omee xercsieseemse mdo re formtehdbe a sfiostr h teh erapeexuetriccfi osre
effectthiaovnte h eTrhsea. p protaoct hh erapeumtuiscc uloskceolnedtiatlfi oorsn osl ongS.pi nal
exercfiolsroe w b acpka idne scriibnte hdib so ok segmensttaalb iliizasdt eisoin gtnoes dp ecifically
evolvferdoa mn e arildye a, gfariornmee sde arcihm protvheue n derljyoiinsngtt a bilirzaatthieorn
andt reatmiennp th ysitchaelr atphya,st o me thatnr ainfiunngc timoonvaelm eanntd h oping
musclheasv ae primafruyn ctfioorsn u pporjto icnotn tirmoplr ocvoensc urrently.
andp rotecotfji ooinnT thsii.sd ewaa se xpanded Changitnrga dititohnianlk ianbgo utth e
intao n eww ayo ft hinkaibnogu etx erctios ee xerctirseea tmoefan c to mmopnr oblseumc ahs
prevelnotw b ackp ainr ecurroirni gn deedb ack piasia nl waydsi ffiTchuele tn.o rmous
occurirnitn hgfe i rpslta ce. challetnoeg fef ecchta nwgaes t hset imutlhuast
Whilree seairstc hhce o rnersftoaorg n ree atelre tdo t hwer itionftg h itse xatn da llowuestd o
understaonfdt ihnegr apeeuxteircci insiet,i aplrleys eonutri defaoser v aluaOtnilotyni .m wei ll
thper imacrhya llewnagsde e vistihnrege levanttei lfalc hanignet hinkdionegos c cuarn di ft his
researqcuhe stitohnaswt o uldu nloctkh e boodko efsu liftirslo liend eveloppihnygs ical
mysteroifte hspe r oblienmt sh meu scloefbs a ck theraptyr eatmeanntds i n fosterainndg
paipna tieTnhtesk .e yt ot hen ewd iscoversiteism ulatinrge sfeuarrtchhe.r
hasb eetnh ec lolsien bke twecelni nicainadn s Thed iscovoefmr oyt ocro ntrporlo bleimns
researcihnae nru sp warsdp iroafld iscovebrayc pka ipna tieanntdts h seu bseqdueenvte lop­
witohn es tevpe nturbeyid n novactliivnei cmaeln tosfn ewm easuorfet sh ese mpursocbllee ms
workt,h en exbty innovatsicviee ntdiifsi­ch avgei vetnh eo pportutnoei ftfye cchta ngien
coveriAess e.a chc yclree peatietds etlhfe, anothweary I.n a ne rwah eraec countaibsi lity
knowledbgaesg er aduaglrleywT .h ipsr ocesism portant, physimcuaslet m btrhaetcrheae p ists
hasd evelofpreodtm h em utuarle cognibtyi ocno ncetphta itt i sn ote nougthh apta tients
clinicainadrn ess earcohfee arcsh other'bse lpiaterhv­eeay r iem provwiintgth r eatmTehnet .
ticutlaalre nts. wayi nw hicthh ehya vbee neffirtoepmdh ysical
Thissp iroafdl i scovhearsby r ougthotg ethetrh erasphyo ubledm easurabbyol bej ectteisvtes
thew orko fm anya stuctlei nicainadin nsn o­thaats setshse w ay physictarle atmiesn t
vatisvcei entTihsert ess.ui lstt h ed evelopmecnhta ngitnhge iprh ysiccoanld itTieosnt.ts h at
x THERAPEUTIECX ERCISEF OR SPINALS EGMENTALS TABILIZATION
reflcehcatn agsea r esuolftt h erapeeuxteircc iseW hati st hfeu tuNreo?wt hatth feu nctoifo n
toe nhanjcoei nstt abilihzaavteni ootnb een thed eepm usclheasv eb eend iscovearnedd
availaTbhlibeso. o ki nclutdheefs i rosftt heses pecific exerctiost easr gtdehetev mii sne d
measurweist,th h eh opet haftu rthreers earcrhe habiliotnaetv iiotnqa,ul e stiroenm aiInns .
andc linical ewnidleslae vteoh ueremsv olavse somec ircumstcaanncl eesss,sp eciefxiecr cises
standard proaccekdnuorwelse dbgye tdh e alscoh antgheme o tocro ntprroolb leimnbs a ck
physical tahnedmr eadpiyc parlo fessaiso npsa ipna tieWnhtisl?we ed on obte litehviiess s o,
beinagp proprainadrt eel evfaonret v aluatiintrg e maiannsi mportraenste aqrucehs tfioorn
thepiart iepnrtosg'r ess. physical tahsew realpalis fs otrms a nyo ther
Technoliospg lya yiannig n creasiimnpgolryt h­ealctahrp er ofessainodni astl hsfe o coufso ur
anrto lienb otthh ter eatmaenndat s sessomfe ncto ntinrueisnega erfcfho rts.
thed eempu sclWehsi.l ieti se ssentthiaattlh e Asf ougro odf rienwdes h aveen joytehdi s
physitchaelr appryo fesismipornot vhee uinrd er­voyaogfed iscovaenrdly o ofko rwatrowd o rking
standionftg h es kelemtuaslc lsey steamn d togetfhoemrra nyy eartsoc omei nd eveloping
embracheisg htleyc hniecqauli pmesnutca hs andf urtheoruirkn ngo wleodfgS epi nsaelg mental
reatli me ultrasounidti sia mlasvgoii tnagls, t abitliiazna.
thatth essek ilalrsei ntroduacpepdr opriately.
Modalistuiceahss r eatli muel trassohuonudl d1 998 CR.
notb es eeans a substiftouhrti eg lhe veolfs G.].
clinsikciabllul tr athsehro ubledi ntrodausc ed P.H.
ana djuntcopt h ysitcraela tmmeondta lities. ].H.
Acknowledgements
Theraer mea nyp eopwleen eetdo t hanFkr.o m theu seo fr eatli muel trasiomuangdi Hnegi .s
thDee partmoefPn hty siothTehreUa npiyv,e rsiatsys isitngi unigd iintigsn troduicnttpioho yns ical
ofQ ueensland,S cQouSteutne,Rt oilnal n da liln therapy pWreat chtainDckreV .a ughKainp pers
theB acPka iAns sessmCelnitnf ioctr h eciorn ­oft hAen atomDye partmTehnetU ,n iverosfi ty
staenntt husiTahsemhy.a vmea dea s ignificQaunete nslfaonhrde lipno urs tudoifet sh dee ep
contribtuott ihoedn e velopmoeftn hte n ew musclaensd f ora ssistwaintcmhea nyo f the
clinsikciallwl hsi,ca hr dee scriibne dtb hoiosk .c adavedriiscs ecitlilounsst irnta htiebsdo okI.n
JoseNpgh a ndC hristHianmei ltcoonn tribuatdeddi titohnec, o llaboroafPt rioofne sSsiomro n
tot hdee velokpnionwgl eidngt eh eea ryleya rsG andevfirao,mt heP rinocfeW aleMse dical
andh elpuesdd evelaob pr oadpeerr specotni vRee searcIhn stituatned, P rofessAolrf
thmeu scdlyes funcatnideo xne rctirseea tmenTthso rstenasnsdDo rnA ndreCwr esswferlolm
associwaittelhdo wb acpka iWne. arger ateftuhlKe a roliInnssktai Stwuetdeei,nn t hdee velop­
fort hehierl apn df riendsAhsispo.c iPartoe­ mento fm anyo ft hes cienqtuiefsitci woanss
fessYovro nnBeu rnHse,a do ft heD epartmegnrte aatplpyr eciated.
showefda iitnoh u rr eseaarncdwh a sa s ourocfe We alsot hankW endy Sparkewsh o
contineunecdo urageWmeew notu.lp da rticuleanrtlhyu siasttoiocokan t lhlery o loefh elpiunsg
likteoa cknowlehdegrhe e lipn t hef ormatiporne patrheem anuscrWiep rte.a lalpyp reciated
andd evelopomfet nhCtel inaincda, l sDorT ony hera ttenttiodo ent awihli cahl lowuesdt o
Wrigfhothr i hse lipna cquirrienatgli muel traf­inalfliyn itshhe b ook. Fiannadlm loys t
sounidm agifnogtr h aes sessments. importawnetc loyu lndo th avdee veloapnedd
Ourk nowledogfer eatli meu ltrasoutnhdew nr itteno aubirod ueftao ser x erciiifsh tea d
imagiwnags o nlpyo ssitbhlreo utghhea ssistn­otb eefno trh ee ncouragepmaetnite,an ncde
ance, instanrdue cntcioounr ageomfeD nrt understanodfi onugr f rienadnsd f amily.
DaviCdo opearno, b stetrwihcosi paenc iailni zTehsa ntkose veryone.