SPINE EXERCISE AND MANIPULATION INTERVENTIONS DPT – SEMESTER 7 Dr. Sarah Ehsan

Topics to be covered: Basic concepts of spinal management with exercise Fundamental interventions Patient education General exercise guidelines Kinesthetic awareness Elements of kinesthetic training–fundamental techniques Progression to active and habitual control of Posture Mobility/flexibility Cervical and upper thoracic region: stretching techniques

Fundamental interventions Fundamental interventions are defined as exercises or skills that all patients with spinal impairments should learn regardless of their functional level at the time of examination and initial treatment.

Patient education Patient must be an active participant : In identifying outcomes Limitations at each stage of healing Patient should not be a passive recipient of treatment Educate on safe progression of self management Safe way to exercise Safe body mechanics instructions in prevention

General exercise guidelines 4 weeks 4 4-12 wk 4 >12 wk 4

Kinaesthetic awareness One of the fundamental interventions for spinal rehabilitation is to develop patient awareness of safe spinal positions and spinal movement as well as what effect the supine, prone, side-lying, sitting, and standing positions have on the spine

Elements of kinaesthetic awareness-fundamental techniques Position of symptom relief Position of bias or resting position Neutral spine is in mid range patient may not find it comfortable initially

Passively move the head and neck with gentle nodding Cervical spine Lumbar spine Passively move the head and neck with gentle nodding motions of the head into flexion and extension, side bending, and/or rotation to find the most comfortable position for the patient. If necessary prop the head and neck with pillows. Cervical collar may be required. While supine, passively position the pelvis in posterior PT by placing the lower extremities in the hook- lying position or anterior tilt by gently pulling on the extended legs or placing a small roll under the lumbar spine. Sitting encourages spinal flexion; if extension is more comfortable, instruct the person to use a lumbar pillow for support.

Effects of Movement on the Spine In general, movement of the extremities away from the trunk (shoulder flexion and abduction, hip extension and abduction) causes spinal extension; movement of the extremities toward the trunk (shoulder extension and adduction, hip flexion and adduction) causes spinal flexion.

Progression to habitual and active control of posture Integrate the awareness of posture and control of the spinal segments into all stabilization exercises, aerobic conditioning, and functional training activities. This principle is also incorporated into body mechanics, such as when going from picking up and lifting to placing an object on a high shelf, or into sport activities when reaching up to block or throw a ball.

Mobility and flexibility Goal. To increase ROM of specific structures that affect alignment and mobility in the neck and trunk.

Cervical and upper thoracic region: stretching techniques

Techniques to increase thoracic extension Self-stretching

Techniques to Increase Axial Extension (Cervical Retraction): Scalene Muscle Stretch MANUAL STRETCHING SELF STRETCHING

Techniques to Increase Upper Cervical Flexion: Short Suboccipital Muscle Stretch MANUAL STRETCHING (Figure) Self stretching

Traction as a stretching technique

Muscle Energy Techniques to Increase Craniocervical Mobility Muscle energy (ME) uses the application of submaximum, isometric contractions of muscles whose line of pull can cause the desired accessory motion of a joint; ME techniques are designed to improve joint mobility. The patient holds the gentle muscle contraction against the therapist’s graded resistance for 3 to 5 seconds and then relaxes. This process is repeated for three to five repetitions.

To Increase Craniocervical Flexion

To Increase Craniocervical rotation