1. Slide 1 Exercise in Spine Care Tara Jo Manal PT, OCS, SCS

2. Slide 2 LBP Treatment Activity vs. Inactivity Activity vs. Inactivity Trunk weakness and association with LBP Trunk weakness and association with LBP Weakness not predictive of first LB injury Weakness not predictive of first LB injury Endurance may be more critical than strength Endurance may be more critical than strength Muscle Performance vs MVC Muscle Performance vs MVC

3. Slide 3 Lumbar Viscosity Cycle spine through available ROM Cycle spine through available ROM Less spinal stiffness Less spinal stiffness

4. Slide 4 Early Activity Transversus Abdominus Transversus Abdominus Hallowing Hallowing –Pull navel up and in Avoid Rectus by retaining a pelvic tilt Avoid Rectus by retaining a pelvic tilt Can start in quadriped Can start in quadriped

5. Slide 5 Early Activity Advance with hooklying marching Advance with hooklying marching Bridging Bridging Functional progression Functional progression –~6% MVIC in upright

6. Slide 6 Curl up Rectus Activity Rectus Activity

7. Slide 7 Horizontal Side Support Low compressive spinal forces Low compressive spinal forces

8. Slide 8 Extensor Activity Quadruped Quadruped Leg lifts Leg lifts –~18% MVIC/side Leg ext with arm Leg ext with arm –~27% lumbar –~45% thoracic Avoid superman in prone Avoid superman in prone –Risk 4000N force –Facet injury at risk

9. Slide 9 Rotational Activity Forward Flexed hand on chair Forward Flexed hand on chair Brace LB Brace LB Lift weight in other hand Lift weight in other hand

10. Slide 10 Exercise Program Advice Perform daily Perform daily Avoid pain Avoid pain Cardiovascular health effective Cardiovascular health effective Avoid full range activity when waking Avoid full range activity when waking Endurance - Low load more reps Endurance - Low load more reps No one ideal set of exercises No one ideal set of exercises Long term compliance needed for improvement and protection Long term compliance needed for improvement and protection