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

2. 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

3. 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.

5. 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

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

8. 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

9. 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

10. 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.

11. 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.

12. 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.

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

14. Cervical and upper thoracic region: stretching techniques

15. Techniques to increase thoracic extension
Self-stretching

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

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

18. Traction as a stretching technique

19. 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.

20. To Increase Craniocervical Flexion

21. To Increase Craniocervical rotation