The Pro sports blog
The material provided here is general information and individual advice should be obtained with an evaluation or assessment by an appropriate physical therapist
By Patrick Knox, SPT
Low back pain is a highly prevalent and debilitating condition that accounts for a substantial amount of the cumulative annual healthcare expenditure. Due to its multifactorial nature, treatment measures for low back pain vary within the realm of physical therapy. Often, clinicians utilize tests and measures in order to stratify patients into subgroups that typically respond to specific interventions. One such classification group of low back pain patients is those with LSI (lumbar segmental instability).
The origins of lumbar stability research are deeply rooted in mathematical and biomechanical analysis given the inherent complexity of the spinal system. Pioneers in the field developed in vitro models that accounted for both passive (osteoligamentous system) and active (muscle stiffness and activation levels) restraints. Over time, these models were updated to include real-time data from research participants (including movement kinematics via video analysis and muscle recruitment patterns via EMG), which eventually resulted in recommendations for how to best treat patients that were predisposed to injury secondary to loss of osteoligamentous integrity, trunk neuromuscular control deficits, or a combination thereof. Particularly, stabilization programs should include the following: abdominal brace, abdominal curl-up, horizontal side-support (side planks), and quadruped extremity lifts (bird dogs).
Research has delineated which tests and measures (prone instability test, aberrant motions during AROM assessment, FABQ-PA value, and hypermobility in the lumbar spine) will best indicate the subgroup of low back pain patients who will positively respond to the aforementioned lumbar stabilization exercises, and has validated the use of such exercises on a longitudinal basis. Additionally, research suggests the addition of NMES to the lumbar paraspinals may be an effective adjunct to lumbar stabilization exercises.
The following presentation explains, in detail, the lineage of lumbar stabilization and provides pragmatic examples of how to optimize clinical practice. More research is needed to determine how these exercises should be adapted to different patient populations, and the magnitude to which NMES augments traditional stabilization programs.