Stabilization Exercises In Care of The Spine by Joyce Demestihas, P.T.,M.A.

Back pain is one of the most common problems seen in the physical therapy clinic. While passive modalities cannot prevent back injury not prevent reoccurrences of back pain injuries, there is a very clear role for modalities in the relief of acute back pain. Exercise, aimed at the core muscles, is the only option to prevent back pain.

Stabilization Exercises are exercises designed to isolate and strengthen the crucial core muscles. Utilizing exercise as the primary portion of the treatment, draws the patient into the therapy session, allowing them to play an active role in their recovery. This way, the patient is given some level of control over their disability and is now motivated to participate in their therapy.

Exercise has been used to treat back pain in the clinical setting, but it is exercise in the neutral spine position that proved the most helpful. When in the neutral spine position, the patient is exercising in a more comfortable position, with the least amount of irritation to the spine and is holding this "symptom quiet" position for an extended period of time. Often, the longer a position is held without insult to the injured area of the spine, the more relief the patient experiences once the exercises are completed. Incredibly, when performed in the neutral spine position, these exercises can at times, stop back pain without the use of other modalities.

Neutral spine posture is one in which the patient is most comfortable and ready for exercise without increasing their pain. This posture can vary with diagnosis, body position, and progression of time. For instance, a stenotic patient biased in flexion in supine, but biased in slight extension in sitting. Very often a patient begins therapy in a very biased posture, but becomes more tolerant of a larger range of movement of their spine as they progress in therapy. It is critical to explore the neutral spine posture in many different positions and for both the patient and therapist to reassess neutral from time to time.

Exercising with a physioball is a very effective way to exercise the core muscles. Movements on the physioball cause the firing of muscles responsible for rotation of the spinal segments, which are so important for activities of daily living and virtually all sport activities. After all, very little of life's activities require straight plane movements.

Once neutral spine has been mastered in all exercise positions, i.e.; supine, prone, quadruped, it is very important to train patients in functional activities that are used for work or sport. These activities could be as simple as transfers from position to position ar as complicated as the swing of a bat for baseball. Through these functional activities will vary from individual to individual, they will help the patient in realizing how neutral spine applies to their particular work or sport.

The patient may find stabilization exercises hard at first. "Hard" may mean difficult but never painful. Often, even the athlete is surprised at how these exercises isolate certain muscles and are therefore "difficult" to perform! They require a commitment from both the patient and the therapist. the patient must be willing to comply not only during therapy session, but at home in an individualized home exercise program. They must also realize that this is a lifelong commitment and they will most certainly suffer if they slack off from their exercises. Whereas the therapist must be willing to be flexible, thorough, creative and willing to demonstrate exercises.

Often the patient will realize the practical benefits of these exercises midway through the program. They are finding that they are in the neutral spine position during daily activities and not having to be consciously placing themselves in this posture. It is at this point that the therapist knows the patient has been thoroughly trained in neutral spine posture.

Stabilization exercises are a long awaited welcome addition to spine care in the clinical setting. If taught and done correctly, the results are long lasting and the patient gains a lifelong education in the care of their spine.
 

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