1. Exercise Prescription for Flexibility and Low-Back Function
C H A P T E R 14
Exercise Prescription for Flexibility and Low-Back Function
Wendell Liemohn
Chapter 14

2. Basic Spinal Anatomy Motion segment Facet joint Ligaments
2 vertebrae and the disc between the two
Facet joint
Junction of the superior and inferior articular processes of two vertebrae
Ligaments
All have pain receptors
(continued)

3. Figure 14.2

4. Basic Spinal Anatomy (continued)
Discs
Allow increased mobility in vertebrae
Contain a central nucleus
Surrounded by connective tissue fibers (contain pain receptors)
Spacers are shock absorbers
Avascular

5. Figure 14.3

6. Normal Curvatures of the Spine
Lordotic (concave)
Cervical and lumbar
Kyphotic (convex)
Thoracic
Presence of both assist disc in cushioning compressive forces; balance of the curves is called neutral spine

7. Functional Versus Structural Curves
Can be removed by assuming a posture that takes away the force responsible for the curve
Structural
Remain even when the force responsible for the curve is taken away
Commonly caused by unhealthy posture over extended time
Can make some exercises difficult (e.g., curl-ups)
Exaggerations may increase stress in low back

8. Spinal Movement Flexion Extension
Occurs with straightening of the lumbar spine (each lumbar vertebra rotates to a neutral position)
After it straightens, no further spinal flexion takes place
Extension
Movements are not as common as spinal flexion
Greater loss in ROM with aging versus flexion
Prolonged sitting often results in loss of normal lordotic curve (greater compressive force on discs)
(continued)

9. Spinal Movement (continued)
Lateral flexion and rotation
Movements that combine bending and rotation
Avoid ballistic movements while performing these movements

10. Lateral Curvature (Scoliosis)
Small, lateral deviations may occur
Sometimes due to hand dominance
Major lateral curves
Not generally correctible with therapeutic exercise
Inappropriate exercise RX can worsen scoliosis
Bracing is generally used in treating young adults
Internal fixation is generally required in adults

11. Mechanics of the Spine and Hip Joint
Sacrum is the foundation of the 24 vertebrae
Pelvic position is important to spinal integrity
Tightness in muscles crossing hip joint may interfere with abdominal muscular control of pelvic position

12. Figure 14.6

13. Low-Back Problems: Adults Versus Youth
Acute pain is commonly caused by damage to discs
Disc injury is usually microtraumatic and occurs over time
Preventing LBP: maintaining fitness, strengthening trunk musculature
Youth
LB problems are not usually disc related
LB problems usually originate in vertebral articular processes
(continued)

14. Low-Back Problems: Adults Versus Youth (continued)
Spondylolysis—stress fracture in part of vertebra
Spondylolisthesis—complete fracture on both sides of a spinous process
Often results in anterior displacement (slippage) over the vertebra below
Most likely cause of LBP in those <26 years of age

15. Core Stability (Spinal Stabilization)
Trunk musculature stabilizes the core
Vertebrae, discs, rib cage, pelvis, and associated connective tissue
Spinal (erector spinae, multifidus, quadratus lumborum) and abdominal (rectus abdominis, internal and external obliques, transversus abdominis) musculature contribute to core stability
Enhances athletic and work-related activities

16. Common CS Exercises Quadruped Horizontal isometric bridge
Low compression force on discs
Likely improves endurance more than it does strength
Horizontal isometric bridge
Little compressive pressure on discs
Emphasizes strength and endurance
Incorporates quadratus lumborum, lateral abdominals
(continued)

17. Common CS Exercises (continued)
Roman chair
Higher compressive force on discs
Develops extensor muscles of spine
Modified equipment exists for those with acute LBP or other LB issues
Generally, normal limits of lordosis should not be exceeded

18. Exercises Involving Abdominal Wall
Rectus abdominis directly controls the tilt of the pelvis
Emphasized in crunch-type activities
Higher compressive forces on the discs
Lateral abdominal muscles
Transversus abdominis, internal and external obliques
Brace the trunk to prevent undesired rotation
Diagonal crunches, side bridge