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

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)

Figure 14.2

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

Figure 14.3

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

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

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)

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

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

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

Figure 14.6

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)

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

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

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)

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

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