1. The Spine: Exercise Interventions
Chapter 16

2. Basic concepts of spinal management with exercise

3. Fundamental Interventions
Definition: Exercises or skills that all patients with spinal impairments should learn….at the time of examination and initial intervention
Kinesthetic training
Stabilization training
Functional training of basic body mechanics
Box 16.1 contains Fundamental Exercise Interventions for Spinal Rehabilitation.

4. Patient Education Active Participation
Limitations at Each Stage of Healing
Safe Self-Management Instruction
Prevention

5. General Exercise Guidelines
Kinesthetic Awareness
Mobility/Flexibility
Muscle Performance
Cardiopulmonary Endurance
Functional Activities
Table 16.1 outlines Spinal Rehabilitation.
Table 16.2 summarizes Intervention for Each Phase of Rehabilitation.

6. KINESTHETIC AWARENESS
Goal: To develop proprioception of spinal positioning, safe movement, and postural control.

7. Elements of Kinesthetic Training: Fundamental Techniques
Position of Symptom Relief (position of bias)
Cervical spine
Lumbar spine
Effects of Movement on the Spine
Blending of Kinesthetic Training, Stabilization Exercises, and Fundamental Body Mechanics

8. Progression to Active and Habitual Control of Posture
Use of Reinforcement
Verbal, visual, tactile
Identify Any Need for Postural Support
Integrate Awareness of Postural Control
Body mechanics
Functional activities

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

10. Cervical and Upper Thoracic Region: Stretching Techniques
Techniques to Increase Thoracic Extension
Self-stretching
Techniques to Increase Axial Extension (Cervical Retraction): Scalene Muscle Stretch
Manual stretching

11. Cervical and Upper Thoracic Region: Stretching Techniques (cont'd)
Techniques to Increase Upper Cervical Flexion: Short Suboccipital Muscle Stretch
Manual stretching
Self-stretching
Traction as a Stretching Technique
Manual traction: cervical spine
Self-traction: cervical spine
Figure 16.5 illustrates Manual Cervical Traction.

12. Cervical Joint Manipulation Techniques
Grading I–V: Definitions
Precautions
Contraindications

13. Cervical Joint Manipulation Techniques (cont'd)
Manipulation to Increase Cervical Flexion
Manipulation to Increase Cervical Extension
Manipulation to Increase Cervical Rotation
Manipulation to Increase Cervical Rotation and Sidebending
Manipulation to Increase Cervical Rotation and Sidebending-Alternate Technique

14. Muscle Energy Techniques to Increase Craniocervical Mobility
To Increase Craniocervical Flexion
To Increase Craniocervical Rotation
Figure illustrates Muscle Energy: Craniocervical Flexion.
Figure illustrates Muscle Energy: Craniocervical Rotation.

15. Mid and Lower Thoracic and Lumbar Regions: Stretching Techniques
Techniques to Increase Lumbar Flexion
Self-stretching
Techniques to Increase Hip Muscle Flexibility
Traction as a Stretching Technique
Manual traction: lumbar spine
Positional traction: lumbar spine
Figures and illustrate self-stretching techniques to increase lumbar flexion.

16. Thoracic and Lumbar Joint Manipulation and HVT Techniques
Manipulation to Increase Thoracic Spine Extension
Manipulation to Increase Thoracic Spine Flexion
Manipulation to Increase Thoracic Spine Rotation
Pistol Thrust to Increase Thoracic Spine Mobility
Cross-Arm Thrust to Increase Thoracic Spine Mobility
Fall Thrust to Increase Thoracic Spine Mobility

17. Thoracic and Lumbar Joint Manipulation and HVT Techniques (cont'd)
Rib Manipulation for Inspiratory Restriction
Rib Manipulation for Expiratory Restriction
Elevated First Rib Manipulation

18. Thoracic and Lumbar Joint Manipulation and HVT Techniques (cont'd)
Manipulation to Increase Lumbar Spine Extension
Manipulation to Increase Lumbar Spine Rotation
Manipulation to Increase Lumbar Intervertebral Sidebending
HVT Lumbar Roll to Increase Lumbar Rotation

19. Thoracic and Lumbar Joint Manipulation and HVT Techniques (cont'd)
SI Joint Manipulation Technique to Increase Sacral Nutation (Flexion)
SI Joint Manipulation Technique to Increase Sacral Counter-Nutation (Extension)
HVT Posterior Rotation to Innominate

20. Muscle performance: stabilization, muscle endurance, and strength training
Goals:
To activate and develop neuromuscular control of deep segmental and global spinal stabilizing muscles to support the spine against external loading.
To develop endurance and strength in the muscles of the axial skeleton for functional activities.
To develop control of balance in stable and unstable situations.

21. Stabilization Training: Fundamental Techniques and Progressions
Guidelines for Stabilization Training
Stabilization Training: Fundamental Techniques and Progressions
Box 16.2 summarizes the Guidelines for Stabilization Training: Principles and Progression.
Shown here, Figure illustrates how exercises to improve muscle performance, cardiopulmonary endurance, and functional activities are integrated over a background of activating the deep segmental and global multi-segmental spinal stabilizing musculature.

22. Deep Segmental Muscle Activation and Training
Cervical Musculature
Deep neck flexors
Lower cervical and upper thoracic extensor
Progression
Stabilization Training: Fundamental Techniques and Progressions
Box 16.3 summarizes Testing and Training Deep Segmental Muscle Activation in the Cervical Spine.

23. Deep Segmental Muscle Activation and Training (cont'd)
Lumbar Musculature
Drawing-in maneuver (abdominal hollowing exercise) for transverse abdominis activation
Abdominal bracing
Posterior pelvic tilt
Multifidus activation and training
Stabilization Training: Fundamental Techniques and Progressions
Box 16.4 summarizes Testing and Training Deep Segmental Muscle Activation (Transversus Abdominis) in the Lumbar Spine.

24. Global Muscle Stabilization Exercises
Stabilization Exercises for the Cervical Region
Stabilization with progressive limb loading
Variations and progressions in the stabilization program
Integration of stabilization exercises and posture training
Progression of isometric and dynamic strengthening in conjunction with functional activities
Stabilization Training: Fundamental Techniques and Progressions
Table 16.3 summarizes Cervical Stabilization with Progressive Limb Loading: Emphasis on Cervical Flexors.
Table 16.4 summarizes Cervical Stabilization with Progressive Limb Loading: Emphasis on Cervical and Thoracic Extensors.
Box 16.5 contains Instructions for use of Stabilizer for Stabilization Training with Leg Loading.

25. Global Muscle Stabilization Exercises (cont'd)
Stabilization Exercises for the Lumbar Region
Stabilization with progressive limb loading
Variations and progressions in the stabilization program
Quadratus lumborum: stabilization exercises
Progression to dynamic exercises
Stabilization Training: Fundamental Techniques and Progressions

26. Isometric and Dynamic Exercises
Exercise for the Cervical Region
Isometric exercises: self-resistance
Isometric resistance activities
Dynamic cervical flexion
Manual resistance: cervical muscles
Intermediate and advanced training
Transitional stabilization for the cervical and upper thoracic regions
Functional exercises

27. Isometric and Dynamic Exercises (cont'd)
Exercise for the Thoracic and Lumbar Regions
Alternating isometric contractions and rhythmic stabilization
Dynamic strengthening: abdominal muscles
Trunk flexion
Trunk flexion (abdominals): sitting or standing

28. Isometric and Dynamic Exercises (cont'd)
Exercise for the Thoracic and Lumbar Regions (cont’d)
Dynamic strengthening: erector spinae and multifidus muscles
Extension exercises in prone or quadriped position
Extension exercises sitting or standing
Trunk side bending (lateral abdominals, erector spinae, quadratus lumborum)

29. Cardiopulmonary Endurance
Goal: To develop cardiopulmonary fitness for overall endurance and well-being.
Box 16.6 summarizes Aerobic Conditioning Principles.

30. Common Aerobic Exercises and Effects on the Spine
Cycling
Walking and Running
Stair Climbing
Cross-Country Skiing and Ski Machines
Swimming
Upper Body Ergometers
Step Aerobics and Aerobic Dancing
“Latest Popular Craze”

31. Functional Activities
Goal: To progress to independence safely.

32. Early Functional Training: Fundamental Techniques
Goal: Progress to Independence Safely
Rolling
Supine to Sit/Sit to Lying Down
Sit to Stand/Stand to Sit
In and Out of a Car
Walking

33. Preparation for Functional Activities: Basic Exercise Techniques
Weight-Bearing Exercises
Modified bridging exercises
Push-ups with trunk stabilization
Wall slides
Partial lunges, partial squats, and steps
Walking against resistance

34. Preparation for Functional Activities: Basic Exercise Techniques (cont'd)
Transitional Stabilization Exercises
Quadriped forward/backward shifting
Squatting and reaching
Shifting weight and turning

35. Body Mechanics and Environmental Adaptations
Principles of Body Mechanics: Instruction and Training
Lumbar spine position
Spinal flexion
Spinal extension
Load position

36. Body Mechanics and Environmental Adaptations (cont'd)
Home, work, and driving considerations
Sleeping environment

37. Intermediate to Advanced Exercise Techniques for Functional Training
Repetitive Lifting
Repetitive Reaching
Repetitive Pushing and Pulling
Rotation or Turning
Transitional Movements
Transfer of Training

38. Education for Prevention
Continual Throughout the Rehabilitation Process
Relationships of Posture and Pain
Home Exercise Program
Flexibility
Muscle endurance
Strengthening
Cardiopulmonary

39. Independent Learning Activities
Critical Thinking and Discussion
Laboratory Practice
Case Studies