Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Functional Spinal Rehabilitation

Key Points

  • Low back pain affects up to 80% of the population at least once in their lifetime.
  • The term core stabilization is used to describe the management of low back pain through training of the deep stabilizing muscles of the trunk to protect the spine and to allow improved motor control of the spine.
  • The spinal stability system features passive, active, and control subsystems, each of which is interdependent but capable of compensating for a deficit in another.
  • The multifidus is the most medial and largest of the paraspinal muscles. It has an origin and insertion from one vertebra to another within the lumbar spine and between the lumbar and sacral vertebrae.
  • The anterior, middle, and posterior layers of the thoracolumbar fascia create an envelope for the muscles of the lumbar spine.
  • The transversus abdominis is the deepest muscle of the abdominal muscle complex. It originates from the lateral one-third of the inguinal ligament, the anterior two-thirds of the inner lip of the iliac crest, the lateral raphe of the thoracodorsal fascia, and the internal aspect of the lower six costal cartilages interdigitating with the costal fibers of the diaphragm.
  • Pain can be significantly decreased and functional ability increased with lumbar stabilization exercises.
  • Proprioception may be assisted by postural retraining and stabilization exercises in neutral postures progressing to unstable surfaces in functional movements.
  • The supine active straight-leg raise test (ASLR) is a valid tool for assessing the load transfer between the trunk and lower extremities. When functioning normally and with adequate stability, the patient should be able to raise his or her straight leg from the table without a great deal of effort and without movement of the pelvis in relation to the thorax and lower extremity. This test combines observations by the patient and the doctor.
  • Functional exercise programs should be directed towards retraining the motor control in as many potential lumbar spine stabilizers, while in erect weight-bearing postures to stimulate day-to-day activities.

Low back pain is a common complaint and reportedly affects up to 80% of the population at least once in their lifetime. A recurrence of low back pain or chronic low back pain is seen in 10% to 40% of this population. “Eighty-five percent of low back pain patients are classified as ‘non-specific’ because a definitive diagnosis cannot be achieved by current radiological methods”.

The terms core stabilization and motor control have been used to describe the management of low back pain through training of the deep stabilizing muscles of the trunk to protect the spine and to allow improved movement of the spine in functional tasks.

Impairment to the lumbopelvic and hip regions requires integration and coordination of treatment approaches to allow effective load transfer between the lower extremity, the trunk, and the upper extremity. There must be a clear understanding of the causes of dysfunction when evaluating the lower quadrant, including the lumbar spine, pelvis, and lower extremity, to determine the causes of dysfunction.

Optimal function requires both mobility and stability  in the joints and muscles of the lumbar spine and pelvis. A lack of identification of the areas of dysfunction, and lack of follow-up with appropriate treatment, may lead to recurrence of low back pain in both daily and sporting activities.

Athletes require coordination, strength, endurance, and flexibility between the trunk and extremities to be effective in achieving rapid and precise movements. Research has focused on the factors contributing to low back pain and on the treatment used to improve stability through improved motor control of the lumbar spine. This chapter reviews the literature concerning stabilization of the lumbar spine and current exercise programs.

Comments are closed.