LUMBOPELVIC LUMBOPELVIC STABILITYSTABILITY

ROLE OF ABDOMINAL AND ROLE OF ABDOMINAL AND PARASPINAL MUSCLESPARASPINAL MUSCLES

STABILITYSTABILITY

THE CONDITION OF REMAINING THE CONDITION OF REMAINING UNCHANGED EVEN IN THE PRESENCE OF UNCHANGED EVEN IN THE PRESENCE OF FORCES THAT WOULD NORMALLY CHANGE FORCES THAT WOULD NORMALLY CHANGE THE STATE OR CONDITIONTHE STATE OR CONDITION

STABILIZATIONSTABILIZATION

THE ACT OF MAKING SOMETHING STABLETHE ACT OF MAKING SOMETHING STABLE

DYNAMIC STABILIZATIONDYNAMIC STABILIZATION

AN INTEGRAL FUNCTION OF THE AN INTEGRAL FUNCTION OF THE NEUROMUSCULAR SYSTEM REQUIRING NEUROMUSCULAR SYSTEM REQUIRING MUSCLES TO CONTRACT AND FIXATE THE MUSCLES TO CONTRACT AND FIXATE THE BODY AGAINST FLUCTUATING OUTSIDE BODY AGAINST FLUCTUATING OUTSIDE FORCES, PROVIDING POSTURAL SUPPORT FORCES, PROVIDING POSTURAL SUPPORT WITH FINE ADJUSTMENTS IN MUSCLE WITH FINE ADJUSTMENTS IN MUSCLE TENSION.TENSION.

PARAMETERS OF SPINAL STABILITYPARAMETERS OF SPINAL STABILITY

CONTROL OF SPINAL ORIENTATION WHICH CONTROL OF SPINAL ORIENTATION WHICH RELATES TO MAINTAINANCE OF OVERALL RELATES TO MAINTAINANCE OF OVERALL POSTURE OF THE SPINE AGAINST IMPOSED POSTURE OF THE SPINE AGAINST IMPOSED FORCES AND COMPRESSIVE LOADING.FORCES AND COMPRESSIVE LOADING.

CONTROL OF INTERSEGMENTAL CONTROL OF INTERSEGMENTAL RELATIONSHIP AT THE LOCAL LEVEL RELATIONSHIP AT THE LOCAL LEVEL (LUMBAR SEGMENTAL CONTROL), (LUMBAR SEGMENTAL CONTROL), IRRESPECTIVE OF CHANGES IN THE IRRESPECTIVE OF CHANGES IN THE OVERALL ORIENTATION OF THE SPINE.OVERALL ORIENTATION OF THE SPINE.

CORECORE

Human core is described as low Human core is described as low back-pelvic-hip complex with its back-pelvic-hip complex with its governing musculature.governing musculature.

Core is important because it is the Core is important because it is the anatomical location in the body anatomical location in the body where the centre of gravity is where the centre of gravity is located, where the movt starts.located, where the movt starts.

MAINTAINANCE OF SPINAL STABILITYMAINTAINANCE OF SPINAL STABILITY

3 ELEMENTS OF SPINAL STABILITY:-3 ELEMENTS OF SPINAL STABILITY:-

PASSIVE SUBSYSTEMPASSIVE SUBSYSTEM

OSSEOUS AND ARTICULAR STRUCTURESOSSEOUS AND ARTICULAR STRUCTURESFACET JOINTSFACET JOINTS PEDICLE PEDICLE LAMINALAMINA IV DISCSIV DISCSPARS INTERARTICULARISPARS INTERARTICULARIS

• CONTROL SEGMENTAL MOVEMENT NOT ONLY CONTROL SEGMENTAL MOVEMENT NOT ONLY AT THE END RANGE BUT AROUND THE AT THE END RANGE BUT AROUND THE NEUTRAL JOINT POSITION ALSONEUTRAL JOINT POSITION ALSO

SPINAL LIGAMENTSSPINAL LIGAMENTS• OFFER MOST RESTRAINT TOWARDS THE END OFFER MOST RESTRAINT TOWARDS THE END

RANGE OF MOVEMENT BUT DO NOT PROVIDE RANGE OF MOVEMENT BUT DO NOT PROVIDE SUBSTANTIAL SUPPORT IN THE NEUTRAL JOINTSUBSTANTIAL SUPPORT IN THE NEUTRAL JOINT POSITIONPOSITION

NEURAL CONTROL SUBSYSTEMNEURAL CONTROL SUBSYSTEM

CONTROL OF SPINAL MUSCLES FOR SPINAL CONTROL OF SPINAL MUSCLES FOR SPINAL SUPPORTSUPPORT• MUSCLES NEED TO BE PROGRAMED IN MUSCLES NEED TO BE PROGRAMED IN

RESPONSE TO THE FEEDBACK IN ORDER RESPONSE TO THE FEEDBACK IN ORDER TO ADJUST TO ANY CONDITION AT ANY TO ADJUST TO ANY CONDITION AT ANY POINT OF TIME, SO THAT THE POINT OF TIME, SO THAT THE APPROPRIATE MUSCLES ARE ACTIVATED APPROPRIATE MUSCLES ARE ACTIVATED TO APPROPRIATE LEVEL.TO APPROPRIATE LEVEL.

ACTIVE SUBSYSTEMACTIVE SUBSYSTEM

REFERS TO THE REFERS TO THE FORCE GENERATING FORCE GENERATING CAPACITY OF THE CAPACITY OF THE MUSCLES WHICH MUSCLES WHICH PROVIDE THE PROVIDE THE MECHANICAL ABILITY MECHANICAL ABILITY TO STABILIZE THE TO STABILIZE THE SPINAL SEGMENTSPINAL SEGMENT..

PARASPINALS

ERECTOR SPINAE – LONGISSIMUS - ILIOCOSTALIS

ROTATORSINTERTRANSVERSARIIMUTIFIDUS

MUSCLES

PARASPINALS

QUADRATUS LUMBORUM

ABDOMINALS

HIP GIRDLE MUSCULATURE

LOCAL AND GLOBAL STABILIZING LOCAL AND GLOBAL STABILIZING SYSTEMSYSTEM

BERGMARK 1989BERGMARK 1989 CATEGORIZED THE CATEGORIZED THE TRUNK MUSCLES INTO LOCAL AND TRUNK MUSCLES INTO LOCAL AND GLOBAL SYSTEM BASED ON THEIR ROLES GLOBAL SYSTEM BASED ON THEIR ROLES IN STABILIZATION….IN STABILIZATION….

LOCAL STABILIZING LOCAL STABILIZING SYSTEMSYSTEM

INTERTRANSVERSARIIINTERTRANSVERSARII INTERSPINALESINTERSPINALES MULTIFIDUSMULTIFIDUS LONGISSIMUS THORACIS LONGISSIMUS THORACIS

PARS LUMBORUMPARS LUMBORUM ILIOCOSTALIS LUMBORUM ILIOCOSTALIS LUMBORUM

PARS LUMBORUMPARS LUMBORUM QUADRATUS LUMBORUM QUADRATUS LUMBORUM

MEDIAL FIBRESMEDIAL FIBRES TRANSVERSUS ABDOMINISTRANSVERSUS ABDOMINIS OBLIQUUS INTERNUS OBLIQUUS INTERNUS

ABDOMINISABDOMINIS

GLOBAL STABILIZING GLOBAL STABILIZING SYSTEMSYSTEM

LONGISSIMUS THORACIS LONGISSIMUS THORACIS PARS THORACISPARS THORACIS

ILIOCOSTALIS LUMBORUM ILIOCOSTALIS LUMBORUM PARS THORACISPARS THORACIS

QUADRATUS LUMBORUM QUADRATUS LUMBORUM LATERAL FIBRESLATERAL FIBRES

RECTUS ABDOMINISRECTUS ABDOMINIS OBLIQUUS EXTERNUS OBLIQUUS EXTERNUS

ABDOMNISABDOMNIS OBLIQUUS INTERNUS OBLIQUUS INTERNUS

ABDOMINISABDOMINIS

LOCAL SYSTEMLOCAL SYSTEMDEEP MUSCLES OR DEEP MUSCLES OR

PARTS OF DEEP PARTS OF DEEP MUSCLES WHICH MUSCLES WHICH HAVE ATLEAST 1 HAVE ATLEAST 1 ATTACHMENT TO THE ATTACHMENT TO THE LUMBAR VERTEBAELUMBAR VERTEBAE

THEY CONTROL THEY CONTROL STIFFNESS , STIFFNESS , INTERVERTEBRAL INTERVERTEBRAL RELATIONSHIP OF THE RELATIONSHIP OF THE SPINAL SEGMENTS, SPINAL SEGMENTS, POSTURE OF LUMBAR POSTURE OF LUMBAR SPINESPINE

GLOBAL SYSTEMGLOBAL SYSTEM LARGE AND LARGE AND

SUPERFICIAL GROUP SUPERFICIAL GROUP OF MUSCLESOF MUSCLES

THEY CONTROL:-THEY CONTROL:-MOVEMENT OF SPINE MOVEMENT OF SPINE DIRECTLY TRANSFER DIRECTLY TRANSFER LOAD FROM LOAD FROM THORACIC CAGE TO THORACIC CAGE TO THE PELVISTHE PELVIS

FUNCTIONAL SIGNIFICANCE OF LOCAL FUNCTIONAL SIGNIFICANCE OF LOCAL SYSTEMSYSTEM

THEY ARE CLOSER TO CENTER OF THEY ARE CLOSER TO CENTER OF ROTATION OF SPINAL SEGMENTSROTATION OF SPINAL SEGMENTS

HAVE SHORTER MUSCLE LENGTHSHAVE SHORTER MUSCLE LENGTHS HENCE IDEAL FOR CONTROLLING HENCE IDEAL FOR CONTROLLING

INTERSEGMENTAL MOTIONINTERSEGMENTAL MOTION

LUMBAR MUSCLESLUMBAR MUSCLES BACK MUSCLEBACK MUSCLE – ACTING BILATERALLY- MAINLY – ACTING BILATERALLY- MAINLY

EXTENSORSEXTENSORS LONGISSIMUS & ILIOCOSTALISLONGISSIMUS & ILIOCOSTALIS -CAN ASSIST – -CAN ASSIST –

LATERAL FLEXION – ACTING UNILATERALLYLATERAL FLEXION – ACTING UNILATERALLY MULTIFIDUS, LUMBAR LONGISSIMUS & MULTIFIDUS, LUMBAR LONGISSIMUS &

LUMBAR ILIOCOSTALISLUMBAR ILIOCOSTALIS – CONTROL ANTERIOR – CONTROL ANTERIOR ROTATION AND TRANSLATIONROTATION AND TRANSLATION

RETURN TO UPRIGHT – RETURN TO UPRIGHT – MULTIFIDUS MULTIFIDUS INDUCES INDUCES POSTERIOR SAGITTAL ROTATION–CONTRIBUTES POSTERIOR SAGITTAL ROTATION–CONTRIBUTES 20% OF TOTAL EXTENSOR MOMENT20% OF TOTAL EXTENSOR MOMENT

--LUMBAR ERECTOR SPINAELUMBAR ERECTOR SPINAE CONTROLS POSTERIOR SAGITTAL TRANSLATION – CONTROLS POSTERIOR SAGITTAL TRANSLATION – 30%30%

-THORACIC ERECTOR SPINAE-THORACIC ERECTOR SPINAE – 50% – 50%

FEATURES SUPPORTING A TONIC FEATURES SUPPORTING A TONIC HOLDING FUNCTIONHOLDING FUNCTION

PARAVERTEBRAL MUSCLESPARAVERTEBRAL MUSCLES NO.OF TYPE I FIBRES > TYPE II FIBRESNO.OF TYPE I FIBRES > TYPE II FIBRES THORACIC ERECTOR SPINAE-70% TYPE ITHORACIC ERECTOR SPINAE-70% TYPE I LUMBAR ERECTOR SPINAE-58%-69%LUMBAR ERECTOR SPINAE-58%-69%

SIZE OF TYPE I FIBRES > TYPE II FIBRESSIZE OF TYPE I FIBRES > TYPE II FIBRES LARGE CAPILLARY NETWORKLARGE CAPILLARY NETWORK

MULTIFIDUS- 4-5 CAPILLARIES/MUSCLE CELLMULTIFIDUS- 4-5 CAPILLARIES/MUSCLE CELL HIGH CONCENTRATION OF OXIDATIVE HIGH CONCENTRATION OF OXIDATIVE

ENZYMESENZYMES HIGH ENDURANCE CAPACITYHIGH ENDURANCE CAPACITY

ROLE OF MUSCLES FOR STABILITYROLE OF MUSCLES FOR STABILITY

KAIGLE ET AL 1995KAIGLE ET AL 1995 TRANSECTED TRANSECTED THE PASSIVE STRUCTURES OF THE THE PASSIVE STRUCTURES OF THE SPINES OF 33 PIGS AND CARRIED SPINES OF 33 PIGS AND CARRIED OUT STIMULATION OF THE MUSCLES OUT STIMULATION OF THE MUSCLES AROUND THE SPINE- THIS RESULTED AROUND THE SPINE- THIS RESULTED IN INCREASED STABILIZATION OF IN INCREASED STABILIZATION OF THE SPINE AND DECREASED THE SPINE AND DECREASED ABNORMAL MOTION IN NEUTRAL ABNORMAL MOTION IN NEUTRAL ZONEZONE

GOEL ET AL 1993GOEL ET AL 1993 IN THEIR STUDY IN THEIR STUDY (INVOLVING INTERSPINALES, (INVOLVING INTERSPINALES, INTERTRANSVERSARII, LUMBAR INTERTRANSVERSARII, LUMBAR MULTIFIDUS, QUADRATUS MULTIFIDUS, QUADRATUS LUMBORUM) – DEMONSTRATED THAT LUMBORUM) – DEMONSTRATED THAT INTRODUCTION OF MUSCLE FORCES INTRODUCTION OF MUSCLE FORCES IN AN UNSTABLE SPINE, DECREASED IN AN UNSTABLE SPINE, DECREASED AP TRANSLATIONS & ANTERIOR AP TRANSLATIONS & ANTERIOR ROTATIONSROTATIONS

WILKE ET AL 1995WILKE ET AL 1995 SHOWED THAT SHOWED THAT MUSCLE FORCES STIFFEN THE MUSCLE FORCES STIFFEN THE MOTION SEGMENTMOTION SEGMENT

STRONGEST INFLUENCE – STRONGEST INFLUENCE – MULTIFIDUS- RESPONSIBLE FOR 2/3MULTIFIDUS- RESPONSIBLE FOR 2/3rdrd OF INCREASE IN SEGMENTAL OF INCREASE IN SEGMENTAL STIFFNESS & DECREASE IN ROMSTIFFNESS & DECREASE IN ROM

Mc.GILL 1991 Mc.GILL 1991 CONCLUDED THAT THE CONCLUDED THAT THE UNCHANGING GEOMETRY OF THE UNCHANGING GEOMETRY OF THE MULTIFIDUS THROUGH THE RANGE MULTIFIDUS THROUGH THE RANGE OF POSTURES INDICATES THAT OF POSTURES INDICATES THAT PURPOSE OF THIS MUSCLE WAS TO PURPOSE OF THIS MUSCLE WAS TO FINELY ADJUST VERTEBRAE WITH FINELY ADJUST VERTEBRAE WITH SMALL MOVEMENTS.SMALL MOVEMENTS.

ROLE OF DIFFERENT FASCICLESROLE OF DIFFERENT FASCICLES

QUADRATUS LUMBORUMQUADRATUS LUMBORUM

Mc.GILL ET AL 1996Mc.GILL ET AL 1996 PROVIDED EVIDENCE PROVIDED EVIDENCE THAT IT PLAYS AN IMPORTANT ROLE IN THAT IT PLAYS AN IMPORTANT ROLE IN STABILITY OF THE SPINE (SYMMETRICAL STABILITY OF THE SPINE (SYMMETRICAL BUCKET HOLDING TASK)BUCKET HOLDING TASK)

ANDERSON ET AL 1996ANDERSON ET AL 1996 FOUND THAT FOUND THAT THERE WAS NO ELECTRICAL SILENCE OF THERE WAS NO ELECTRICAL SILENCE OF QUADRATUS LUMBORUM EVEN IN FULL QUADRATUS LUMBORUM EVEN IN FULL FORWARD FLEXION – THUS IT HAS A FORWARD FLEXION – THUS IT HAS A STABILITY FUNCTIONSTABILITY FUNCTION

OBLIQUUS INTERNUS ABDOMINISOBLIQUUS INTERNUS ABDOMINIS

CONTRIBUTES TO FIXATION OF CONTRIBUTES TO FIXATION OF PELVIS DURING LEG MOVEMENTSPELVIS DURING LEG MOVEMENTS

IT ACTS AS A PART OF LOCAL IT ACTS AS A PART OF LOCAL SUPPORT SYSTEM OF THE LUMBAR SUPPORT SYSTEM OF THE LUMBAR SPINE - SPINE - BERGMARKBERGMARK

PELVIC FLOOR MUSCLESPELVIC FLOOR MUSCLES

THEY ARE ACTIVE DURING LIFTING THEY ARE ACTIVE DURING LIFTING TASKSTASKS

ACTIVATION OF PUBOCOCCYGEUS ACTIVATION OF PUBOCOCCYGEUS INCREASES THE ACTIVATION OF INCREASES THE ACTIVATION OF ABDOMINAL MUSCLES AND VISE ABDOMINAL MUSCLES AND VISE VERSAVERSA

THUS HELPING IN STABILITYTHUS HELPING IN STABILITY

TRANSVERSUS ABDOMINISTRANSVERSUS ABDOMINIS

CONTRACTION – RAISED INTRA-CONTRACTION – RAISED INTRA-ABDOMINAL PRESSUREABDOMINAL PRESSURE

- TENSION ON - TENSION ON THORACOLUMBAR FASCIATHORACOLUMBAR FASCIA

STUDIES SUGGEST ITS ROLE IN BOTH; STUDIES SUGGEST ITS ROLE IN BOTH; PRODUCING ROTATIONPRODUCING ROTATION

RESTRICTING ROTATIONRESTRICTING ROTATION

SPINAL INSTABILITYSPINAL INSTABILITY

A SIGNIFICANT DECREASE IN THE A SIGNIFICANT DECREASE IN THE CAPACITY OF THE STABILIZING SYSTEM OF CAPACITY OF THE STABILIZING SYSTEM OF THE SPINE TO MAINTAIN THE THE SPINE TO MAINTAIN THE INTERVERTEBRAL NEUTRAL ZONES WITHIN INTERVERTEBRAL NEUTRAL ZONES WITHIN THE PHYSIOLOGICAL LIMITS WHICH THE PHYSIOLOGICAL LIMITS WHICH RESULTS IN PAIN AND DISABILITY RESULTS IN PAIN AND DISABILITY (Panjabi)(Panjabi)

NEUTRAL ZONE INCREASES WITH NEUTRAL ZONE INCREASES WITH INSTABILITYINSTABILITY

NEUTRAL ZONE AND INSTABILITYNEUTRAL ZONE AND INSTABILITY

ACCORDING TO PANJABI THE LOAD DEFORMATION ACCORDING TO PANJABI THE LOAD DEFORMATION BEHAVIOR OF THE SPINAL SEGMENT IS NON BEHAVIOR OF THE SPINAL SEGMENT IS NON LINEAR AND IS HIGHLY FLEXIBLE IN THE LINEAR AND IS HIGHLY FLEXIBLE IN THE VICINITY OF THE NEUTRAL POSITION… THIS IS VICINITY OF THE NEUTRAL POSITION… THIS IS CALLED AS THE CALLED AS THE NEUTRAL ZONE.NEUTRAL ZONE.

MOTION OCCURS IN THIS REGION AGAINST MOTION OCCURS IN THIS REGION AGAINST MINIMAL INTERNAL RESISTANCE, WITH MINIMAL INTERNAL RESISTANCE, WITH LIGAMENTOUS STRUCTURES PROVIDING LIGAMENTOUS STRUCTURES PROVIDING RESTRAINT IN THE ELASTIC ZONE TO LIMIT END RESTRAINT IN THE ELASTIC ZONE TO LIMIT END ROM.ROM.

WHAT CONSTITUTES INSTABILITY?WHAT CONSTITUTES INSTABILITY?

LOSS OF JOINT STIFFNESS,LOSS OF JOINT STIFFNESS,INCREASE IN MOBILITY,INCREASE IN MOBILITY,

ABNORMAL SPINAL MOTION,ABNORMAL SPINAL MOTION,CHANGES IN THE RATIOS OF SEGMENTAL CHANGES IN THE RATIOS OF SEGMENTAL

ROTATIONS AND TRANSLATIONSROTATIONS AND TRANSLATIONS

PANJABI IDENTIFIES CONTROL OF PANJABI IDENTIFIES CONTROL OF INTERSEGMENTAL MOTION AROUND THE INTERSEGMENTAL MOTION AROUND THE NEUTRAL ZONE AS A MAJOR PARAMETER NEUTRAL ZONE AS A MAJOR PARAMETER OF SPINAL INSTABILITY OF SPINAL INSTABILITY (as in definition)(as in definition)

REASONS FOR INSTABILITY

INJURY TO ANY OF THE STABILIZING INJURY TO ANY OF THE STABILIZING STRUCTURESSTRUCTURES

REPETITIVE LOADING OF THE REPETITIVE LOADING OF THE INFERIOR ARTICULAR FACETS WITH INFERIOR ARTICULAR FACETS WITH EXCESSIVE LUMBAR FLEXION & EXCESSIVE LUMBAR FLEXION & EXTENSIONEXTENSION

COMPRESSIVE & SHEARING LOADS COMPRESSIVE & SHEARING LOADS TO THE IV DISCTO THE IV DISC

MUSCULAR WEAKNESSMUSCULAR WEAKNESS

MODEL OF ASSESSMENTMODEL OF ASSESSMENT- 3 TIER SYSTEM- 3 TIER SYSTEM

DIAGNOSTIC MEASURES

CLINICAL MEASURES

SCREENING TESTS

FIRST TIERFIRST TIER NON INVASIVE VOLITIONAL TESTS: NON INVASIVE VOLITIONAL TESTS:

--TESTING TRANSVERSE ABDOMINIS TESTING TRANSVERSE ABDOMINIS (ABDOMINAL DRAWING-IN ACTION)(ABDOMINAL DRAWING-IN ACTION)

-TESTING SEGMENTAL LUMBAR -TESTING SEGMENTAL LUMBAR MULTIFIDUSMULTIFIDUS

-TESTING CONTROL OF LUMBOPELVIC -TESTING CONTROL OF LUMBOPELVIC POSTURE (LEG LOADING) POSTURE (LEG LOADING)

ABDOMINAL DRAWING-IN ACTIONABDOMINAL DRAWING-IN ACTION

INSTRUCTION: DRAW THE LOWER PART OF INSTRUCTION: DRAW THE LOWER PART OF ABDOMEN TO THE SPINE WHILE KEEPING ABDOMEN TO THE SPINE WHILE KEEPING THE SPINE & PELVIS STABLETHE SPINE & PELVIS STABLE

- DISSOCIATE IT FROM BREATHING- DISSOCIATE IT FROM BREATHING

- SLOW & CONTROLLED CONTRACTIO- SLOW & CONTROLLED CONTRACTIO

- TAUGHT IN CROOK LYING - TAUGHT IN CROOK LYING

- PRESSURE BIOFEEDBACK IS USED - PRESSURE BIOFEEDBACK IS USED (CENTER OF CUFF AT THE NAVEL)(CENTER OF CUFF AT THE NAVEL)

- HOLD 10 sec, MAX 10 reps- HOLD 10 sec, MAX 10 reps

SUCCESSFUL TESTSUCCESSFUL TEST REDUCTION IN PRESSURE BY 6-10mm HgREDUCTION IN PRESSURE BY 6-10mm Hg--INDICATES THAT THE PATIENT IS ABLE TO CONTRACT INDICATES THAT THE PATIENT IS ABLE TO CONTRACT

THE TRANSVERSUS ABDOMINIS INDEPENDENTLYTHE TRANSVERSUS ABDOMINIS INDEPENDENTLYPOOR TESTPOOR TEST

DROP LESS THAN 2mmHgDROP LESS THAN 2mmHg NO CHANGE IN PRESSURENO CHANGE IN PRESSURE INCREASE IN PRESSUREINCREASE IN PRESSURE--INDICATES INABILITY TO ACTIVATE TRANSVERSUS INDICATES INABILITY TO ACTIVATE TRANSVERSUS

ABDOMINIS SUFFICIENTLYABDOMINIS SUFFICIENTLY-CO-CONTRACTION OF GLOBAL MUSCLES-CO-CONTRACTION OF GLOBAL MUSCLES-SUBSTITUTION BY RECTUS ABDOMINIS OR OBLIQUUS -SUBSTITUTION BY RECTUS ABDOMINIS OR OBLIQUUS

EXTERNUSEXTERNUS

TEST FOR SEGMENTAL LUMBAR MULTIFIDUSTEST FOR SEGMENTAL LUMBAR MULTIFIDUS

INSTRUCTION: GENTLY SWELL OUT YOUR INSTRUCTION: GENTLY SWELL OUT YOUR MUSCLES UNDER MY FINGERS WITHOUT MUSCLES UNDER MY FINGERS WITHOUT MOVING YOUR SPINE OR PELVISMOVING YOUR SPINE OR PELVIS

HOLD WHILE BREATHING NORMALLYHOLD WHILE BREATHING NORMALLY

CLINICIAN PALPATES AND COMPARES CLINICIAN PALPATES AND COMPARES SIDE-TO-SIDE OR WITH UPPER AND LOWER SIDE-TO-SIDE OR WITH UPPER AND LOWER LEVELSLEVELS

RESULTSRESULTS

DEEP DEVELOPMENT OF TENSION IN THE DEEP DEVELOPMENT OF TENSION IN THE MUSCLEMUSCLE – ACTIVATION OF MULTIFIDUS AT THAT – ACTIVATION OF MULTIFIDUS AT THAT SEGMENTSEGMENT

ABILITY TO HOLD THE CONTRACTIONABILITY TO HOLD THE CONTRACTION – – MUSCLE’S TONIC HOLDING CAPACITYMUSCLE’S TONIC HOLDING CAPACITY

LITTLE OR NO TENSIONLITTLE OR NO TENSION – INABILITY TO – INABILITY TO ACTIVATE SEGMENTAL MULTIFIDUSACTIVATE SEGMENTAL MULTIFIDUS

RAPID AND SUPERFICIAL DEVELOPMENT OF RAPID AND SUPERFICIAL DEVELOPMENT OF TENSIONTENSION – USE OF ONLY SUPERFICIAL – USE OF ONLY SUPERFICIAL FIBRES CAUSING EXTENSIONFIBRES CAUSING EXTENSION

- USE OF TENDON OF - USE OF TENDON OF THORACIC THORACIC PORTION OF ERECTOR SPINAEPORTION OF ERECTOR SPINAE

LEG LOADING

DETERMINES THE ABILITY OF THE TRUNK DETERMINES THE ABILITY OF THE TRUNK MUSCLES TO HOLD THE LUMBOPELVIC REGION IN MUSCLES TO HOLD THE LUMBOPELVIC REGION IN A STEADY POSITION DURING PROGRESSIVE A STEADY POSITION DURING PROGRESSIVE LEVELS OF LEG LOADING (Sahrmann 1987)LEVELS OF LEG LOADING (Sahrmann 1987)

POSITION: CROOK LYINGPOSITION: CROOK LYING PRE CONTRACTION- DRAWING IN OF THE PRE CONTRACTION- DRAWING IN OF THE

ABDOMINAL WALLABDOMINAL WALL PRESSURE BIOFEEDBACK PLACED UNDER THE PRESSURE BIOFEEDBACK PLACED UNDER THE

LUMBAR SPINE TO DETECT ANY MOVEMENT OF LUMBAR SPINE TO DETECT ANY MOVEMENT OF THE LUMBOPELVIC REGION (INFLATED TO THE LUMBOPELVIC REGION (INFLATED TO 40mmHg40mmHg

LEG LOADING PROGRESSIONLEG LOADING PROGRESSION

LEVEL1:LEVEL1:SINGLE LEG SLIDE, CONTRALATERAL LEG SINGLE LEG SLIDE, CONTRALATERAL LEG

SUPPORTSUPPORT(LEFT) LEG SLIDE WITH HEEL SUPPORT TO FULL (LEFT) LEG SLIDE WITH HEEL SUPPORT TO FULL

EXTENSION AND RETURNEXTENSION AND RETURN(RIGHT) SUPPORTED LEG SLIDE- HEEL HELD 5cm FROM (RIGHT) SUPPORTED LEG SLIDE- HEEL HELD 5cm FROM

THE SUPPORTING STRUCTURESTHE SUPPORTING STRUCTURES LEVEL2:LEVEL2:SINGLE LEG SLIDE, CONTRALATERAL LEG SINGLE LEG SLIDE, CONTRALATERAL LEG

UNSUPPORTEDUNSUPPORTED(LEFT) LEG SLIDE WITH HEEL SUPPORT TO FULL (LEFT) LEG SLIDE WITH HEEL SUPPORT TO FULL

EXTENSION AND RETURNEXTENSION AND RETURN(RIGHT) UNSUPPORTED LEG SLIDE- HEEL HELD 5cm (RIGHT) UNSUPPORTED LEG SLIDE- HEEL HELD 5cm

FROM THE SUPPORTING STRUCTURESFROM THE SUPPORTING STRUCTURES

SECOND TIERSECOND TIER

DETAILED NON INVASIVE VOLITIONAL DETAILED NON INVASIVE VOLITIONAL TESTSTESTS

PRESSURE BIOFEEDBACK & EMG PRESSURE BIOFEEDBACK & EMG BIOFEEDBACKBIOFEEDBACK

OBSERVATION OF BODY CONTOURS OBSERVATION OF BODY CONTOURS & BREATHING PATTERN.& BREATHING PATTERN.

THIRD TIERTHIRD TIER

EMG WITH FINE WIRE ELECTRODES EMG WITH FINE WIRE ELECTRODES INSERTED INTO DEEP MUSCLES IS INSERTED INTO DEEP MUSCLES IS USED FOR INVASIVE TESTUSED FOR INVASIVE TEST

&/OR&/OR

NON INVASIVE VOLITIONAL NON INVASIVE VOLITIONAL ASSESSMENTASSESSMENT

Jeffreys I Developing a progressive Core Jeffreys I Developing a progressive Core Stability Program. Strength Cond J Stability Program. Strength Cond J

2002;24:65-66.2002;24:65-66.

CORE STRENGTHENINGCORE STRENGTHENING- SOME EXERCISES- SOME EXERCISES

ABDOMINAL CRUNCHABDOMINAL CRUNCH

BRIDGINGBRIDGING

SINGLE LEG ABDOMINAL PRESSSINGLE LEG ABDOMINAL PRESS

SINGLE LEG ABDOMINAL PRESS SINGLE LEG ABDOMINAL PRESS MODIFIEDMODIFIED

DOUBLE LEG ABDOMINAL DOUBLE LEG ABDOMINAL PRESSPRESS

DOUBLE LEG ABDOMINAL DOUBLE LEG ABDOMINAL PRESS MODIFIEDPRESS MODIFIED

SEGMENT ROTATIONSEGMENT ROTATION

QUADRUPEDQUADRUPED

MODIFIED PLANKMODIFIED PLANK

MODIFIED PLANK 2MODIFIED PLANK 2

SIDE PLANKSIDE PLANK

SUPERMANSUPERMAN

CORE STRENGTHENINGCORE STRENGTHENING

-WITH SWISS BALL-WITH SWISS BALL

SQUAT AND REACHSQUAT AND REACH

BALL SIT - BACKBALL SIT - BACK

BRIDGE ON BALLBRIDGE ON BALL

BRIDGE HEEL DIGBRIDGE HEEL DIG

BALL PLANKBALL PLANK

FORWARD LEANFORWARD LEAN

BALL RAISEBALL RAISE

BALL ROTATIONBALL ROTATION

TRUNK EXERCISETRUNK EXERCISE

REVERSE CRUNCHREVERSE CRUNCH

REFRENCESREFRENCES GOEL ET AL A COMBINED FINITE ELEMENT OF LUMBAR GOEL ET AL A COMBINED FINITE ELEMENT OF LUMBAR

SPINE, SPINE, 18, 1993,1531-1541SPINE, SPINE, 18, 1993,1531-1541 MANOHAR ET AL STABALIZING FUNCTION OF TRNUNK MANOHAR ET AL STABALIZING FUNCTION OF TRNUNK

FLEXORS, SPINE,1997, 22, 2207- 2212FLEXORS, SPINE,1997, 22, 2207- 2212 CRESSWELL ET AL OBSERVATIONS OF INTRA ABDOMINAL CRESSWELL ET AL OBSERVATIONS OF INTRA ABDOMINAL

PRESSURE, ACTA PHYSIOL SCAND1992, 144, 409- 418PRESSURE, ACTA PHYSIOL SCAND1992, 144, 409- 418 JOHANNE ET AL MUSCLE ACTIVATION EXERCISES APMR, JOHANNE ET AL MUSCLE ACTIVATION EXERCISES APMR,

2000, 2000, ACTIVATON OF PARASPINAL MUSCLES AM J PHYS MED ACTIVATON OF PARASPINAL MUSCLES AM J PHYS MED

REHAB 2002REHAB 2002 BACK AND ABDOMINAL FUNCTION APMR 2001BACK AND ABDOMINAL FUNCTION APMR 2001 CORE STRENGTHENING APMR 2004CORE STRENGTHENING APMR 2004 THERAPUTIC EXERCISES FOR SPINAL SEGMENTAL LBA THERAPUTIC EXERCISES FOR SPINAL SEGMENTAL LBA

RICHORDSON RICHORDSON