Charlie Kornberg's Musculoskeletal Physiotherapy Home Page |
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For many years, Practitioners have attempted to treat spinal conditions with exercises. In recent times, accurate diagnosis has been made possible with technological advances, such as the Cybex Trunk Extension/Flexion (TEF) Dynamometer, as well as improving Practitioner assessment techniques. In the U.S., over the years, there has been a shift from the traditional stretching and mobilizing exercises, with greater emphasis on strengthening and stabilizing routines. But why do we need to strengthen or stabilize? There has been much said of “functional instability” - a condition recognized as being one of hypermobility/laxity of the motion segment (i.e. disc, joints and ligaments), rather than the traditional “stiffness” condition (although it is recognized that stiffness may be a secondary symptom of instability). For a Practitioner to provide the patient with stretching or mobilizing exercises for “functional instability”, the condition could not be corrected, as the exercises would be moving an already hypermobile region. The answer would be to strengthen and stabilize the area with a series of exercises designed specifically for that purpose. Dynamic Lumbar Stabilization exercises are a series of approximately 84 exercises that have been amalgamated from those designed by a different groups of Practitioners around the world, to stimulate muscular control around the “deconditioned” spine. They provide their mode of action by using dynamic bracing techniques, combined with various manoeuvres designed to make the supporting muscles work harder and more efficiently. The patient usually only has to attend for 3 - 4 sessions, over 6 weeks, where they are assessed by a Practitioner well versed in the prescription of stabilisation exercises. The assessment's primary function is to correlate the signs to the symptoms, determine the extent of the "functional instability" and then provide clues as to which set of exercises would be most beneficial. The programs are individualized to suit the patient’s condition and needs. There are varying difficulty levels, and the patient is progressed as they complete the preceding level. Following the final stage of the program, the patient is instructed of a maintenance program, usually comprising a selection of the exercises they have already performed. This will last approximately another 6 weeks. The entire program covers 3 months. Anecdotally, the success rate is in the 70 - 80% region, with good return to function. Above all else, the success of the program is totally determined by the specificity of the program to the condition - if the spine is stiff then move it, but if it’s loose, tighten it! The stabilization program provides a system of exercises that will give the patient a feeling of self control, which will hopefully minimize the risk of recurrence. Please do not request a copy of the programme, as those who prescribe it have been trained over the last 18 years and have a certain expertise in being able to individualise the exercise programme based on the particular assessment. We don't give "recipes" to our patients, so please don't ask for one from us.
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Brighton Spine Institute | 441 Bay Street Brighton, Victoria 3186 | AUSTRALIA | Tel. + 61 3 9596 7211 | Fax. + 61 3 9596 7871 |
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