COLUMN TECHNIQUES TOOLBOX Evidence-based rehabilitation L Best practices for managing lumbar spine degeneration include extreme or excessive bending, lifting and twisting. Other factors can include age, occupation, cigarette smoking and gender. Although some chiropractors may refer to other health practitioners or therapists for rehabilitative exercise, it’s important to use best-practice knowledge to guide patients toward correct management or co-manage-ment options. Recent studies have shown that spinal stabilization exercise for acute, subacute and chronic lower back pain patients produced a positive effect in terms of relieving pain, im-proving spinal function, and increas-ing functional activities of daily living. BY JENNIFER D. ILLES ow back pain (LBP) is one of the most common diseases, with a prevalence rate of nearly 80 per cent of the pop-ulation. Since there is a high potential for recurrence, successful rehabilitation is important in prevent-ing the return of LBP. Though there are various causes of LBP, the primary factors include damage to the soft tissues of the trunk and weakening of the muscles, leading to pain, decreased muscle endurance and flexibility, and restriction of spine movement. Specifically, the deepest layer of lumbar spine muscles experiences more atrophy in patients with LBP, when compared with healthy controls. In addition to muscular atrophy, the contraction speed of their muscles is decreased. This type of muscle weak-ening may give rise to disc and joint degeneration, and potentially cause instability of the spine. Another study reported that exces-sive mechanical load when applied to the spine caused irreversible altera-tions of cellular tissues. Therefore, a hypothesis of what then occurs is that once disc degeneration (i.e. alteration in the cellular tissue) had progressed, the vertical height of the disc de-creases, instability of the spine devel-ops, and the deep intrinsic muscles undergo atrophy, taking on a major role in destabilizing the spine. It is important to keep in mind that there are many factors that contribute to the way each individual experiences degeneration in the spine. These can include mechanical, traumatic, nutri-tional, biochemical and genetic influ-ences. Mechanical factors that can contribute to disc degeneration Quadriceps stretch Hip flexor stretch Lumbar stabilization program Adductor stretch The lumbar stabilization program is a program of back exercises designed to teach patients strengthening and flex-ibility in a pain-free range. It not only improves the patient’s physical condi-tion and symptoms but also helps the patient with efficient movement. It provides the patient with movement awareness, knowledge of safe postures, and functional strength and coordina-tion that promote management of LBP. The basic concept of these spinal stabilization exercise programs is to enhance musculoskeletal capacity, which maintains the neutral posture of the spine by preventing excessive movement. Some researchers have focused on activating the transversus abdominis, multifidus, and psoas ma-jor muscles, because strengthening these deep muscles helps in stabilizing the spine quickly. Stabilizing and strengthening the lumbar spine through a lumbar stabi-lization program is also an important Hamstring stretch Sidelying ITB/TFL Stretch DR. JENNIFER ILLES, DC, is assistant clinical professor at D’Youville College’s Chiropractic Program. She has practised in Ontario, Florida and New York. She can be reached at [email protected]. 20 Canadian Chiropractor May 2015 www.canadianchiropractor.ca
Chiropractic + Naturopathic Doctor May 2015: Page 20
