Spinal Stabilisation: 5. An Exercise Programme to Enhance Lumbar Stabilisation

The concept of sensory-motor stimulation is introduced and the importance of sub-cortical control of active lumbar stabilisation (ALS) is emphasised. The ALS programme is divided into four stages representing muscle re-education, static stabilisation, dynamic stabilisation and functional activities. In stage 1 the oblique abdominals, transversus abdominis, and multifidus are facilitated. Abdominal hollowing (AH) is used to dissociate rectus abdominis activity from that of the other abdominal muscles. AH is performed by pulling the abdomen in without allowing significant lumbar flexion. Pressure biofeedback is used to monitor the depth of the lumbar lordosis and give information concerning maintenance of lumbar stabilisation. In stage 2, load is imposed on the trunk in various starting positions while the subject braces the trunk muscles. The lumbar spine is held in mid range while exercising, an alignment termed the ‘neutral position’. In stage 3 emphasis is placed on the restoration of correct pelvic tilting. Patients are taught to exercise within their pain-free range of motion, a position termed the functional position or safety zone. Stage 4 describes functional exercises. The importance of proprioceptive training is discussed, and stabilisation activities using a 65 cm gymnastic ball are described. Stabilisation programme results are briefly reviewed.