2. The Core is like a muscular box
(Richardson, C., G. Jull, P. Hodges, and J. Hides.)
• Abdominals in the
front
• Para spinals and
gluteus in back
• Diaphragm roof
• Pelvic Floor and hip
girdle bottom
3. Conceptual model of control of
lumbopelvic stability
The model incorporates :
1. Passive subsystem.
2. Active subsystem.
3. Neural control
subsystem.
4. Neural control system
The system must activate muscles:
1. At the right time(recruitment time).
2. By the right amount(number of motor unit recruitment).
3. In the correct sequence(recruitment order).
4. Muscles turn off appropriately.
6. Muscle categories
(Richardson et al. 1992)
STABILISERS
• Deeply placed
• Slow twitch nature
• Active in endurance
activities
• Selectively weaken
• Poor recruitment, may
be inhibited
MOBILISERS
• Superficial
• Fusiform
• Fast twitch nature
• Active in power activities
12. Limitations of the global system
Gardner-Morse and Stokes(1998): Global co-
activation increases the compressive lode on lumber
segments.
• The superficial trunk muscles generate torque at the trunk.
• This torque must be overcome by antagonist activation in
order to keep the spine upright, and this co activation
results in a compressive load on the spine.
(Lavender et al.1992, Mirka and Marras 1993,
Thelen et al 1995, Gardner-Morse and Stokes 1998) .
13. Radebold et al 2000
Increased co-contraction of the global muscles has
been detected in patients who develop low back pain
compared with normal pain-free subject.
Cholewicki et al 1997
Dysfunction in the passive stabilization system may be
indicated by increase level of trunk muscle co-activation.
14. • The superficial abdominal muscles depress the rib cage
and are involved in forced expiration.
( DeTroyer and Estenne 1988).
Increased activity of these muscles in individuals
with pain may lead to compromised respiratory function.
for example restricted movement of the chest wall. In
contrast, local muscle have limited effect on rib cage
motion.
( DeTroyer and Fstenne 1988)
21. Treatment procedure
(Richardson et.al. )
1. Warm up- Stationary bicycle (10 minute)
2. Self Stretching/Flexibility exercises-(3 set,10
repetition daily )
A. Single and double knee to chest from
supine position.
B. Cat camel .
C. Side bending in standing position with and
without contralateral arm elevation.
D. Low back sustained rotation from supine
position.
26. 3.Potential exercise
These sets of exercise will be given for six weeks, for
three days a week.
In this group treatment protocol divided in three
stages
Stage 1: local segmental control
Stage 2: closed chain segmental control
Stage 3: open chain segmental control and progression
into function.
27.
28. Stage 1: local segmental control (TrA, LM)
Transverses abdominis
Position – prone
pressure biofeedback unit-
• Under the abdomen
• Navel in the centre
• Distal edge of the pad in line with the right and left ASIS
Pressure – 70 mmHg
Command- Relax the abdomen, normal breath, without
breathing in draw the abdomen towards the spine,
with verbal counting.
34. • Procedure: Explain that the muscle encircles the trunk;
and when activated, the waistline draws inward
.Palpation of the muscle is possible just distal to the
anterior superior iliac spine (ASIS) and lateral to the
rectus abdominis .
• When the internal oblique (IO) contracts, a bulge of the
muscle is felt;
• when the TrA contracts, flat tension is felt. The goal is to
activate the TrA with minimal or no contraction of the
IO. This is a gentle contraction.
35.
36.
37.
38.
39.
40. Lumbar Multifidus
Position –prone
The thumb and/ or fingers gently but firmly deeply into
the muscle bellies adjacent to the spinous process in
order to facilitate the contraction
Command- TrA , plus
Gently swell out your muscles under my fingers
without moving your spine or pelvis; Hold the
contraction with verbal counting
Hold- 10sec
Repetition -10
Set - 3
43. Stage 2: closed chain segmental control (TrA, LM )
A. Training individual part of antigravity weight
bearing holding position
a) Upper quadrant closed chain exercise
b) Trunk forward lean
.
51. Gluteus maximus exercises
Stage -1. Correct recruitment order
Patient lying prone with unilateral knee flex to 90
degree, hip externally rotated.
then corset action both glutei squeezed
together , then extend the hip on same side, hold the
position with verbal counting for 10 sec.