It is our duty to remember at all times and anew that medicine is not 
only a science, but also the art of letting our own individuality interact with the individuality of the patient.

 -Albert Schweitzer, 1875-1965

Back Rehabilitation

ANATOMY 

• # of Vertebrae?

 

• # of cervical?

 

• # of Thoracic?

 

• # of Lumbar?

 

• Sacrum

• Coccyx

Vertebral Anatomy

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Anatomic Landmarks: Ligaments

• Anterior Longitudinal

• Posterior Longitudinal

• Supraspinous

• Interspinous

• Intertransverse

• Ligamentum Flavum

• Facet Capsulary

Anatomy-Muscles of the Trunk
Which muscles extend? 

 


Which muscles extend/rotate?

Which muscles flex? Flex & Rotate


Which muscles laterally flex?

Anatomy-Muscles of Neck
Which muscles flex? Lat Flex?

 

Which muscles extend?


Which muscles rotate?

Anatomy: Intervertebral Disks

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Evaluation

• Complete & Thorough

• Structures Involved & Nature of Injury

• Other Factors:

– LLD

– Scoliosis

– Muscle Assymmetry

• Body Type

Common Back Rehab Philosophies

• Extension Exs (McKenzie Extensions)

• Flexion Exs (Williams Flexion)

• Core Stabilization

 

 

Extension Exercises

• Postural Pain

• Dysfunction

• Derangement

 

Indications

• Pain < w/ lying down, > w/sitting

• Flexion limited & > pain

• Extension limited but centralizes < pain

 

How do they work?

• < nerve tension

• < disk load

•   > strength & end. of ext. muscles

• Proprioceptive interference w/pain

 

 

 

 

Flexion Exercises

Indications

• Pain < w/sitting, > w/lying down or standing & walking

• Flexion < pain

• Ext > pain

• Poor Ab strength

• Lordotic curve does not reverse w/flexion

How do they work?

• < stress on facet jts

• Stretches fascia & muscles

• Opens intervertebral foramen

• < stenosis of canal

• > stabilization

• Proprioceptive pain interference

 

 

Core Stabilization Exercises

• Controlling spinal movement to minimize repetitive microtrauma

• Holding pain-free position for all activities

• High Endurance

• Antalgic Neutral

• Abdominal Bracing

• Stabilization Exs

Rehabilitation Goals

• Optimize Healing Environment

• Maintain Normal function of un-injured tissues

• Restore maximum available motion and mechanics

 

General Rehabilitation Outline

• Modalities

• Pain Control

• Inflammation

 

• Soft Tissue & Jt Mobilizations

• ST: trigger pts

• Jts: manual or self

Joint Mobilizations

Indications

• Pain at specific jt

• < accessory motion

• < AROM & PROM

• Muscular or fascial tightness

• Asymmetrical movement

• Flex/Ext away from midline

Effects

• Stretch tight structures

• Nutrient/Waste Exchange

• Promotes normal biomechanics

• Proprioceptive pain interference

 

 

• Flexibility 

• Surrounding musculature

• Flexion Exs

 

• Pelvic Stabilization

• ABS!!!!!

• Core Stabilization

 

 

• Trunk Strengthening

• Postural Assessment

• Abs

• Posture

• Trunk Rotation

• Extensions

 

 

 

• Functional Progression

• Job/ Sport skills

• ADLs

Special Rehabilitation Considerations

Low Back Pain:
? Sprain/Strain?

• 90% LBP resolves w/in 6 wks 

• Acute: 

– Address pain/spasm

– Mobs: self or Gr I or II

– Address posture & body mechanics

– Progressive strengthening Exs

• Chronic: may be self-sustaining

 

 

 

 

Hypermobility Conditions

• Spondylolysis

• Spondylolisthesis

Rehab for Hypermobility Conditions

• Avoid Extension

• Stabilize Hypermobile segment

• Progressive Trunk Strengthening

• Core Stabilization

• Avoid: mobilization;limit-flexibility

• Corset may increase comfort

 

 

 

 

Disk Injuries

• MOI: flex & rotation

• Centrally located pain w/radiation

• Flex, sitting, coughing > pain

• Worst in am & better as day goes on

 

Treatment

• Extension exs

• Acute:tape in ext

• Traction

• Ab & Back strengthening

• Microdecompresion

• IDET

Facet Joint Impingement/Sprain

• Impingement: jt capsule or synovium

• Sprain: ligaments

• Posture: locked in side bend & rotation

 

Treatment of Facet Joint Injuries

• Traction

• Joint Mobs

• Treat spasm

• Gentle rotation w/side bend in pain-free motion; progress into painful range w/traction

• Traumatic Sprain: more conservative

 

 

SI Joint Dysfunction

• MOI: twisting w/feet planted, fall on side of buttocks, stepping too far down

• May result in asymmetry of pelvis

• Dull, achy pain near PSIS unilaterally

Treatment of SI Dysfunctions

• Mobilization Techniques 

• Strengthening Exs

• Stabilization Exs

• Assess posture & body mechanics