Stabilization Exercise Training (Back to contents)

The purpose of stabilization exercises is the development of the physical capacities needed to achieve maintenance of neutral spine positioning during activities of daily living. By themselves however, exercises are of relatively little value. For example, strong abdominal muscles will not reduce microtrauma to the spine if the patient does not know when to contract the muscles during daily activities. Stabilization exercises are designed to increase:

Maintenance of neutral spine position with meticulous technique during the exercises is essential. The trainer must carefully observe and correct exercise performance in the clinic to assure that optimum benefit is obtained from the home program. The patient should be told that the exercises require concentration and should not be performed when attention to detail is not possible (e.g. while watching television). Exercise progression ranges from low level, indirect techniques to dynamic stabilization exercises with increasing resistance and duration to high level stabilization exercises and drills for athletes and manual laborers, etc. Extremity and aerobic exercises with or without gym equipment is usually indicated.

Note: No instruction in specific stabilization exercises is included in this document. Because the neutral spine position often varies from one individual to another and because precision is required in the performance of stabilization exercises patients should only begin a stabilization exercise program after specific, individualized instruction from a spine rehabilitation clinician.

Range of motion exercises should be selected specifically for the individual patient. The main purpose is to achieve and maintain sufficient flexibility to allow functional movement and positioning while maintaining a neutral spine. Some out of neutral position stretches can help decrease pain (e.g.knee to chest, press-up, etc.). Care should be taken to avoid repetitive microtrauma through overly forceful or inappropriately chosen stretches.

Examples of ROM exercises:

 

Indirect techniques are appropriate for low level or pain inhibited patients.

Examples of indirect techniques:

Direct techniques consist of progressive exercises which challenge the patient's ability to maintain neutral position against forces which reproduce the flexion, extension, rotation and side bending forces which the patient encounters in daily activities.

Examples of direct techniques:

Quantification of Progress in Rehabilitation

The Functional Gym Stabilization Evaluation was developed in the late 1980's by the physicians and physical therapists at SpineCare in California. Initially it was designed to facilitate communication between physical therapists and physicians regarding the stabilization ability of spine patients. The equipment needed for the test (3 and 5 pound ankle/wrist weights, a clock with second hand, and a plinth) is universally available. The uses of the stabilization evaluation include:

The stabilization evaluation measures the patient's endurance, strength, control, and body mechanics as related to the ability to maintain a neutral spine position.

The Functional Gym Stabilization Evaluation Form is composed of two parts:

  • STABILIZATION LEVEL; screening the patient's physical ability to maintain a neutral spine position. This consists of six exercises which measure control and endurance of the abdominals, hip and knee extensors, and paraspinals.
  • FUNCTIONAL LEVEL; screening the patient's body mechanics.
  • Transfers, reaching and lifting are examined. In an initial stabilization evaluation no instruction in mechanics is given. In subsequent tests the amount of cuing needed is measured.

    Scoring: Patients are given points for the completion of each exercise or task. These scores are added to determine stabilization and functional levels (levels I, II or III, lowest to highest). For example, if a patient scored seven points on the exercise tests (6-12 points = level I) and zero points on the functional tests (1-4 points = level I) he would be scored Stabilization Level: I, Functional Level: < I. The test is constructed so that an isolated deficiency, e.g. knee pain which prohibited squats, would not markedly effect the level scored. In order to complete a stabilization test successfully the patient must demonstrate the ability to maintain his neutral spine position by use of the appropriate muscles. The tester must carefully monitor the patient's form throughout the test. The exercises should be arranged so that the same muscle group is not tested consecutively, i.e. dying bug should not immediately follow partial sit-ups. Although not included on the evaluation form, it is important to asses the range of motion of the soft tissues and joints which are required for maintenance of neutral spine positioning particularly in bending, reaching and lifting activities. This includes flexibility of hamstrings, hip adductors, hip flexors and paraspinals. Soft tissue or articular restrictions may be the primary cause of a patient's inability to complete one or more of the exercise or functional tests successfully.

    Common findings: Frequently the chronic low back patient can not control pelvic movement in performing the level I dying bug or bridge. Palpation of the pelvis and ribs will reveal movement during these exercises as a result of the ineffectiveness of the patient's abdominal bracing. The quadruped tests are usually the easiest for the low level patient. In the absence of detailed instruction in the functional applications of neutral spine positioning, the chronic low back patient is usually unable to maintain neutral while stooping and reaching.

    Although during training all patients are encouraged to attain the highest stabilization level possible, generally speaking, persons whose lifestyle includes only moderate activity may require only level II stabilization ability to be able to manage spine stresses successfully. More active persons (manual laborers, athletes, etc.) will require level III stabilization ability (or higher) to be able to resume their previous activity level without undue spinal stress and functional deficits. In any case of chronic spine dysfunction, level III functional ability is always essential.

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