Hi guys,
In the last couple of weeks of my musculoskeletal placement I starting having patients with motor control issues of the lumbar spine. For each of these patients the reason they actually came into the clinic was for an acute onset of low back pain. But after a few sessions and their pain started to decrease, it became apparent during re-assessment that their underlying problem was a motor control disorder of the lumbar spine.
Their pattern of pain changed from onset at the start of most active movements to the onset low back pain only in the mid ranges of active movements. For example, the patient would only complain of low back pain at about ¼ - ¾ range flexion but no pain at both ends of the range. This is a good indication that these patients were experiencing a lack of lumbar control when their passive structures were not able to give them stability. They also presented with poor activation of the local muscle system and an inability to find neutral lumbar spine.
Therefore, treatment became focused on teaching activation of the lower abdominals and multifidus as well as finding a neutral lumbar spine on the stability ball. This leads me to my blog this week, as I was able to teach the first stages of lumbopelvic motor retraining but then found that I was less than effective on providing progressions for these patients.
So I was able to progress the patients from TA activation in crook-lying to a sitting position but was unsure of how to make the task more functional and still ensure the patient was using the LMS and not reverting back to abdominal splinting.
Patients were also practicing finding their neutral spine while sitting on the stability ball but where I got stuck was in teaching progressions for lumbopelvic dissociation. We talked about the importance of dissociation in labs but I was unsure of how to actually make these exercises more functional.
So if you guys have some ideas about progressions for lumbar motor control disorder cases that would be much appreciated as I’m sure these types of patients will be a fairly common occurrence.
Thanks
Gareth
Subscribe to:
Post Comments (Atom)
1 comment:
hi gareth, i think you could possibly add to progressions for activating the deep abs standing positions or even like moving in and out of sitting/standing. i guess once they get the hang of lms activation, they should be able to tell if they're activating it well or just compensating? also don't forget functional activities like lifting or just raising and lowering their hands while activating the lms. hope that helps.
Post a Comment