Lumbo Pelvic Stability: Difference between revisions

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== Muscles ==
== Muscles ==
[[Pelvic Floor Anatomy#Pelvic Floor Myology|Pelvic floor muscles]] (PFM) is proven to activate during tasks that challenge lumbopelvic stability, which supports the hypothesized role of the PFM in control of the lumbar spine and pelvis. <ref>Vesentini G, Prior J, Ferreira PH, Hodges PW, Rudge M, Ferreira ML. Pelvic floor muscle training for women with lumbopelvic pain: A systematic review and meta‐analysis. European Journal of Pain. 2020 Nov;24(10):1865-79.</ref>
The [[Core Muscles|core muscles]] provide dynamic stabilization for the lumbar spine. These muscles are the [[Pelvic Floor Anatomy|pelvic floor muscles]], the [[Rectus Abdominis|rectus abdominis]], the internal and external obliques, the [[Transversus Abdominis|transversus abdominis]], the [[Erector Spinae|erector spinae]] muscles, and the multifidus muscles. Among them, deep compartment muscles such as the transversus abdominis are most important for lumbar stability. <ref>Lynders C. [https://journals.sagepub.com/doi/full/10.1007/s11420-019-09717-8 The critical role of development of the transversus abdominis in the prevention and treatment of low back pain]. HSS Journal®. 2019 Oct;15(3):214-20.</ref>
 
The [[Gluteus Medius|gluteus medius]] <ref>Baik SM, Cynn HS, Kim SH. [https://www.ptkorea.org/journal/view.html?doi=10.12674/ptk.2021.28.1.27 Understanding and exercise of gluteus medius weakness: A systematic review]. Physical Therapy Korea. 2021 Feb 20;28(1):27-35.</ref>, [[Gluteus Maximus|gluteus maximus]], [[piriformis]] and deep core muscles are responsible for pelvic stabilisation.
 
Pelvic floor muscles is proven to activate during tasks that challenge lumbopelvic stability, which supports the hypothesized role of the PFM in control of the lumbar spine and pelvis. <ref>Vesentini G, Prior J, Ferreira PH, Hodges PW, Rudge M, Ferreira ML. Pelvic floor muscle training for women with lumbopelvic pain: A systematic review and meta‐analysis. European Journal of Pain. 2020 Nov;24(10):1865-79.</ref>


== Physical Therapy ==
== Physical Therapy ==

Revision as of 22:37, 20 January 2024

Original Editor - Kris Porter Top Contributors - Kris Porter, Kim Jackson, Sehriban Ozmen, Vidya Acharya and Rishika Babburu


This article is currently under review and may not be up to date. Please come back soon to see the finished work! (20/01/2024)

Definition[edit | edit source]

Assessment[edit | edit source]

Lumbopelvic stability can be assessed with either equipment or clinical measures such as palpation, active straight leg raise, lumbar lordosis, pelvic inclination and dynamic tests. Dynamic tests include runner pose, hopping tests, single-leg squat, dip test. [1]

Muscles[edit | edit source]

The core muscles provide dynamic stabilization for the lumbar spine. These muscles are the pelvic floor muscles, the rectus abdominis, the internal and external obliques, the transversus abdominis, the erector spinae muscles, and the multifidus muscles. Among them, deep compartment muscles such as the transversus abdominis are most important for lumbar stability. [2]

The gluteus medius [3], gluteus maximus, piriformis and deep core muscles are responsible for pelvic stabilisation.

Pelvic floor muscles is proven to activate during tasks that challenge lumbopelvic stability, which supports the hypothesized role of the PFM in control of the lumbar spine and pelvis. [4]

Physical Therapy[edit | edit source]

Training Principles for Phase 1[edit | edit source]

  1. Injury Prevention and Body Mechanics
  2. Total Health (Nutrition, Cardiopulmonary exercise)
  3. Movement Retraining Basics
  4. Core Setting
  5. Evidence for Stability Training for Low Back Pain (and pelvic pain) [5][6]


Criteria for Progression to Phase 2

Below outlines the criteria that each patient must accomplish before allowed to complete the phase 2 exercises. At times, some phase 2 exercises may be given when a patient has not met this criteria. But rarely, will a patient be given the entire cuff program and the big 4 without meeting this criteria. This is based on anecdotal evidence of how best to prevent injury.

  1. Able to engage the primary core muscles without compensatory firing or pain in non-weight bearing (supine or prone)
  2. Able to engage the primary core muscles without compensatory firing or pain in static weight bearing positions (standing)
  3. Core Endurance and Ratio Testing has been completed[7] [8][9]
  4. The Big 4 exercises (or modifications of each one) are tolerated for at least a single hold of 8 seconds[10]

Training Principles for phase 2[edit | edit source]

  1. Movement Retraining Intermediate
  2. Big 4 Exercises

Training principles for Phase 3[edit | edit source]

  1. Static Balance - Stable Surface
  2. Static Balance - Unstable Surface
  3. Dynamic Balance - Stable Surface
  4. Dynamic Balance - Unstable Surface

Training Principles for Phase 4[edit | edit source]

  1. Movement Retraining Advanced
  2. Big 4 Exercises - Advanced

Training Principles for Phase 5[edit | edit source]

  1. Advanced Strength Training and Postural Stability

CRITERIA FOR DISCHARGE FROM PHYSICAL THERAPY

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Perrott MA, Pizzari T, Opar MS, Cook J. Athletes with a clinical rating of good and poor lumbopelvic stability have different kinematic variables during single leg squat and dip test. Physiotherapy theory and practice. 2021 Aug 3;37(8):906-15.
  2. ↑ Lynders C. The critical role of development of the transversus abdominis in the prevention and treatment of low back pain. HSS Journal®. 2019 Oct;15(3):214-20.
  3. ↑ Baik SM, Cynn HS, Kim SH. Understanding and exercise of gluteus medius weakness: A systematic review. Physical Therapy Korea. 2021 Feb 20;28(1):27-35.
  4. ↑ Vesentini G, Prior J, Ferreira PH, Hodges PW, Rudge M, Ferreira ML. Pelvic floor muscle training for women with lumbopelvic pain: A systematic review and meta‐analysis. European Journal of Pain. 2020 Nov;24(10):1865-79.
  5. ↑ Gatti R, Faccendini S, Tettamanti A, Barbero M, Balestri A, Calori G. Efficacy of trunk balance exercises for individuals with chronic low back pain: a randomized clinical trial. journal of orthopaedic & sports physical therapy. 2011 Aug;41(8):542-52.
  6. ↑ Macedo LG, Maher CG, Latimer J, McAuley JH. Motor control exercise for persistent, nonspecific low back pain: a systematic review. Physical Therapy. 2009;89(1):9-25. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19056854.
  7. ↑ McGill SM, Childs A, Liebenson C. Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database. Arch Phys Med Rehabil. 1999;80(8):941-944.
  8. ↑ McGill S. Ultimate back fitness and performance. Waterloo Ont.: Wabuno Publishers; 2004.
  9. ↑ McGill S. Low back disorders: evidence-based prevention and rehabilitation. Second. Human Kinetics; 2007.
  10. ↑ Mcgill S, Karpowicz A. Exercises for Spine Stabilization: Motion/Motor Patterns, Stability Progressions, and Clinical Technique. Archives of Physical Medicine and Rehabilitation. 2009;90(1):118-126. Available at: http://www.archives-pmr.org/article/S0003-9993%2808%2901505-0/abstract
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