Exercises for

Lumbar Instability
 Introduction
• Motion of the lumbar spine is result of a
complex interaction of : bony structures
and soft tissues.
• Therefore abnormalities of any of these
structures may limit the range of motion of
the lumbar spine.
• The loss of motion may be due to pain,
muscle spasm, mechanical block, or
neurological defect.
 Major Diagnostic
Possibilities (after trauma)
• Fracture
• Ligamentous Injury
• Low back strain/sprain
• Herniated Disk
During Fracture & Ligament. injury – (Sx
related to movement/stability) pt. unwilling
to move.
LB strain – ROM typically painful
Herniated Disk – Flex spine = reproduces leg
symptoms – pain in SLR tests.
 Major Diagnostic
Possibilities (without
• Degenerativetrauma)
Disk Disease
• Lumbar Arthritis
• Infection
• Tumors
• Spinal Deformities
Lumbar Arthritis esp. ĉ Stenosis– unilateral
leg weakness
Spinal Stenosis – loss of lumbar lordosis
Lumbar Spondylosis - ↓ lumbar ROM
 What is Lumbar
Instability?
• Lumbar instability is when there is
decreased stiffness (there is a
resistance to bending) of a segment.
As a result, excessive movement
occurs, even under minor loads.
 Management
• Treatment Aim: to ↓ or
eliminate completely the
Sx of the condition rather
than getting a bony
reunion.
• Depend on condition –
“active rest” “total bed
rest”.
• Braces – Casts
• MOST IMPORTANT
component of management
is closely supervised
EXERCISE THERAPY.
 How to maintain spinal
stability?
• Three inter-related systems.
• Passive support
• Active support
• Control centres

• If stability of 1 system ↓ the other

systems most compensate.
 What can the PT do?
• This inter-related system
gives the PT opportunity to
↓ pain and ↑ function by
REHABILITATING active
lumbar stabilization.
• A 10 wk specific stability
programme is shown to
be more EFFECTIVE than
regular ex’s in the gym, sit
– ups, swimming using
measures of pain intensity.
• The benefits of this
programme have been
maintained even after a
30 mnth follow-up
(O’Sullivan et. al.1997)
 Lumbar Stabilization
Programme
• Divided into 3 stages and has been
constructed by Richardson and Jull in
1994.
The muscles that function poorly after
injury to lumbar spine are the
stabilizers (lumbopelvic region): deep
abdominals, gluteals, and multifidus.
Signs of msl instability:
– msl twitching when pt. shifts weight
to one leg.
-pt. shakes or judders while trying to
bend trunk forward.
 Phase 1:
Begins ĉ abdominal hollowing.
Pt. in prone kneeling & spine in
mid-pst.
Pull abdominal wall in &hold pst.
for 2 seconds.
Then 5,10, 30 secs. & breathing
normally. Build up to 10 reps.
*PT cueing “in and up”/ encouraging
*PT tells pt. to contract abdominal
msls hard as possible then relax.
PT monitor the ribcage to avoid
excessive movement.
*Use visual stimulation
*pt focus attention on body part
(umbilicus)

*slow steady movements

 Phase 2
• Next action = heel slide while maintaining neutral
lumbar position. Hip flexors try to tilt pelvis
forward & ↑ lumbar lordosis.
• The abdominal msls work hard to stabilize the
pelvis & lumbar spine against pull.
• Bridging
actions
work
abdomina
ls &
gluteals
combined
.
•Side lying movements work
quadratus lumborum and
trunk side flexors
**important stabilizers*
• Dynamic movement and alignment
are maintained in this phase
 Phase 3
• PT teach patient to draw attention
away from spine by use of
proprioception to check the stability
of the spine so that stability of the
spine becomes automatic.
• Resistance Training can be used.
• Balance Board

• Swiss Gym ball

 Those are the main
points of the exercise
programme for
lumbar stability
Thank u!