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Health & Exercise Forum

Lumbar Stabilization

Mar 8, 2009

Dr. Paul MackareyLow back pain (LBP) and/or injury inhibit specific muscles that support and stabilize the spine and pelvis. Despite complete resolution of symptoms, recruitment of these crucial muscles is significantly diminished. Therefore, the probability of subsequent LBP and/or injury is increased, exposing the spine to further damage with each episode intensifying in severity.

Lumbar stabilization is the remedy for dysfunctional musculature of the spine and pelvis incriminated in recurrent LBP and/or injury. The focus of lumbar stabilization is the simultaneous activation of the lumbar multifidi and the transversus abdominus which will provide a deep, internal, protective corset around the spine maintaining stability during activity. The multifidi are the small, deep muscles attached directly to the spine. Weakness of the multifidi may cause excessive movement of the spinal joints resulting in instability. The transversus abdominus is the deepest abdominal muscle with direct attachments to the spine and pelvis. It is not only the first muscle to contract in anticipation of body movement but also an important stabilizer of the spine. This protective co-contraction of the multifidi and transversus abdominus is disrupted with LBP and/or injury.

To achieve proper performance of and progression through a lumbar stabilization program, identification of the neutral spine position (NSP) is imperative. This position is the most comfortable point between the extremes of an arched back position and a flat back position. This position is maintained during all lumbar stabilization exercises with progression into functional daily activities.

Determining the NSP is the most important aspect of the lumbar stabilization program. Maintaining the NSP allows the individual to sense and control inappropriate spinal motion which, in turn, will improve proprioception (sense of position) and kinesthesia (sense of movement) of the lumbar spine. Improved position and movement awareness reduces excessive spinal joint motion decreasing irritation at these segments that may produce pain. The NSP will eventually become automatic during all daily activities.

The lumbar stabilization program includes movements of the arms and/or legs while maintaining the NSP. These extremity movements are performed in a variety of functional positions: lying on the stomach, lying on the back, on all fours, sitting and standing. The program is advanced as follows:

  • From static (lying) to dynamic (standing or jumping)
  • From resisting gravity to resisting additional outside force (e.g. cuff/hand weights or resistive tubing)
  • From predictable to unpredictable movements (therapeutic ball)
  • From individual components of a movement to functional movement patterns (e.g. sit to stand and return; stand to kneel and return)

Progression depends on the ability to maintain the NSP during the current exercise. A comprehensive lumbar stabilization program will also include exercises for:

  • Flexibility: allows the muscles to assume the neutral spine position
  • Endurance: sustained activation of the spinal stabilizers is required for painfree activity throughout the day

Your physician can evaluate for a musculoskeletal source to your LBP. If your LBP is musculoskeletal in origin, a comprehensive rehabilitation program including lumbar stabilization may be recommended. Lumbar stabilization exercises require professional hands-on instruction since they are more difficult than they appear and will not benefit if performed incorrectly.

Example of Intermediate Lumbar Stabilization Exercise

  • Lie on back
  • Bend hips and knees so that soles of feet are flat on exercise surface
  • Elevate arms toward ceiling with elbows straight
  • Find and hold NSP by contracting tranversus abdominus
  • Simultaneously bring right knee toward chest while elevating left arm overhead, slowly
  • Return to start position
  • Repeat with opposite arm and leg
  • Continue to alternate opposite arm/leg movements until a total of 10 repetitions is achieved

Example of Advanced Lumbar Stabilization Exercise

  • Sitting on therapeutic ball with hips and knees bent 90 degrees and feet resting on floor
  • Find and hold NSP by contracting transversus abdominus
  • Slowly raise one foot while simultaneously raising opposite arm (with elbow straight) overhead
  • Return to start position
  • Repeat with opposite foot and arm
  • Continue to alternate opposite foot/arm movements until a total of 10 repetitions is achieved

Visit your doctor regularly and listen to your body.