Rehabilitating Low Back Disorders - Fundamentals and Assessment Tools for Occupational Ergonomics - page 464

FIGURE 20.8 The flexion-extension stretch is performed by slowly cycling through full spine flexion to full
extension. Spine mobility is emphasized rather than “pressing” at the end range of motion. This exercise
facilitates motion for the spine with very low loading of the intervertebral joints, reduces viscous stresses for
subsequent exercise and “flosses” the nerve roots through the foramenae at each spine joint (hence coordination
of full cervical, thoracic and lumbar flexion-extension).
the other leg straight to lock the pelvis-lumbar spine and minimize the loss of a neutral lumbar posture.
Then, lateral musculature exercises are performed — namely the side-bridge, for QL and muscles of the
abdominal wall for optimal stability (Figure 20.6). Advanced variations involve placing the upper leg-
foot in front of the lower leg-foot to facilitate longitudinal “rolling” of the torso to challenge both anterior
and posterior portions of the wall. The extensor program consists of leg extensions and the “birddog”
(Figure 20.10). In general, we recommend that these isometric holds be held no longer than 7 to 8 sec
given recent evidence from near infrared spectroscopy indicating rapid loss of available oxygen in the
torso muscles contracting at these levels — short relaxation of the muscle restores oxygen. 34
Motivated by the evidence for the superiority of extensor endurance over strength as a benchmark for
good back health, we have recently documented “normal” ratios of endurance times for the torso flexors
relative to the extensors (e.g., it is “normal” to hold a flexor posture — see Reference 32, about 0.98 of the
maximum time holding a reference extensor posture) and for the lateral musculature relative to the
extensors (0.5) to assist clinicians to identify endurance deficits — both absolute values and for one
muscle group relative to another. Our most recent evidence suggests that these endurance ratios (both
right to left sides and flexor to extensor) are significantly “out of balance” in those who have had a
history of low back troubles with work loss. 36 Finally, as patients progress with these isometric stabiliz-
ation exercises, we recommend conscious simultaneous contraction of the abdominals (i.e., bracing —
simply isometrically activating the abdominals for maximum stability).
FIGURE 20.9 The curl-up, where the head and shoulders are raised off the ground with the hands under the lumbar
region to help stabilize the pelvis and support the neutral spine. Only one leg is bent to assist in pelvic stabilization
and preservation of a “neutral” lumbar curve. Additional challenge can be created by raising the elbows from the floor
and generating an abdominal brace or cocontraction.