Therapeutic Exercise for Lumbopelvic Stabilization: A Motor Control Approach for the Treatment and Prevention of Low Back Pain

264 Pages·2004·45.55 MB·English

by  Carolyn Richardson

SECONEDD ITION
THE EUTIC
EXERCISE FO
LUMBOPELVIC
STABILIZATION
A MotoCro ntrAoplp roacfho rt he
reatmeanntd P revention
ofL ow BaPcaki n
CAROLYN RICHARDSON
PAULH ODGES
JULIHEI DES
,/j)CHURCHIU
lIVINGSTON�
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SECOND EDITION
THERAPEUTIC
EXERCISFEO R
LUMBOPELVIC
STABILIZATION
A MotoCro ntrAoplp roafcohr
theT reatmaenntdP revention
ofL owB acPka in
TherapeuEtxiecr cifsoerL umbopelvSitca biliza(tpiroenv iouesnltyi tlTehde rapeuEtxiecr cifsoer
SpinaSle gmentSatla bilizaitnLi oownB ackP aini)sb asedo n thee videnfcreo mr esearch
undertakbeynt hea uthorosv era numbero fy earTsh.e s ignificoafnt chee sfei ndintgost he
treatmeanntd p reventioofln o wb ackp aina ren ow widelayc knowledgneodt,o nlya mong
researchbeurtas l soa,n dp erhapmso rei mportantalmyo,n gp ractitiocnoenrcse rnweidt ht he
managemenatn dp reventioofbn a ckp ainI.n t hinse w edititohne yh avet aketnh eo pportunity
toe xtentdh es copoef t heb ookt oa ccommodatteh em ostr ecenetv idencweh,i chh ase merged
sincteh ef iresdti tiwoans p ublishiend1 999.
KeyF eatures
• Writtebny t hreoef t hef oremosrets earchientr hse f ielodfm usculoskeldeytsaflu nction
• Incorporathteev se rlya tersets earfcrho mk eyw orkerisnt hef ield
• Demonstrattheesc linircealle vanocfet her esearfcihn dintgost hes tudenatn db usy
practitioner
• Presenat nse w, problem-solvingt oab papcrkpo aaicnah s sessmeanntd m anagemenbta sedo n
thel ateusntd erstandoifnt gh ea natomyp,h ysioloangdyb iomehcanicisn volved
• Suggesftust urdei rectifoonrcs l inimcaanla gemenatn df uturree search
• Extensivielllyu strwaittehld i ndei agramasn dp hotographs.
TherapeuEtxiecr cifsoerL umbopelvSitca bilizaptrieosne ntthse l ateisntf ormatoino n thmeu scle
systemisn volviendt hep reventiaonndm anagemenotf m usculoskelpeatianal n dd ysfunicotn,
andi ntroduac eusn iquaep proactho c linimcaanla gemenatn dp reventiboans edo n that
researcIhti. sa ni mportabnoto ki nt hati tn oto nlyp resentthse e videnbcuet a lsgoi vepsr actical
guidancoen how thef indinmgasy b ea pplieidne veryday
practiTchee.f iresdti tiwoans w idelwye lcomeadn d /
Thipsr oducitsa pproprifaotre.
acc,laimbeydr esearchaenrdsc linicailainksTe h.i nse w
• manuatlh erapy
editiwoinl clo ntintuoep rovidaen i ndispensparbalcet ical
referenscoeu rcfeo ra ltlh osweo rkinign t hef ielodf • physiotherapy
musculoskeleptaailna ndd ysfunction. • chiropractic
• osteopathy
• orthopaedics
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�� • paimna nagement
CHURCHILL
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LumbopelSvtiacb ilization
ForC hurchLiilvlgi snione:
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Stabilization
A MotoCro ntrAoplp roafcohr t he
TreatmeanntdP reventoifLo onw BaPcaki n
SECONEDD ITION
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Associate ParnodfR eesasdoeDrr,i visoifoP nh ysiotheSrcohpoy,oo lfH ealtahn dR ehabilitSactiieonnc e,
UniverosfiQ tuye enslaBnrdi,s baAnues,t ralia
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NHMRCS eniRoers earFcehl laonwd A ssociPartoef esDsiovr,i soifoP nh ysiotherapy,o fHS ecahlotaohnl d
RehabilitatioUnn SicvieeronsfciQ etuy,e ensland, Brisbane, Australia
JuliHei deBsP hMtPyh tyPShtD
CliniScuaple rviTshoeUr, n iverosfiQ tuye ensl/MaantdeHro spiBtaaclSk t abilCiltiynB irci,s baAnues,t ralia
Thibso okh asb eene ndorsbeydt heM ACP
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ASSOCIATOIFO N
aD CHARTERED
PHYSIOTHERAPISTS
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CHURCHILLL IVINGSTONE
An impriontfE lseviLeirm itde
f)Ha rcouBrrta caen dC ompanyL imite1d9 89
�)H arcourtP ublisLhimeirtsed 1 999
G�E)ls eviLeirm ite2d0 04A.l lr gihtsr eserved.
Ther igohftC a rolyn RichardsPoanu,lH odgesa ndJ uliHei dets ob ei dentifaise d
authorso ft hiwso rkha sb een assebrytt heedm ina ccordanwciet hth e Copyright,
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Firsedti tion 1999
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BritiLsihb rarCya taloguiinnPg u blicatDiaotna
A cataloguer ecorfdo trh ibso oki sav ailbale fromt heB ritiLsihb rary
LibraorfyC ongresCsa talogiinnPg u blication Data
A catalorge corfdo rt hiboso k isav ailafblreo tmh eL ibraorfy oCngress
Notice
Knowledeg andb esptr acticei nth isf ieladr ec onstancthlanyg ingA.s n ew
researacnhd e xperiebnrcoaed en ourk nowledgceh,a ngeisnp r actcie,t reatment
andd rug therapmya yb ecomen ecessaorrya ppropriRaetaed.e sra re advised to
chectk hmeo stc urreinJfotlrm at iopnr ovide(dio )np rocedurse featuroerd( ub)y
them anufactuorfee ra chpr oductt ob ea dministerteodv ,e rify ther ecommended
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tion[st.i st her esponsiboiflt ihtepy r actitiroenyleirn,go nt heiorw n experience
andk nowledgoeft hep atient, tom aked iagnosteosd ,et ermine dosageasn dt he
besttr eatmenfto re achi ndividpuaatli eanntd, t ot akael alp proprisaatfetye
precautiToont sh.e f ulleesxtt eonftt hel awn,e ithtehreP ublisnhoertrh e a uthor
110rt heM ACPa ssumaen yli abiltiy foarn yi njuarnyd /odra mage.
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v
Contents
Preface VII 6.T her oloef w eightbeaarnidnn go n­
Acknowledgements ix weightbeamruisncgl e9s3
CarolRyinc hardson
SECITON 1 Introduction
SECTIO3N Impairmeinntt h ej oint
--_ ......... _--=
protectmieocnh anismcso:n cepts 103
1.T het imet om ovef orwar3d
CarolRyinc hardson
7.T hed el oamdo deolf i njur1y0 5
CarolRyinc hardson
SECTIO2N Thej oinptr otection 8.J oinitn jur1y1 9
mechanisms 9 JuliHei des
9. Paimno dels1 29
PART1 Introduction 11 PauHlo dges
2.L umbopelvic sat faubnicltiitoymn:oa dle olf t he
biomechanaincdms o torc ontro1l3 SECTIO4N Impairmeinntt sh ej oint
PauHlo dges
protectmieocnh anisimnsl ow
backp ain 139
PART2 Specijfoiicn ptr otectoifot nh e
10.A bdominmaelc haniisnml owb ackp ain1 41
spinsaelg ments 29
PauHlo dges
3.A bdominmaelc haniasnmd s uppoorftt he
11.P araspimneaclh aniisnml owb ackp ain1 49
lumbasrp inaen dp elvi3s1
JulHiied es
PauHlo dges
12.I mpairmeinntm su sclceosn trolpleilnvgi c
4.P araspimneaclh aniasnmd s uppoorftt he
orientaatnidow ne ightbear1i6n3g
lumbasrp ine5 9
CarolRyinc hardson
JulHiied es
SECTI.O5N Treatmeanntd p revention
PART3 Thea ntigramvuistcyl seu pport
ofl owb ackp ain 173
system 75
5.S tiffnoefst sh el umbopelrveigci ofno r 13.P rinciopflt ehse' segmensttaalb ilization'
loatdr ansf7e7r exercimsoed el 175
CarolRyinc hardasnodJn u lHiied es Caronl RyichardJsuolniH,ei deasn dP auHlo dges
14.L ocasle gmentcaoln tro1l8 5
JulHiied eCsa,r olRyinc hardasnodnP auHlo dges
15.C losecdh aisne gmentcaoln tro2l2 1
CarolRyinc hardasnodJn u liHeid es
16.O penc haisne gmentcaoln traonld p rogression
intfou nctio2n3 3
Carolyn RichaanrdJd usloiHnei des
Referenc2e4s7
Index2 65
vii
Preface
Overt hep asdte cadaem ajofro cuosfr ehabilitatCiloinn ical studailessco o hnalvier mtehdep resence
hast urnedt oe xerctiosi em provteh es tabiolfitt hye ofm uscldey sfunctiinovnosl vintgh ed eepm uscle
lumbasrp inea ndp elviTsh.e raer ea v arieotfcy l in­ systeinm pelvipca ins yndromeOst.h edre velop­
icaaln dr esearocphi nioinn st hiasr eaan dm any mentinsc ludger eatuenrd erstandoiftn hgem ech­
methodhsa veb ecompeo pulairnb otht hec linicaaln ismfso rc ontraonld c oordinaotfit ohnis sy stem
arenaan df itneisnsd ustTrhyi.bs o okp rovidaens andt hee ffecotfus n loadianngd,p aina ndi njury.
overvioefwo uri nterpretoaftt hieof ni eblads eodn Ourr ecenrte searicnhv olvinmgi crogravity envi­
ourr esearacnhd c linical prWhaiclteit chee.f irstr onmenitssp roviditnhgeo pportuntiote yva luate
editiopnr ovideadn introdunc titoo our new thee ffecotfes x tremeen vironmetnhtasat r el ikely
modelosf e xerciasnedt hes tatoefkn owledgea t toh avea ni mpacotn functioennavli ronmeonnt s
thatitm e,t hisse conedd itiporno vidaen su pdated EarthAn. additionaarle at hati sc ontinuitnog
view thaintt egrattehesb urgeoningr esearinc thh is expanids in thea ssessmeonfmt u sclceo ntrino l
fiealndd t hec liniacdavla nces. lumbopelvpiaci nIn. thifise ldw e havem ade
Inr elatitootn h erapeuetxiecr ciins leo wb ack majoard vanciensn on-invasimveet hodtso a ssess
painw,e belietvhea tth ef ocuosf e xerciisnet er­thissy stem.
ventiobnys physiotheraapnids ottsh ehre alth Asr esearpchhy siotherainp tihseat rse oaf t hera­
professiosnhaoluslb de d esignteode stabltihseh peuteixce rcfiosrle o wb acpka iwne havec hosetno
optimuimn teracotfim ouns clense cessatrocy o n­ investigina tthee,f irinsstt ancet,h en europhysio­
troaln dp rotetchtej ointdsu,r intgh ep erformancel ogicmaelc hanismsin volvedin joinptr otection
ofa greavta rioeftyf u nctiobnoadlym ovements. ofth e lumbo-pelrveigci oann dth e dysfunctions
In ourf iresdti tiwoen f,o cusoendt hes ysteomf whichc ano ccuErv.e nt hougmhan y oft hei deas
deepm uscletsh aotu rr esearacnhd c liniecvail­ andh ypothesesp resentheadv en oty etu ndergone
dences uggesatr ev itainl c ontrooflt hel umbar rigorosucsi entisfcircu tinwye, f eetlh awte havea n
segmenttsh:em ultifitdruasn,s verasbudso minis,o bligatini ao tne xbto oko nt herapeuetixce rcitsoe
diaphragamnd t hep elvifcl oomru scleSso.h ow providdeet aiolfts h en eww ayst oa pproaechx er­
haso urr esearpcrho gresosevdet rh el as5t y ears? cisper escripatswi eolnal s p rovidihnygp othefsoers
Severkaely a spechtasv ep rogressFeodri. n stancew hy certaeinx ercitseec hniqtureasd itiounsaeldl y
longt ermf ollow-duapt an ow indicattehsa tth e byp hysiotheraarpeil sitkset loyb ev ereyf fective.
interventdieosncsr ibine thde firesdti tiloend t o Thust her esearfcinhd ingsp luasr guehdy pothe­
reductioofln o wb ackp ain recurrernactee Osu.r sesin thitse xhta veb eenu sedt og ivseo mei nsight
biomechansitcuadli heasv ec onfirmtehdei mport­inttoh erapeeuxteircc tiescehn iquwehsi cahr el ikye l
antc ontribuotfit ohned eepm uscle sytsotc eomn ­ tob ee ffectainvdea lstoo d evelonpo n-invasive
troolfn otj ustth el umbasrp in,be uta lstoh ep elvis.m easurewshi ch wilrle flectth ep roblemins the
viiiP REFACE
musculoskelseytsatle inm relatitoojn o inptr otec­usingt herapeuetxiecr ciassae p reventamteiavse­
tionTh.e principlperse sentceadnb ea ppliteoda ny urea ndt op romotae c hange inl iesftyle,n oto nly
regioonft heb ody. asa treatmenta fteprr oblemhsa veo ccurrTehdi.s
Oneo ft hem aina imso fo urp asats w ella so ur isa m ajrof ocufso rou ro ngoing work.
futurree searicsht od emonstratthea tt hep re­ We hopet hayto uf indr eadintgh es econedd ition
scribetdh erapeuetxiecr cisaerse r esultinign oft hitse xtbotohko ughptr ovokinagn de njoyable.
improvemeinn tt hej oinptr otectsiyosnt emasn,d We aree xcittehda tth ew orkc ontinuetso e volve
henced emonstratthea cth angesin thesem echa­ andg rowin new directiWoen hso.p et hatth ibso ok
nismasr ec loselliyn ketdot her esolutainodne ven wilble u seftuolc linicisatundse,n tansd researchers
preventoifop na infsuylm ptomsA.s a finanlo te, alikea,n d may stimulanteew ideawsh ichw ill
we alswoo uldl ikteoe mphasitzhee i mportanocfe ultimatheellytp h oswei th lumbopelpvaiicn .