The development of research on stabilization exercises to relieve back pain caused the "strengthening" of the transverse come to the gyms, and sponsors beauty and aesthetics. In some gyms advertised by asking:
"swollen abdomen? The solution is to "transverse abdominals" ... Yeah!
"All pregnant, undergoing inguinal and obese in the world have back pain? Provided that the transverse "not working well there back pain? Some argue that the cross is nothing more important than other trunk muscles to stabilize the trunk. There is no single, universal exercise to control body which serves to the specific needs of all activities. Trunk control will depend on the activity undertaken and how prepared you are that person for that activity.
Here are some ideas holding "the myth of the core estability"
Do better exercises core stabilizers than other trunk exercises?
Here , a Cochrane review concluded that the motor control exercises are more effective than general exercises to reduce pain.
instability and hypermobility are different concepts. There may be an excess of movement (hypermobility) without compromising stability (Good control) of a segment. And there may be no excess movement and if a bad motor control, which determines the loss of the neutral zone.
lack or excess of motion is not a finding in itself. Excessive movement associated with pain is what determines the status of clinical instability (Kirkaldi-Willis), although hypermobility is not a prerequisite.
Panjabi established the concept of neutral zone. Poor motor control may involve the loss of the neutral zone and the inability of the musculaura to stabilize the area. Panjabi also CLASFICADO stabilizer system of the spine in active, passive, and neural.
Following the classification of Steady Panjabi, lumbar instability may result from a loss of system:
- Liabilities: When there is an alteration in the anatomy osteoligamentous (trauma, degenerative process , etc)
- Active: alteration of the muscles due to lack of extensibility (relative stiffness) or weakness
- Neural : loss of motor control (poor recruitment, or alteration timming in the sequence of recruitment).
No doubt the ligamentous support and the very morphology of the vertebra of the passive stabilizing system determines the mobility of the spine, but the loads on the passive system would not be possible without the muscles.
" We are only stable because we" Paul Hodges
osteoligamentous The passive stabilizing system can only support up to 80-90 N. During ADL endure forces to 6000 N and 18000 N in sports. Muscles are those that guarantee the stability of the lumbar spine. The exercise of the superman is compression forces on the lumbar spine of 6000N (McGill)
The natural history of instability by a degenerative process tends to drive its decision on the re-stabilization phase. This process can take up to 10 years, but after this period there will be no pain. Therefore, the spinal fixation with osteosynthesis degenerative processes is disliked is because it tends to resolve spontaneously, but during that time what to do? To a pattern of disc degeneration, is it better mobilize or stabilize? As the study concludes, for now, that stabilizing exercises better results, and as shown by a button.
Today there is great difficulty in identifying the lumbar instability and the profile of patients who could benefit from the exercise of stabilization. In fact there is difficulty to unify criteria for the definition, symptoms, diagnosis and treatment.
The patient "unstable" may refer to the feeling of being "party in two. " Bilateral pain; although sometimes unilateral. Small rapid movements cause pain, such as walking or standing. However, if you walk quickly reduce the pain because there is more muscle recruitment. Segment can be seen more extension or flexion than the rest. Typical of women over 40 years are overweight or gymnasts. In some areas they are called "downers" because they tend to find the rest. The pain is relieved at rest and in supine position and increases throughout the day (Eisenstein).
Sahrmann, however, describes a patient with spinal instability with pain in postural changes, but can not hold a position for a period of time and frequency surgical tends to move to achieve remission of symptoms. Often the triggers more sitting than standing symptoms ... ("" Anti-downers "?)
There is some difficulty in identifying the patient with instability. Numerous tests have been proposed and some of them even tried to be validated. These are a few:
Test extensor strength in prone.
normative values \u200b\u200bfor this test are estimated at an average of 173 seconds. McGill (2004).
Test of resistance of the trunk flexors.
Holding the position of the trunk at 60 degrees. Normative values \u200b\u200bare 34 seconds.
Test prone bridge
If the subject is unable to maintain position, it adds support to the his weight on his knees. normative values \u200b\u200babout 60 seconds.
Test side bridge
This exercise involves a significant activity for oblique and very little for the psoas as EMG studies (Juker 1998). It allows for support on the knees. Normative values \u200b\u200bestimated in 86 seconds to the left and 83 seconds to the right.
Bird-dog test
is valued the ability to maintain elevated position opposite arm and leg. There are no normative data for this test.
lumbo-pelvic rhythm
Prone hip extension. If activated initially lumbar and buttocks after it is submitted that the subject is altered when lumbo-pelvic (Liebenson, 1999. Adapted from Sahrmann). This should be considered a sign rather than a diagnostic test.
Test passive accessory intervertebral motion (PAIVM's of Maitland) or testing for Lumbar segmental mobility (Test of lumbar segmental mobility).
Manual pressure posteroanterior and try to feel too much segmental mobility.
sensitivity: 29%
specificity: 89%
passive intervertebral bending test
sensitivity: 5%
specificity 99.5 %
prone instability test or PIT (Prone Instability Test)
The test is positive if pain occurs with pressure and decreases your feet off the ground. It is thought that this indicates a temporary pain relief through the spine stability and is a good indication Predictive negative ITP patients would not benefit from a stabilization exercise program.
profit forecast stabilization work (if 3 of the 4 following are present):
\u0026lt;40 years
SLR> 91 º
this aberrant movement
PIT (+)
We can not conclude that any movement dysfunction is due either by a problem of relative stiffness or by a problem of stabilizing local, global or mobilizers. Pain upon movement will result in movement dysfunction and that is the definition of mechanical pain, not instability.
prone The test is not completely reliable to diagnose instability. Used to immobilize the segment concluded that reduces pain, not that it is unstable. If it hurts when you move, if we can move less it hurts less.
same applies to the dressing esabilización McConnell for a lumbar segment. This dressing is designed to download the tissue and reduce pain, and if that involves some restraint in that segment, one can only conclude that this segment hurts when it moves not volatile. Furthermore, it is still unclear exactly what action has the tape of McConnell.
stabilizers Work have demonstrated effectiveness in reducing pain, but I think that not all patients improve with exercise they should be included in the group of instabilities.
posterior lumbar extension test or test PLE (Posterior Lumbar Extension)
sensitivity: 84, 2%
specificity: 90.4%
positive predictive value: 8.84
The PLE test showed be the most reliable in a 2006 study of 122 subjects examined.
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