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Therapeutic Exercise Strategies for Disorders of the Spine

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CHAPTER OBJECTIVES

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Chapter Objectives

At the conclusion of this chapter, the reader will be able to:

  • Discuss the primary indications for the use of therapeutic exercise (TE) in the management of spinal disorders and how such interventions may be integrated with orthopaedic manual physical therapy into a comprehensive physical therapy regimen.

  • Be aware of the current best evidence related to the use of TE in treating disorders of the spine.

  • Discuss concepts related to classification and differential diagnosis, including primary reasons for classification, types of classification systems, and common systems for classification in the management of low back pain and neck pain.

  • Identify the theoretical underpinnings, principles of examination/classification, and principles of intervention for three common approaches to exercise for the management of spinal disorders.

  • Understand the myriad of ways in which spinal movement aberrations may be present and subsequently managed.

  • Analyze exercise approaches based on the results of testing repeated end-range spinal movements, intervertebral motion testing, muscle balance testing, muscle function testing, and evaluation of kinesthesia.

  • Apply appropriate exercise recommendations to decrease symptoms and improve spinal mobility and stability.

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INTRODUCTION

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Therapeutic exercise (TE) is routinely considered to be among the myriad of interventions deemed to be effective for the remediation of spinal dysfunction. The use of exercise to relieve symptoms, improve range of motion and muscle function, and enhance the effects of other interventions is considered to be a primary feature in the standard of care for the management of spinal dysfunction within physical therapy. Exercise is routinely used as an adjunct to prepare, support, correct, prevent, and maintain the effects before, during, or after the utilization of orthopaedic manual physical therapy (OMPT) (Fig. 17–1).

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FIGURE 17–1

Primary indications for therapeutic exercise in patients with mechanical disorders of the spine.

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CLINICAL PILLAR

When developing a comprehensive intervention plan for individuals with spine-related disorders, therapeutic exercise may be used to

  • Prepare

  • Support

  • Correct

  • Prevent

  • Maintain

the effects before, during, or after OMPT.

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Few studies have attempted to identify patient characteristics that warrant a specific exercise approach. A systematic review by the Philadelphia Panel1 suggests that there is "good evidence to include stretching, strengthening, and mobility exercises" in intervention programs directed toward the management of chronic low back pain (LBP).1 While these findings are similar to other meta-analyses investigating the management of chronic LBP,2,3 the information provided in these reviews offer little guidance regarding the efficacy of specific therapeutic exercise approaches.

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This chapter will introduce three TE approaches that are commonly used in the management of spinal disorders, with an emphasis on clinical decision-making. The theoretical underpinnings, principles of examination and classification, and principles of intervention for each approach will be provided in light of ...

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