Chapter 16: The Spine: Exercise and Manipulation Interventions

Introduction

The basic anatomy, spinal mechanics, and posture are presented in Chapter 14. In Chapter 15, the pathomechanics, common pathologies, and management guidelines related to the spine are presented. The management guidelines are outlined based on stages of healing as well as subgroupings based on diagnostic categories that reflect impairments and movement disorders. Chapter 16 is a continuation of this material in which the techniques of intervention using mobilization/manipulation and therapeutic exercise for management of neck and trunk impairments are described.

This chapter is divided into six main sections. The first section describes the underlying concepts and approaches to exercise interventions. Each of the remaining five sections describes elements of physical function for the neck and trunk. The topics covered in these sections include exercises for kinesthetic awareness, mobility/flexibility, muscle performance (including stability, muscle endurance, and strength), cardiopulmonary endurance, and functional activities. Stress relief and relaxation principles and techniques, important components of total rehabilitation, are covered in detail in Chapter 14.

Basic Concepts of Spinal Management with Exercise

It is important to recognize that, even though the material in this chapter is presented in separate sections, there is an overlap in the use of the techniques described in each section, and there are fundamental interventions basic to all exercise programs.

Fundamental Interventions

When patients seek treatment from a physical therapist, they come with different diagnoses, impairments, and functional limitations and are at different stages of tissue healing. Yet the treatment plan for each patient must begin with fundamental interventions in order to lay the foundation on which to build an effective therapeutic exercise program. Fundamental interventions are defined as exercises or skills that all patients with spinal impairments should learn regardless of their functional level at the time of examination and initial treatment. The interventions include basic kinesthetic training, basic spinal stabilization training, and functional training of basic body mechanics. These interventions are summarized in Box 16.1.