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Basic spinal anatomy, 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 therapeutic exercise and mobilization/manipulation 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 for spinal impairments. Each of the remaining five sections describes components of exercise interventions for the neck and trunk. The topics covered include exercises for kinesthetic awareness, mobility/flexibility (including manipulation), 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 activity 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.

BOX 16.1 Fundamental Exercise Interventions for Spinal Rehabilitation

These fundamental interventions are adapted or modified based on patient abilities and responses.

Kinesthetic Training
  • Awareness and control of safe spinal motion: head nodding and pelvic tilts

  • Awareness of neutral spinal position (if needed begin in the patient's spinal bias) while supine, prone, sitting, and standing

  • Awareness of effects of activities of daily living and extremity motion on the spine (see Functional Training)

Stabilization Training
  • Deep segmental muscle activation and sustained contraction

    • Cervical region: controlled axial extension (cervical retraction) with craniocervical flexion and lower cervical/upper thoracic extension

    • Lumbar region: drawing-in maneuver and multifidus muscle activation techniques

  • Superficial multi-segmental (global) muscle control of spinal posture with extremity loading

  • Passive support of spinal posture only if needed; progress to active control

  • Coordinate segmental muscle activation with maintenance of a stable spine in neutral spinal position (or position of bias) with all arm ...

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