julie sherry rehabilitation of spondylolysis2-1.pdf
TRANSCRIPT
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Rehabilitation of Spondylolysis (what to expect)
Julie Sherry, PT, MSUW Health Spine [email protected]
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PT Interventions
•
Core Stabilization•
Glute
Strengthening
•
Joint Mobilization•
Flexibility
•
Body Mechanics•
Return to Sport Progression
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Treatment: Core Stabilization
•
activation of deep abdominal muscles
–
transverse abdominus
& internal oblique–
“draw-in”
•
with co-activation of lumbar multifidi
–
“swell back muscles”
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Why Abdominal Stabilization?-Delay in transverse abdominal contraction
in patients with LBP*
-Lumbar multifidus
atrophy correlated to the same side and vertebral level of symptomatic LBP**
*Hodges and Richardson. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus
abdominis. Spine 1(22): 2640-50. 1996.
** Hides etal. Evidence of lumbar multifidus
muscle wasting ipsilateral to symptoms in patients with acute/subacute
low back pain. Spine
19(2):165-72. 1994.
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Phases of Core Stabilization
Phase 1:
Core Initiation: supine, 4-point drawing-in
Phase 2:
Static Stabilization: 4-point, ½ kneel, standing drawing-in with arm/leg motion
Phase 3:
Dynamic Stabilization:
allow trunk motion to occur with dynamic control
Phase 4:
Reactive Core Control: dynamic control during specific drills & various environmental challenges
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Core Initiation
Transverse Abdominus: “drawing-in”
Lumbar Multifidus: “swell back muscles”
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NWB Static Stabilization
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Standing Static Stabilization
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Swiss Ball Dynamic Stabilization
rotation from above rotation from below
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Medicine Ball Dynamic
Stabilization
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Treatment: Strengthening
•
Core “Strengthening”: External oblique•
Gluteus Maximus: pelvic stability in sagittal
plane•
Gluteus Medius: pelvic stability in fromtal
plane•
Oblique Abdominals
•
Erector Spinae
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Glute
& External Oblique Strength
Squat with hip hinge Backward lunge with twist
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Glute Strength
Sidestep with band at knees → ankles→ forefoot
in squat position (weight on heels) in bow position (weight on heels)
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Treatment: Joint Mobilization
if necessary: “steal” joint ROM from elsewhere….
•
Mobilization of Hips•
Manipulation of Thoracic spine
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Hip
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Thoracic Spine
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Treatment: Flexibility
•
Hip Flexors: Psoas and Quads
•
Latissimus
Dorsi (overhead athlete)
•
Hamstrings: tight from growth spurt or muscle spasming
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Treatment: Flexibility
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Treatment: Body Mechanics•
Body Mechanics–
Sleep: avoid sleeping prone (suggest body pillow to break the habit)
–
School: unload backpack to10% BW (suggest double copy of textbooks for home and school, rolling bag); use both straps
–
Footwear: avoid flip flops, tie shoes, consider arch supports to improve LE alignment
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Treatment: Return to Sport Progression
•
NWB to WB postures
•
Static to Dynamic Stabilization
•
Sport-Specific planes of movement, speeds, loads, dosing impact
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ReferencesHodges and Richardson. Inefficient muscular stabilization of the
lumbar spine associated with low back pain. A motor control evaluation of transversus
abdominis. Spine. 1996:1(22): 2640-50.
Hides etal. Evidence of lumbar multifidus
muscle wasting ipsilateral to symptoms in patients with acute/subacute
low back pain. Spine. 1994:19(2):165-72.
O'Sullivan PB, Phyty
GD, Twomey
LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic
diagnosis of spondylolysis
or spondylolisthesis.Spine. 1997: Dec 15;22(24):2959-67.
Klein G, Mehlman
CT, and M McCarty. Nonoperative
treatment of spondylolysis
and grade 1 spondylolisthesis
in children and young adults. A meta-analaysis. J Pediatr
orthop. 2009: 29: 146-156.