Sue DuPont – Advances in Treating Spinal Instability: The Kinetic Chain Impact

Outline

INTRODUCTION

BACK PAIN: WHY IT’S A PROBLEM

• Biotensegrity: The Anti-Gravity Model
• Role of the “Core” stiffness or movement?
• Myofascial connections and their role in stabilization and function

LAB #1 — MYOFASCIAL MOBILIZATIONS

BACK PAIN: ARE WE CHASING THE PAIN?

• Structural vs. functional pathology
• Effects of sustained postures and forces
• Effects of chronic pain and dysfunction on movement

WHAT IS SPINAL INSTABILITY?

• Ambiguity of term spinal instability
• Disconnect between medical diagnosis and clinical signs and symptoms
• Historical perspective of spinal instability
• Muscle dysfunction and lumbar spinal instability
• Functional vs. pathological muscle imbalances
• Rehab goal for muscle imbalances

KINETIC CHAIN REHAB FOR FUNCTIONAL MOVEMENT

• Kinetic chain rehab principles
• Functional coupling between muscles and fascia
• Components for optimal functional movement
• Myofascial slings and common dysfunctions
• Biomechanical link between lower kinetic chain and spinal instability

IS SPINAL INSTABILITY JUST ABOUT STIFFNESS?

• Static vs. dynamic spinal instability
• Synergist, agonist, and antagonist effects of muscles and force vectors

WHERE ARE WE NOW?

• Motor control vs. general exercise
• Clinical prediction rules for back pain
• Influence of posture and body type
• Muscle sling dysfunctions – “Gluteal Amnesia,” Quadratus Lumborum Syndrome, etc.
• Importance of dynamic functional movement analysis

LAB #2 – POSTURE, ROM, & MUSCLE LENGTH

SPINAL INSTABILITY: CLINICAL PRESENTATION & OBSERVATIONS

• Patient case studies
• Finding myofascial imbalances and compensatory patterns
• Best clinical tests for spinal instability
• Clinical “pearls” for determining weak quadrant

LAB #3 — DYNAMIC FUNCTIONAL MOVEMENT OBSERVATIONS & CLINICAL ANALYSIS

CORRECTIVE EXERCISE PROGRESSIONS FOR SPINAL INSTABILITY

• Motor control of local stabilizers
• Adding tri-planar stabilization
• Turning on the gluteal muscles
• Progression of Spinal Stabilization Exercises
  • EMG evidence-guided progressions
  • Adding equipment and unlevel surfaces
  • 5 functional tasks to ALWAYS include

LAB #4 — PRACTICE CORRECTIVE EXERCISE PROGRESSIONS LIVE CASE STUDY

• Identify and develop a treatment plan
• Myofascial sling dysfunction and spinal instability

RESOLUTION