Lumbo-Pelvic Translation Control

Lumbo-Pelvic Translation Control

Neuromuscular Retraining for the Local Core Cylinder for Lumbo-Pelvic Joint Translation Control

Course Description

There are good diagnostic accuracy studies to sub-classify articular translation control deficits in the lumbo-pelvic region. Not everyone needs these exercises, but when there is a translation control deficit, segmental stabilization can be beneficial.  The muscles that control segmental translation, multifidus, transversus abdominis, posterior fascicles of psoas major, diaphragm and pelvic floor muscles have been shown in extensive research literature to exhibit altered motor control and delayed activation timing.  This causes failure to control segmental translation in patients with chronic low back pain.  These clients also lose awareness of their lumbopelvic positioning and of how they are moving.

It can be the uncontrolled segmental translation and movements in the lumbar spine or pelvis that continue to provoke the patient’s pathology or sensitise overloaded tissues.  Retraining proprioceptive awareness of the lumbo-pelvic neutral position and activation of the appropriate local muscles to control segmental translation will be the focus.  Strategies to rehabilitate and integrate the whole lumbar cylinder along with breathing and the pelvic floor will be covered.

We will provide participants with easy to use clinical prediction rules to know when to use exercise strategies.

Specific exercises (and not general) can correct the deficit, control translation and change clinically meaningful outcomes.

Five reviews support the use of specific segmental stabilizing exercises and a recent review supports the use of specific segmental exercises exercise for articular dysfunction in low back pain.

key words: clinical prediction rules; diagnostic sub-classification; Translation control deficits; clinical problem solving; sub-classification; transversus abdominis

Course objectives

The participant will be able to:

  • Apply a clinical prediction rule to know who will need and respond to specific motor control stability exercises
  • Understand the different mechanisms behind translation control deficits including
    • lack of proprioception
    • pain inhibition
    • fatigue
    • restrictions
  • Identify suitable starting points and appropriate progressions of stability exercises
  • Integrate the treatment of stability training with other techniques into clinical practice
  • Appreciate the importance of concurrent respiratory control in the rehab of local muscle function.
  • Show an understanding of the progression of translation control into movement and function using
    • Kinetic chain sequencing and
    • The Functional Performance Evaluation
  • Understand the evidence from randomized controlled trials to support the use of specific motor control stability exercises.

What will you get from this course that you may not already have?

Clinical Prediction Rule for who will respond to specific motor control exercise
We can tell you who these exercises are most appropriate for and who are not.

Diagnostic Accuracy of the Lumbar Spine & SIJ
We’ll review the best tests for you to use clinically

Psoas Major as a Stabilizer
Psoas major barely flexes the hip! – it’s main function is to stabilize the lumbar spine, SIJ and hip. Research shows that it has segmental atrophy similar to multifidus and needs specific rehab.  We can also use psoas major for pelvic floor rehab!

Gluteus maximus is a multitasking muscle!
It has three functional subdivisions. The Deep Sacral Gluteus Maximus only crosses the sacroiliac joint and is ideally suited for SIJ stability.  Why don’t some people progress with glut max training and what can we do about it?

Transversus Abdominis Asymmetry
We’ll show you how to test for and rehabilitate asymmetry

Breathing
Do you know what normal breathing is?  Do you know how to retrain it? The diaphragm is a muscle and changes with posture and pain and can affect all aspects of our function.  Breathing is an essential part of rehabilitation and needs to be addressed.

Pelvic Floor Muscles
The training of the pelvic floor is influenced by tone changes in certain primitive reflexes. We’ll show you how to assess and train this. As well, we’ll give you some top tips for training the pelvic floor.

Primitive Reflexes
Primitive reflexes can influence the ability of people to perform these exercises.  We will show you how to identify some of these and give you options of how to deal with them.

Core Cylinder
The translation control mechanism of lumbo-pelvic stability partially depends on integration of the whole cylinder. We’ll show you how to assess and rehabilitate this.

Core Stability Explained
There are many interpretations of core stability.  Some people do better with strengthening and some do better with gentle and specific exercises.  We will explain all the interpretations and show you how it all fits into rehabilitation.

Program & Pre-course Reading

Suggested pre-course reading

Revision of the Sub-classification, Clinical Reasoning or Key Concepts course (whichever version of the pre-requisite you have taken)

Gibbons SGT, Comerford M J 2001 Strength versus stability Part I; Concepts and terms. Orthopaedic Division Review, March/April: 21-7 (see www.smarterehab.com/resources/publications)

Gibbons SGT, Comerford M J 2001 Strength versus stability Part II; Limitations and benefits.  Orthopaedic Division Review. March/April:28-33 (see www.smarterehab.com/resources/publications)

Free articles available at:  http://www.ncbi.nlm.nih.gov/sites/gquery
http://pubmedcentralcanada.ca/

Regional differences in lumbar spinal posture and the influence of low back pain
Tim Mitchell, Peter B O'Sullivan, Angus F Burnett, Leon Straker, and Anne Smith
BMC Musculoskelet Disord. 2008; 9: 152. Published online 2008 November 18. doi: 10.1186/1471-2474-9-152. PMCID: PMC2605454

Biomechanical Analysis of Reducing Sacroiliac Joint Shear Load by Optimization of Pelvic Muscle and Ligament Forces J. J. M. Pel, C. W. Spoor, A. L. Pool-Goudzwaard, G. A. Hoek van Dijke, and C. J. Snijders Ann Biomed Eng. 2008 March; 36(3): 415–424. Published online 2008 January 18. doi: 10.1007/s10439-007-9385-8. PMCID: PMC2239251

An investigation of the reproducibility of ultrasound measures of abdominal muscle activation in patients with chronic non-specific low back pain
Leonardo Oliveira Pena Costa, Chris G. Maher, Jane Latimer, Paul W. Hodges, and Debra Shirley Eur Spine J. 2009 July; 18(7): 1059–1065. Published online 2009 May 5. doi: 10.1007/s00586-009-1018-5. PMCID: PMC2899591

Altered breathing patterns during lumbopelvic motor control tests in chronic low back pain: a case–control study Nathalie Roussel, Jo Nijs, Steven Truijen, Liesbet Vervecken, Sarah Mottram, and Gaëtane Stassijns Eur Spine J. 2009 July; 18(7): 1066–1073. Published online 2009 May 10. doi: 10.1007/s00586-009-1020-y. PMCID: PMC2899579

Muscle thickness changes during abdominal hollowing: an assessment of between-day measurement error in controls and patients with chronic low back pain. Anne F. Mannion, Natascha Pulkovski, Deborah Gubler, Mark Gorelick, David O’Riordan, Thanasis Loupas, Peter Schenk, Hans Gerber, and Haiko Sprott. Eur Spine J. 2008 April; 17(4): 494–501. Published online 2008 January 15. doi: 10.1007/s00586-008-0589-x. PMCID: PMC2295268

Contraction of the human diaphragm during rapid postural adjustments. P W Hodges, J E Butler, D K McKenzie, and S C Gandevia. J Physiol. 1997 December 1; 505(Pt 2): 539–548.  PMCID: PMC1160083

Postural activity of the diaphragm is reduced in humans when respiratory demand increases
Paul W Hodges, Inger Heijnen, and Simon C Gandevia. J Physiol. 2001 December 15; 537(Pt 3): 999–1008. doi: 10.1111/j.1469-7793.2001.00999.x. PMCID: PMC2278995

Pelvic floor muscle training and adjunctive therapies for the treatment of stress urinary incontinence in women: a systematic review. Patricia B Neumann, Karen A Grimmer, and Yamini Deenadayalan. BMC Womens Health. 2006; 6: 11. Published online 2006 June 28. doi: 10.1186/1472-6874-6-11. PMCID: PMC1586224

The Functional Anatomy of the Female Pelvic Floor and Stress Continence Control System
James A. Ashton-Miller, Denise Howard, and John O. L. DeLancey. Scand J Urol Nephrol Suppl. Author manuscript; available in PMC 2005 August 26. PMCID: PMC1192576

Passive Mechanical Properties of the Lumbar Multifidus Muscle Support its Role as a Stabilizer
Samuel R. Ward, Akihito Tomiya, Gilad J. Regev, Bryan E. Thacker, Robert C. Benzl, Choll W. Kim, and Richard L. Lieber. J Biomech. Author manuscript; available in PMC 2010 July 22.
PMCID: PMC2752430

Differentiation between deep and superficial fibers of the lumbar multifidus by magnetic resonance imaging. Nele Dickx, Barbara Cagnie, Erik Achten, Pieter Vandemaele, Thierry Parlevliet, and Lieven Danneels.  Eur Spine J. 2010 January; 19(1): 122–128. Published online 2009 September 24. doi: 10.1007/s00586-009-1171-x.. PMCID: PMC2899729

Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain?
Per Kjaer, Tom Bendix, Joan Solgaard Sorensen, Lars Korsholm, and Charlotte Leboeuf-Yde
BMC Med. 2007; 5: 2. Published online 2007 January 25. doi: 10.1186/1741-7015-5-2.
PMCID: PMC1796893

Australian Journal of Physiotherapy     http://physiotherapy.asn.au/

Ferreira PH, Ferreira ML, Maher CG, Herbert RD Refshauge K 2006 Specific stabilization exercise for spinal and pelvic pain: A systematic review. Australian Journal of Physiotherapy 52: 79-88

 

Program
Day 1
8:30 – 9:00 Overview of motor system changes with chronic pain & Sub-classification
9:00 – 9:30 Fundamentals of motor control exercise
9:30 – 10:00 Clinical prediction rule for specific motor control exercise
10:00 – 10:30 Diagnostic accuracy of clinical tests for translation control
10:30 – 10:45 Break
10:45 – 12:00 Lumbo-sacral neutral
12:00 – 1:00 Lunch
1:00 – 2:30 Transversus abdominis rehabilitation
2:30 – 3:00 Transversus abdominis asymmetry rehabilitation
3:00 – 3:15 Break
3:15 – 4:30 Lumbar multifidus rehabilitation
Day 2
8:30 – 10:00 Psoas major rehabilitation
10:00 – 10:15 Break
10:15 – 12:00 Pelvic floor rehabilitation
12:00 – 1:00 Lunch
1:00 – 2:30 Breathing retraining
2:30 – 3:00 Local core cylinder integration
3:00 – 3:15 Break
3:15 – 4:00 Progression into function
4:00 – 4:30 Clinical integration, Summary

 


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