Saturday, October 4, 2008


According to a review paper by Kyle Kiesel (PT, ATC ,CSCS) titled "Local Segmental Stabilization Theory and Low Back Pain (LBP) Considerations for Incorporating Ultrasound Imaging into Clinical Pracice" there is ample rationality behind incorporating US imaging biofeedback for core training exercises in LBP. Let us discus his paper in little more detail:
1. Ideal treatment for mechanical low back pain (LBP) is spinal stabilization. This spinal stabilization theory views the abdominal and lumbar musculature as a corset of sorts, that provides dynamic support to the lumbar spine. A local segmental theory of lumbar stabilization with its roots in motor control.
2. Failure of the abdominal and lumbar musculature to provide adequate support to the lumbar spine during movement and while under load is considered a contributing factor to the persistence of LBP and dysfunction. Lumbar multifidus atrophy has been shown to be a natural occurring side effect of acute LBP, and related to reoccurrence and chronicity.
3. Advocates of this approach (spinal stabilization) utilize global stabilization exercises to illicit general abdominal muscle contraction for spinal support. From this theory, many diverse clinical training techniques have developed.
4. These “global stabilization programs” challenge the supporting musculature through a variety of upper extremity and lower extremity movements while the subject attempts to maintain a neutral spine position. Variations of these programs are common physical therapy intervention for LBP management today.
But Popular global stabilization programs may not be specific enough to normalize local stabilization of the lumbar spine as they do not account for the local motor control component as said in point no.1.
1. Hence Kyle Kiesel suggested Clinical use of real-time ultrasound imaging as biofeedback with specific segmental stabilization exercise intervention.
2. The author also has shown US imaging biofeedback to be effective in reversing the atrophy and loss of motor control associated with mechanical LBP over a 4-week intervention period.
2. Imaging may also be useful for documentation purposes to measure the amount of multifidus atrophy present as a percentage loss compared to the contralateral side.

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