SPINAL STABILISATION

Figure 5a

Figure 5b

Figure 5c

than production of large levels of axial torque, as indicated by a large degree of muscle coactivity (17). Of particular interest is the contribution of the thoracic extensors to axial torque and direction of twist, despite having no mechanical potential to generate axial torque. This may suggest a stabilisation role for these muscles dur- ing twisting, with the dynamic contributions being made by the external oblique and latissimus dorsi.

Modified back extension With this in mind, the modified back extension exercise aims to enhance correct muscle coactivation patterns for stability during twisting rather than actual twisting itself. Once this is achieved, the patient may progress to larger ranges of rotation. Considering the large number of twisting movements performed in everyday activi- ties, this exercise has been suitably modified in favour of endurance.

Modified back extension

The patient begins in a prone position (neutral spine) over a sta- bility ball, with the knees slightly bent, and the apex of the ball placed under the mid ribcage (Fig.4a). A weight is held in the right hand, and the abdominal wall is braced. From this position, the spine is allowed to flex and twist slightly to the left, keeping the head in good alignment (Fig.4b). This is followed by an extension combined with a slight twist back to neutral (Fig.4c). The aim is to activate the right thoracic extensors as much as possible, simulta- neously with the external oblique and latissimus dorsi to produce a slight twist. The exer- cise is performed for two minutes before swapping sides, and can be progressed by moving the ball progressively towards the pelvis.

Figure 4a Figure 4b Figure 4c www.sportex.net

Spinal stability and work rate Performance athletes and workers who regularly experience high physiological work rates, will often need to maintain spinal stability during elevated ventila- tion. Such individuals may bene- fit from stabilisation training that is performed when out of breath, consequently challenging muscu- lar endurance further. Any of the above exercises can be modified to accommodate increased venti- lation by simply getting the indi- vidual to perform two minutes of cardiovascular exercise, at an

Figure 5d

Figure 5e

intensity that will increase breathing rate, immediately prior to per- forming the exercise. As the individual attempts to maintain co-con- traction of the back extensors and abdominal wall, increased ventila- tion demands will serve to simultaneously coordinate diaphragm and other thoracic muscle contractions involved in breathing.

Performance progressions When consistent levels of torso muscle coactivation have been achieved, resulting in enhanced spinal stability, further progression may be warranted for the purpose of improving work or sports per- formance. Although significant improvements in spinal stability can be achieved with the above exercises alone (and their variations), the increased ranges of motion found in work and sporting envi- ronments, combined with additional load-bearing, often demands a more functional approach to training using additional equipment. Many performance-based activities take place in standing positions, involving multiplanar complex movements, often requiring increased endurance of the torso muscles in order to stabilise the spine. For this adaptation to occur, exercises can be performed that simulate performance movement patterns in a number of planes of motion, using additional resistance where necessary. Figures 5a to 5e provide examples of how these objectives can be met safely and effectively. More details of these exercises can be found in the interactive section of this article online. ■ Medicine ball wood chop ■ Front raise with exercise band ■ Side lunge ■ Vertical oscillations with Body Blade ■ Single arm push

CONCLUSION The unique anatomical features of the back extensor and abdomi- nal muscles, as well as the functional demands placed on them, suggest two important considerations in the context of stabilisation training: (a) that endurance-based training may be preferable over traditional strength training, and (b) that exercise should integrate movement patterns that simultaneously challenge the back exten- sors and the abdominals. Both of these objectives can be achieved with low levels of lumbar compression, using a variety of therapeu- tic exercises.

THE AUTHORS Kesh Patel is a corrective exercise and movement specialist and lec- turer in clinical sports therapy. He runs a private clinic in Surrey, spe- cialising in developing optimal movement strategies for rehabilitation and performance. Kesh is course director for Origin Health Training, which runs a series of CPD courses for trainers and therapists. For more information, e-mail Kesh via kesh@origin-health.co.uk or tele-

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