Top 3 exercises for Lumbar
Spondylosis, Spinal stenosis and Spondylolisthesis
By Chris Gellert, PT, MMusc &
Sportsphysio, MPT, CSCS, C-IASTM
Pinnacle Training & Consulting Systems
Background
There are a multitude of exercises
available at the fingertips of a fitness professional. Choosing
the most accurate and objective exercise should be the cornerstone of any
fitness
programming. Working with any client who has a spinal injury, should involve a
thorough
history, fitness assessment and most importantly, a sound understanding of the
pathophysiology
and programming of that movement dysfunction. In this article, we will review
and clarify
the differences between spinal conditions that include spondylosis, spinal
stenosis and
spondylolisthesis discussing the pathophysiology, common rehabilitation and
post
rehabilitation training.
Clarifying
the differences
Spondylosis
is the degeneration of one joint on another also known as degenerative
disc
disease(DJD). Patient will typically presents with tightness in the lower
lumbar and may or may
not present with radicular symptoms in their legs. Physical therapy addresses
these impairments
by conducting a comprehensive examination, using manual therapy, and targeted
exercises.
Spinal stenosis is a
narrowing within the vertebral canal
coupled
with hypertrophy of the spinal lamina and
ligamentum flavum or facets as the result of age-related
degenerative process. The patient who has spinal stenosis
usually has very tight hamstrings and
lumbar extensors.
They often will complain of unilateral vs. bilateral numbness in their legs due
either having central lateral(to side) foraminal stenosis.
Physical therapy addresses these areas
with myofascial
release, stretching, and joint mobilizations to address
mobility then teach flexion
based exercises, which will
improve the opening of the spinal lamina.
Figure 1. Spinal stenosis
Spondylolistehsis is an anterior (forward) slippage or
posterior (back) slippage of one vertebrae on another following bilateral
fracture of the pars interarticularis. The slippage is graded from 1-4 (25% to
100%) from an x-ray. In degenerative spondylolisthesis, as the intervertebral
disc loses height, the annulus may bulge circumferentially and the ligamentum
flavum can buckle. These types of injuries are seen in wrestlers, due to the
combined extension and rotation movements seen in the sport as well as in older
patients due to their lifestyle. Physical therapy/training emphasis is on elimination of extension-based
exercise (back extension, press ups, etc.). Biomechanically, this will force
the vertebra forward causing more translation and instability. Training emphasis is on flexion-based exercises (strengthening of
abdominals). Flexion based exercises will decrease shearing force and
translation on the effected segment. Postural education is key, static and
dynamic core strengthening should also be included. Core strengthening using medicine balls, cables and physioballs shoulder
be personalized to the client.
Recommendations
All of the spinal
conditions discussed previously are unique, requiring a thorough understanding,
while designing a program that is personalized for the client. With respect to
spondylosis, the three top exercises for this client are abdominal bracing with
alternate leg lift, bridging with physioball and prone alternate leg lift/arm
lift over physioball. All three exercises target the multifidus and transverse
abdominis. Two essential muscles of the core.
Figure 2. Abdominal bracing with alternate leg lift Figure 3. Prone alternate arm and leg lift
With respect to both spinal
stenosis and spondylolisthesis, the focus is on flexion exercises.
My top three for both
include reverse abdominal crunch, dead bug and prone alternate leg and arm lift
over physioball, stopping at neutral(as seen in figure 3).
Figure 4. Reverse crunch
Figure 5. Dead bug
Summary
Lumbar Spondylosis,
Spinal stenosis and Spondylolisthesis are three common spinal conditions
affecting most adults today. Understanding the pathophysiology, mechanism of
injury, common physical therapy treatments and a few targeted exercises, should
help you, the fitness professional while designing a program for your client.
If you should have any questions, please feel free to contact PTCS at ptcg1999@verizon.net or www.pinnacle-tcs.com
