Dynamic Lumbar Stabilization Program Assists Patients
in Reduction of Lumbar Pain and Further Reinjury

By Theresa Barry-Greb, M.S.P.T.

Conservative management of low back pain includes the use of exercises in reducing pain and restoring flexibility and muscle strength after the onset of low back pain. Little has been published in the literature to indicate which exercises are the most effective for a specific lumbar diagnosis. The types of exercises available for the lumbar spine include 1) Williams Flexion exercises that stretch the lumbar muscles, 2) McKenzie Extension exercises that emphasize lumbar lordosis to reduce bulging of the lumbar disc posteriorly onto the nerve root, and 3) Dynamic Lumbar Stabilization1 exercises that stress dynamic stability of the lumbar spine to maintain neutral spine position during static and dynamic activities.

The Dynamic Lumbar Stabilization program focuses on positioning the lumbar spine in a neutral position, which is the most pain-free and balanced position for the lumbar spine. The neutral position is controlled by abdominal bracing to reduce lumbar movement and abnormal stresses to various structures such as the intervertebral discs, facet joints, and trunk and hip musculature. Therefore, a dynamic lumbar stabilization program can relieve pain and stress on the lumbar structures by increasing the load to the abdominals and other large muscle groups.

The first instruction for the patient is to learn how to achieve the neutral spine position. The patient uses the abdominal muscles to tilt the pelvis, which will flex and extend the lumbar spine until the most pain-free or mid-range balanced position has been obtained. Once the patient has learned to find the neutral spine position, more progressive exercises are added to challenge the patient to maintain this position when moving the extremities and performing functional activities such as lifting.

This program also emphasizes that other muscles around the spine and hips should be evaluated for tightness and weakness to restore normal lengths and strength to reduce stress on the lumbar spine. The muscles that are prone to tightness are the iliopsoas, quadriceps, lumbar paraspinals, hamstrings, and iliotibial band. The muscles that are usually found to be weakest are the lower and upper abdominals. Therefore, the Dynamic Lumbar Stabilization program uses a comprehensive approach to restore trunk stability by using abdominal muscular force to reduce excessive stresses to the lumbar spine during functional activities.

When the patient uses the basis principles of the lumbar spine stabilization program during everyday functional activities, the chances of reinjury and chronic lumbar pain can be significantly reduced.

1. Dynamic Lumbar Stabilization Program. San Francisco Spine Institute, San Francisco, CA, 1989.

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