Let us understand Spinal Stabilization. Have you heard about it before?
Updated: Oct 20
It is the natural ability of the spinal column to maintain its anatomical structure during physiological loading. The stability is maintained by: three interacting systems that are responsible for the maintenance of spinal stability.
The passive system comprising of the vertebral bodies, the intervertebral discs, the zygapophyseal joints, the zygapophyseal joint capsules, and the spinal ligaments
The active system comprising of the muscles and
The neural system that interacts between these two systems
For the normal pain free movement and function, these three systems interact in coordination.
The active system (muscles) comes into play and prevent abnormal deformation when the passive system undergoes stress loading. The inability of the active system to maintain the relationship between different elements of the passive system during physiological loading can lead to spinal pain . The active system prevents the spine from entering the elastic zone.
Neural control subsystem
The nervous or the neural control system receives information from the passive and the active subsystems and then direct the spinal musculature to stabilize the spine. The timely action of the neural system protects the spine from injury and allows the desired movement.
clinical instability can be defined as the abnormal displacement that occurs within the motion segment when a normal physiological load is applied. If there is an injury or degeneration to the passive system, the active system needs to work harder to compensate for the decreased contribution from the passive system.
The range of movement in the spine
This consists of:
A neutral zone and
An elastic zone.
The neutral zone is the normal functional range of movement with no stiffness of movement within the neutral zone. Maintaining the spine in the neutral zone is important to prevent injury.
The Elastic zone lies at the ends of the range of motion, where the stiffness of the system increases. There are chances of injury in the elastic zone when the spine is loaded.
There is increased flexibility around the neutral position of the spine and increased passive resistance and decreased flexibility in the end ranges of motion.
This ability to maintain the spinal neutral zones during routine functional activity without causing the neurological deficit, significant deformity, or incapacitating pain is otherwise called as Lumbar stability.
The stability in the neutral zone is provided by the Muscles.
Endurance is required to maintain stability over long periods of static postures.
Increased strength is essential when the spine is subject to suddenly increased stress (fall/ sudden loading of spine).
Weakness of these muscles can lead to segmental instability and cause back pain even in the absence of structural defects.
The mainstay of treatment in chronic low back pain is exercise and retraining to improve the strength and endurance of the muscles to provide spinal stability
A strong core is an important factor of spinal stabilization.
The core is a box structure made up of :
the abdominal muscles in the front and the sides,
the paraspinal and gluteal muscles at the back,
the diaphragm at the roof, and
the pelvic floor and the hip girdle muscles as the floor.
The abdominal muscles create a rigid cylinder around the spine during movement and provide stability. The activity of the transverse abdominis is recorded during the entire range of flexion and extension of the spine. This co-activation of the abdominal muscles during spinal movement is necessary to maintain spinal stability.
The muscles in the back of the core or that which envelope the vertebrae can be subdivided into the deeper uni-segmental muscles, i.e., the multifidus and the superficial large multisegmented muscles i.e., the erector spinae for lifting. The oblique abdominal muscles are involved in rotational movements of the spine
Delay in contraction of Multifidus
When there is a delay in the contraction of the multifidus, the larger and global superficial muscles like the erector spinae contract to compensate for the delay in increasing the stiffness of the lumbar spine.
But this creates abnormal forces across the individual segments, resulting in back pain.
Right activation of the right muscle, at the right time and in the right amount is very essential in avoiding any imbalance between the interacting systems.
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