More than two decades of research has shown that appropriate muscular function can drastically lower the likelihood of spinal injury. Research has also shown that muscular function can be readily trained through specific rehabilitation protocols.
When looking at muscle dysfunction and corrective exercise there are four overlapping areas that need consideration:
1. Hypertonicity and contracture of dynamic stabilisers:
Dynamic stabilisers are muscles charged with maintaining posture. They should be active all the time, but should be kept in a neutral position by opposing muscles. However, work by Professor Janda and others has shown that these muscles are commonly over contracting in pain sufferers. Stretching of these muscles is a sound theory, but research has yet to show any benefit to this approach.
2. Proprioceptive deficit:
Ineffective neuromuscular control mechanisms prevent neutral positioning of joints, but also prevent muscles from providing stability to areas of the body. Proprioceptive deficits are of particular importance when considering chronic pain patients and post traumatic patients.Sensory motor training has been shown to be effective in shoulder, cervical, and lumbar rehabilitation.
3. Regional strength and endurance:
The correlation between low local muscular endurance and spinal injuries has been extensively studied. An inability of muscle to maintain a small voluntary contraction is a good predictor of pain recurrence. Primarily, muscle weakness is substituted for by muscular hypertonicity and redistribution of load onto ligaments or joints.
4. Local muscle activity:
Closely linked to the above, muscle inhibition can result from any of the previous functional deficits, as well as pain. Over time voluntary contraction to a useful level is no longer possible. As well as having a role in stabilising musculature, muscular inhibition is also important when considering movement patterns and injury prevention.
Despite significant relationships between functional deficits, no single approach to rehab will successfully address all. All components need to be addressed in a rehabilitation programme for dependable results.