Phase 1 - Initial Goal -- Motor Control.
Improve speed of contraction/activation of spinal, pelvic & scapular stabilizers, coordination & endurance. Improve the early activation of coordinated co-contraction of spinal agonist and antagonist muscles.
Begin with Spinal Stabilization type exercises using the appropriate tracts, such as dead bug and bridge tracts; cardiovascular training using treadmill, stepper or lower body cycle; and prioprioception training using proprio-sandles, rocker boards, and wobble boards. Once the patient successfully completes the above floor exercises, move into:
Phase 2 - Swiss Theraball Spinal Stabilization protocol for a more liable surface and challenging exercises. At this time also begin using theraband exercises for specific muscles groups shown weak or inhibited on the functional assessment.
When the patient successfully completes the second phase of rehabilitation, a follow-up functional capacity assessment should be performed. If the patient shows adequate improvement, move to the last phase of rehabilitation:
Phase 3 - Chief Goal: Strength development (torque production) following a progressive resistance protocol on isotonic machines.
General estimate is two to three weeks to accomplish the goals of the first two clinical phases, and four weeks to accomplish the third clinical phase.
The Order of Treatment:
- Adjust Fixations to improve joint function.
- Stretch tight muscle groups.
After joint mobility & muscle length are restored:
- Train motor control of spinal, pelvic & scapular stabilizers: rocker board, wobble board , balance shoes
- Train speed of contraction (propriosensory therapy).
- Train co-contraction ability & coordination.
- Train endurance (e.g. begin w/ abdominal hollowing then add motions of extremities, etc).
- Train strength (torque production ability of large prime movers, especially trunk flexors & extensors.
Thanks to Fred Deutsch, DC, DACRB of Deutsch Chiropractic, Watertown, SD
for contributing this document!
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