Therapy goals | Physiotherapeutic treatment of spinal instability

Therapy goals

A prerequisite for the start of the training is the elimination of accompanying possible causes of pain, such as mechanical dysfunctions. Short-range goals Long-range goals

• Learning how to activate the deep musculature through perception training
• Improvement of the strength endurance of the deep musculature
• Integration of both (global and local) muscle systems, activity without loss of stability
• Automatic transfer of the correct muscle activity in everyday situations
• Improvement of spinal stability and reduction of back-neck or headaches caused by instability in terms of pain duration and intensity
• Reduction of relapse rates and prevention of chronification

Until the last two therapy goals are reached, the patient has to go through a difficult process that requires absolute compliance (motivation and cooperation). 3 months of intensive daily practice are required to achieve improved basic stability and sustained pain reduction, after which in most cases the exercise units can be reduced.

However, many individual exercises can be carried out after initial learning in the supine, lateral or quadruped position in an upright posture such as sitting or standing. Therefore the exercise units can be integrated very well into everyday life. In order to help the patient improve motor control, complex exercises are taught in individual steps and, after learning individual tensions (can take up to 4-6 weeks), can be combined into 2 combined exercises (neck flexor/extension, shoulders/belly, back, pelvic floor) or into one overall body tension, which significantly reduces the daily exercise time.

If the patient is able to maintain the basic body tension correctly, additional movement sequences (activity of the global movement muscles) are added. In the last step, the learned tension and movement sequences are integrated into everyday life for the purpose of automation. Preference is given to everyday situations that cause difficulties for the patient.

On the part of the physiotherapist, a good methodology and the ability to convey perception exercises in a clear and vivid way is required. Especially at the beginning of the training the therapist has to give a lot of support by means of easy to implement exercise instructions and tactile help and feedback about his hands. As additional control and feedback for the patient, the physical therapist can use a biofeedback device, a pressure gauge for muscle tension or an ultrasound device.