Joined: May 1, 2003
From: Dundas, ON, Canada (for now)
As a student on clinical placement, I recently provided a patient with a progression of lumbar/pelvic stabilization exercises that included a double knee lift (from the crook-lying positon). This patient was very capable of activating TA and Multifidus during activities such as knee fall-out and single knee lift (each from crook-lying). My preceptor warned me never to give the double knee lift exercise to anyone, as it produces too much shear in the lumbar spine. Many years ago I learned, on a course I attended, that this exercise WAS a progression for lumbar stab.
I realize there is no "gold standard" for lumbar stabilization programs, as it seems everyone makes up their own and usually from a core group of exercises (no pun intended). Anyway... what I'm looking for is your opinions on the safety of the double knee lift with regards to lumbar shear.
BTW... the double knee lift that I'm referring to is described as: lying in the supine crook position activate TA and Multifidus (as well as the pelvic floor), then lift both knees off the floor so that the knees are pointing to the ceiling. Progressions from here include lowering one leg at a time, both legs at the same time, to progressively extending ones legs.
Thanks for your input. I want to keep the patients safe!
Joined: October 9, 2001
From: Pittsburgh, PA USA
In the beginning stages of pelvic stab, I have found very very few patients who can maintain an adequate pelvic tilt when lifting both feet off the bed. Shear forces perhaps not as bad as excessive lordosis and extension.
John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
Joined: November 11, 2002
From: colorado usa
I agree with John....I never give this exercise unless in the very rare situation I am dealing with Zena. In many cases people with instability have a tendency to overuse their hip flexors and this exercise may cause them to engage them more thus increasing the lordosis even more....very compressive. Also, watch your client's body. This exercise may cause them to compensate in other areas of their body including their neck. It is also not very functional...unless you work and play on your back in crook lying.
Instead, stabilization may be more effective and safely used in more functional positions. For example have your clients stand or kneel in a neutral pelvic position, and add external challenges while they maintain the posture (pulleys, bands, etc) Narrow their base of support to increase the challenge etc.
Try this exercise yourself, and the progressions to double leg extension. Can you hold the pelvic position adequately...without using compensatory movements, and what functional basis would you use for this exercise?
Joined: February 14, 2003
From: Madison WI USA
Timbo, Recently, Stuart McGill PhD, put out a book on evidence based rehab for low back disorders. In it, he provided some good rationale for doing specific stabilization exercises, but perhaps more importantly, he outlined the lack of sound rationale for some things typically done. Chapter 13 and 14 describe the programs. He is a bit high on his own research,(Im sure we all would be), but it is good stuff, probably some of the best that we have to work with. Copyrighted 2002,