Stabilization Strategies of the Lumbar Spine in Vivo

Abstract

In developing a method of quantifying stability in the lumbar spine Cholewicki and McGill (1996) have also broached the notion of sufficient stability, where too much stiffness (and stability) would hinder motion. Thus people highly skilled at maintaining stability may use different and optimal strategies, where <i>sufficient</i> stability is maintained. The purpose of this work was to explore the contributors to <i>sufficient</i> stability, how they coordinate and relate to injury mechanisms. This work represents a cascade of investigations where. 1) To explore the balance of various sources of stiffness and their effect on the critical load and post-buckling behaviour, simulations were undertaken where the buckled configuration of the spine was predicted and its stability in this new configuration was assessed. 2) The various sources of stiffness contributing to stability in the lumbar spine have been in some cases found to be deficient. The question of how these deficiencies place individuals at risk of instability, if at all, remains unresolved. A challenged breathing task was used to determine if there was a difference in stabilizing potential between healthy individuals and low back pain sufferers. Given that differences in stabilizing potential are apparent, several tasks which included a predetermined motor strategy, such as 3)pressurizing the abdomen and 4) abdominal hollowing vs. muscle bracing, were evaluated to determine if individuals can utilize motor strategies to augment stability. The stabilizing potential of abdominal pressure (IAP) and its interaction with muscle activation was evaluated. Some individuals are more skilled at stabilizing their lumbar spine than others. Some consciously controlled motor strategies are better stabilizers than others. These strategies highlight the relative contributions of various components (posture, passive tissue, muscle activation, and load) in that no single muscle dominates stability and IAP appears to augment stability beyond muscle activation alone. The margin of safety is considerable and depends on the task at hand, but it is possible to speculate on which tissues are at greatest risk of injury.