Q&A Time! When Do You Prescribe Stability Exercises? | Modern Manual Therapy Blog

Q&A Time! When Do You Prescribe Stability Exercises?

Today's Q&A asks: When Do You Prescribe Stability or Core Strengthening Exercises?

Here is my short answer: If the question is referring to planks, pressure cuff feedback, etc...rarely in my practice.

Keep in mind my clinical caseload ranges from 60-70% general ortho to 30-40% athletic. Despite research from a while back showing the TA to be the first muscle that fired in a sequence of UE movements, I don't believe in prescribing stability exercises for two reasons

  • they are often difficult to perform correctly or as a protocol demands
  • not performing any movement or exercise correctly = not getting the intended benefits from the exercise
My ther ex for HEP falls into several categories
  • MDT based repeated motions in the directional preference if rapid responders (derangements)
  • movement into the new range several times an hour if slow responders (dysfunctions)
  • corrective exercise based on a motor control or stability issue found in the SFMA
The last part is the closest I prescribe to "core strengthening" or stability exercises, but they tend to be more FMS based. Many of them are in the patterns the patients fail from movement patterns like an in line lunge, or single leg stance. The patient practices these, for example anti-rotational exercises while being pulled in another direction by a cable or at home with an exercise band. 

I may give cues on firing the core (blow out for cylindrical activation) and change pelvic alignment to see if this facilitates it. Firing the core often changes mobility during some tests like standing forward bending, ASLR, etc. That would state the "mobility" problem is really a core stability/motor control issue. The corrective exercise then becomes that movement with the core activation. The patient knows they are performing it correctly at home because the movement increases and more comfortable. This is much easier than exercises over a cuff, which most patients do not have at home.

Rolling is a basic pattern of motor control that often helps a lot of upper and lower body dysfunction. You would be surprised the number of even high level athletic individuals that cannot roll properly from supine to prone, prone to supine, whether it's upper or lower body (although upper body is harder for most). 

Many of my sedentary office workers who come in, respond to manual therapy and MDT for HEP, rarely, if ever get spinal stabilization exercises. I would say less than 5%. I prescribe traditional pressure cuff strengthening for deep cervical flexors, or under the lumbar spine only if someone is not responding, which in my practice is very rare. Even when I do "resort" to these exercises, I find they rarely changed the patient's complaints; the exception would be a few cases where someone was almost 80-90% better and that was the only thing they needed to get a bit more movement back. YMMV. 







3 comments:

  1. Dr. E,
    You make very good points here and I would say I agree wholeheartedly with your % of pts who you specifically prescribe core work. I think The whole TA contraction voodoo was a way to separate PT from personal trainers, etc back in the 90s. It may have stemmed from the research that TA is delayed by 50ms (I think this is the right number) with LBP with you raise your arm. But other research shows a 38% or so improvement when you perform OMPT and take away pain. So, pain is the limiting factor; and not to get into great detail here but core work to train a motor control and timing issue is ludicrous.

    We may be of the minority in terms of PTs out there...

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  2. Paul hodges, carolyn richardson and july hides will ״fall from the chair" if they will read it :-)

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  3. If only they would read it! I always wonder, when stability exercises are your main form of prescription, what do you do if they don't help?

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