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Keywords: spinal column; stabilization; low back pain; transversus abdominis; multifidus
summary
This manuscript presents an overview of spinal stabilization for the lumbar spine. Emphasis is placed on the local stabilization musculature, which has received considerable support in the literature. A progressive stabilization program targeting the local stabilizing musculature is recommended for the diverse athletic population.
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Introduction
Approximately 60-80% of the adult population will experience an episode of low back pain (LBP) at some point in their lives (13, 49, 58, 65). The natural history, however, is favorable, as over 80% of individuals may recover independently of treatment within 4-6 weeks of initial complaints (49, 75). Although the natural history is favorable, the reported recurrence rate of LBP is as high as 58-90%(13,29,49,72,73). LBP is only second to the common cold for physician visits, and the costs of LBP in some societies exceed that of coronary artery disease and diabetes combined (49). From an economic standpoint, the total cost of LBP including societal factors exceeds $40 billion per year (20,49, 75).
LBP is not limited to the nonathletic population, as individuals involved in athletic endeavors may be affected at an equal or greater frequency than the general population (6,15, 23, 50, 58,64,71). Specific sports such as weightlifting and American football are associated with a higher incidence of degenerative conditions, stress fractures, and injuries of the lumbar spine when compared to the general population (3, 6, 23, 36, 37, 44). Athletes who perform sports involving repeated or forceful loading of the spine are considerably more prone to spondylolysis (stress fractures of the pars interarticularis) and instability of the low back (22, 25, 26,40, 41, 59, 70). Stress fractures and spinal instability have been identified as risk factors for LBP in the athletic population (22,36,37).
Intervention for athletes with LBP is often based upon the educational dogma of the trainer, clinician, or strength and conditioning specialist. Differences of opinion exist as to what the optimal exercises are for LBP (19). Among interventions for the athlete with LBP, spinal stabilization has received considerable attention and, therefore, will be the focus of this discussion. This manuscript will elucidate the research relating to spinal stabilization, discuss muscular changes associated with lumbar spine disorders,...