Re: question on dynamic lumbar stabilization

[Guest guest]

Minga,

Look in Craig Libermans book, Spinal Rehabilitation. There are a number of dynamic lumbar stabilization techniques using BAPS boards, wabble boards, balance beams, gymnastic balls, mini trampolines... For spinal stenosis, most of these provide dynamic challenges to neutral position stabilization and muscular firing order.

Ted

Ted Forcum, DC, DACBSP, CSCSBack In Motion Sports Injuries Clinic, LLC11385 SW Scholls Ferry RoadBeaverton, Oregon 97008ph 503.524.9040

On Sun, 21 Oct 2001 16:21:47 EDT AboWoman@... writes:

Listmates, A local MD is asking about something he heard about that chiropractors do for spinal canal stenosis. He said it was called 'dynamic lumbar stabilization'. Anyone familiar with this phrase as a specific technique? Minga Guerrero DC Portland Oregon

[Guest guest]

Minga,

Dynamic lumbar stabilization refers to active rehabilitation of the

lumbar paraspinal, gluteal and other related muscles to improve strength,

coordination and endurance. Using the principle of centralization

of leg symptoms when assuming certain postures/postions, observing the

firing pattern of key muscle groups and assessing muscle weakness assist

in the selection of appropriate exercise "tracks". This is taught

at WSCC, LACC and other undergraduate programs and is available on the

post-graduate level through the "Chiropractic Rehabilitation" program sponsored

by WSCC and LACC. "Rehabilitation of the Spine: A Practitioner's

Manual" edited by Craig Liebenson, DC (who developed the LACC rehab program)

is an excellent resource for this approach.

Ravid Raphael, DC, DABCO

Staff Clinician, WSCC

AboWoman@... wrote:

Listmates,

A local MD is asking about

something he heard about that chiropractors do for spinal canal stenosis.

He said it was called 'dynamic lumbar stabilization'. Anyone familiar with

this phrase as a specific technique?

Minga Guerrero DC

Portland Oregon

[Guest guest]

Minga the " Dynamic Lumbar Stabilization " program was, I believe, a product of Saal & Saal (brothers who got 90% of the disc patients well without sugery prompting them to state that as much as 90% of all disc surgery is uneeded) at the San Fran. Spine Institute founded by Arthur White MD orthopaedic surgeon (the guy who did the surgery on Joe Montana for us football fans). Anyway they have a video and photo work book on the program which I have and I believe can still be purchased. The last phone number I have is 415-991-6761.

Vern Saboe, DC., DACAN

Albany, Oregon

question on dynamic lumbar stabilizationListmates, A local MD is asking about something he heard about that chiropractors do for spinal canal stenosis. He said it was called 'dynamic lumbar stabilization'. Anyone familiar with this phrase as a specific technique? Minga Guerrero DC Portland Oregon

[Guest guest]

Minga,

The one thing that comes to mind is the work from Jull and Hodgson on Lumbar segmental stabilization, along the lines of what Panjabi and Centeno talked about at the Spring CAO conference. I think Vern's reference to the Saal brothers is with regard to IDET, and as the Saals had a large quantity of Orotec stock (the folks who make the IDET catheters) they can be forgiven if their numbers are a bit optimistic. Everything that I have been hearing is that there is about a 50% chance that the IDET procedure will result in a >50% reduction in discogenic pain in well selected patients. In poorly selected patients (a more frequent finding these days as more poorly trained docs are hopping on the IDET bandwagon) the proportion of good results will drop.

BTW, Orotec stock, once well over $20, is now <$1. Here today, gone tomorrow, eh?.

D Freeman

Mailing address: 2480 Liberty Street NE, Suite 180Salem, Oregon 97303ph 503 763-3528fax 503 763-3530page 888 501-7328

question on dynamic lumbar stabilizationListmates, A local MD is asking about something he heard about that chiropractors do for spinal canal stenosis. He said it was called 'dynamic lumbar stabilization'. Anyone familiar with this phrase as a specific technique? Minga Guerrero DC Portland Oregon

[Guest guest]

The key issue here is getting the patient to know how to use their spinal stabilization muscles in synchronization, including the transverse abs, the multifidi, and the pelvic floor.

If you go to Craig Liebenson's columnist site for Dynamic Chiropractic, Craig has done a whole series of articles on this, he often calls it abdominal co-contraction, heres the link, good articles. The link will take you to his latest article, on the thoracics, which is not relevant to this discussion, use the search engine here to find his whole list of articles.

http://www.chiroweb.com/columnist/liebenson/

As others have said, this is taught is nearly all rehab programs, WSCC, LACC, etc, as well as my Basics of Rehab.

Here's a plug. If you want to learn the basics of this, free, and you are a chironet member, I am doing a 4 hour presentation on low back pain at the Chironet annual meeting Oct 27 in Eugene, and Nov 3 in Portland. The first 2 hours of this 4 hour presentation will focus on spinal stabilization.

I think that this is a basic and key skill for chiropractors!. It helps people that manipulation alone cannot solve the problem, especially discs, both DJD and bulged/herniated. i think that everyone with chronic or recurrent low back problems should know how to do this, and this is one of the few things that has great literature support. We all should either learn this, or know who in our community does this well. Palates (?spelling) exercise programs use this same concept, and are an excellent way to train these muscles.

PS- I think that this is something that doesn't require a whole rehab center, except for those who are motor morons, or won't do home exercise. I think that these are relatively simple ideas that are learnable for both the practitioner, as well as by the patient.

Marc Hellermheller@...987 Siskiyou Blvd.Ashland, OR 97520541-482-0625

-----Original Message-----From: AboWoman@... [mailto:AboWoman@...]Sent: Sunday, October 21, 2001 1:22 PM Subject: question on dynamic lumbar stabilizationListmates, A local MD is asking about something he heard about that chiropractors do for spinal canal stenosis. He said it was called 'dynamic lumbar stabilization'. Anyone familiar with this phrase as a specific technique? Minga Guerrero DC Portland Oregon

[Guest guest]

Actually not , and Saal of the San Francisco Spine institute at Seton Medical Center and the SpineCare medical Group reported on their results back in 1989 (Spine 14:4 431-437, 1989) well in advance of frying (IDET) any discs. Their rather inflated comments regarding the amount of inappropriate spinal surgery (90%) is based on their getting 90% good, or excellent outcomes with a 92% return to work rate in a small group (N 64) of patients with confirmed disc herniated nucleus pulposus with concomitant radiculopathy. They used this often in advertisments relative to the San Francisco Spine Institute, they even had one with Joe Montana standing on the sidelines talking with Dr. White! I believe they (the Saal bros) are the originators of the " dynamic lumbar stabilization " rehab program to which Minga refers. These are also referred to as " stabilization exercise training, " and " dynamic muscular stabilization " and as I also told Minga I have the videos and picture work-book produced by the San Fran Institute. Also Saal published similar results in 1990 (Orthopaedic Review Vol. XIX., No 8 Aug., 1990) and further refines the role of non-surgical ACTIVE treatment/stabilization exercises in 1996 (Spine 21:24S, 2S-9S, 1996).

Finally Minga, getting back to your original question and that of your medical colleague Saal & Saal actually got very poor results with patients who had stenosis, in fact in their 1989 study four out of the six patients who failed their nonoperative (stabilization exercises) were found to have stenosis at subsequent lumbar spine sugery.

Again, Minga I think the videos and work-book are available, also if you would like give me a call and we can maybe arrange " something " at my clinic.

Hope this helps,

Vern Saboe, DC

Albany

Re: question on dynamic lumbar stabilization

Minga,

The one thing that comes to mind is the work from Jull and Hodgson on Lumbar segmental stabilization, along the lines of what Panjabi and Centeno talked about at the Spring CAO conference. I think Vern's reference to the Saal brothers is with regard to IDET, and as the Saals had a large quantity of Orotec stock (the folks who make the IDET catheters) they can be forgiven if their numbers are a bit optimistic. Everything that I have been hearing is that there is about a 50% chance that the IDET procedure will result in a >50% reduction in discogenic pain in well selected patients. In poorly selected patients (a more frequent finding these days as more poorly trained docs are hopping on the IDET bandwagon) the proportion of good results will drop.

BTW, Orotec stock, once well over $20, is now <$1. Here today, gone tomorrow, eh?.

D Freeman

Mailing address: 2480 Liberty Street NE, Suite 180Salem, Oregon 97303ph 503 763-3528fax 503 763-3530page 888 501-7328

question on dynamic lumbar stabilizationListmates, A local MD is asking about something he heard about that chiropractors do for spinal canal stenosis. He said it was called 'dynamic lumbar stabilization'. Anyone familiar with this phrase as a specific technique? Minga Guerrero DC Portland Oregon

[Guest guest]

Great post Marc, just a " plug " for what I and most of my colleagues do that being spinal manipultion/adjustments for disc herniations, there are in fact 3 radiomized controlled trials and 10 observational type studies all supporting the efficacy of this modality alone. With that said I personally combine this with botanicals, spinal stabilization exercises (they get the video and work book) and my adjuctive PT for even better outcomes.

Vern

RE: question on dynamic lumbar stabilization

The key issue here is getting the patient to know how to use their spinal stabilization muscles in synchronization, including the transverse abs, the multifidi, and the pelvic floor.

If you go to Craig Liebenson's columnist site for Dynamic Chiropractic, Craig has done a whole series of articles on this, he often calls it abdominal co-contraction, heres the link, good articles. The link will take you to his latest article, on the thoracics, which is not relevant to this discussion, use the search engine here to find his whole list of articles.

http://www.chiroweb.com/columnist/liebenson/

As others have said, this is taught is nearly all rehab programs, WSCC, LACC, etc, as well as my Basics of Rehab.

Here's a plug. If you want to learn the basics of this, free, and you are a chironet member, I am doing a 4 hour presentation on low back pain at the Chironet annual meeting Oct 27 in Eugene, and Nov 3 in Portland. The first 2 hours of this 4 hour presentation will focus on spinal stabilization.

I think that this is a basic and key skill for chiropractors!. It helps people that manipulation alone cannot solve the problem, especially discs, both DJD and bulged/herniated. i think that everyone with chronic or recurrent low back problems should know how to do this, and this is one of the few things that has great literature support. We all should either learn this, or know who in our community does this well. Palates (?spelling) exercise programs use this same concept, and are an excellent way to train these muscles.

PS- I think that this is something that doesn't require a whole rehab center, except for those who are motor morons, or won't do home exercise. I think that these are relatively simple ideas that are learnable for both the practitioner, as well as by the patient.

Marc Hellermheller@...987 Siskiyou Blvd.Ashland, OR 97520541-482-0625

-----Original Message-----From: AboWoman@... [mailto:AboWoman@...]Sent: Sunday, October 21, 2001 1:22 PM Subject: question on dynamic lumbar stabilizationListmates, A local MD is asking about something he heard about that chiropractors do for spinal canal stenosis. He said it was called 'dynamic lumbar stabilization'. Anyone familiar with this phrase as a specific technique? Minga Guerrero DC Portland Oregon

[Guest guest]

Hey, Vern,

I'm not questioning manipulation, I'm saying that we will all get better results if we know how to teach spinal stabilization.

PS- I don't think you can do teach someone how to properly use their musculature with a video andl/or a workbook, it a hands on skill, that needs personalized instruction.

Marc

RE: question on dynamic lumbar stabilization

The key issue here is getting the patient to know how to use their spinal stabilization muscles in synchronization, including the transverse abs, the multifidi, and the pelvic floor.

If you go to Craig Liebenson's columnist site for Dynamic Chiropractic, Craig has done a whole series of articles on this, he often calls it abdominal co-contraction, heres the link, good articles. The link will take you to his latest article, on the thoracics, which is not relevant to this discussion, use the search engine here to find his whole list of articles.

http://www.chiroweb.com/columnist/liebenson/

As others have said, this is taught is nearly all rehab programs, WSCC, LACC, etc, as well as my Basics of Rehab.

Here's a plug. If you want to learn the basics of this, free, and you are a chironet member, I am doing a 4 hour presentation on low back pain at the Chironet annual meeting Oct 27 in Eugene, and Nov 3 in Portland. The first 2 hours of this 4 hour presentation will focus on spinal stabilization.

I think that this is a basic and key skill for chiropractors!. It helps people that manipulation alone cannot solve the problem, especially discs, both DJD and bulged/herniated. i think that everyone with chronic or recurrent low back problems should know how to do this, and this is one of the few things that has great literature support. We all should either learn this, or know who in our community does this well. Palates (?spelling) exercise programs use this same concept, and are an excellent way to train these muscles.

PS- I think that this is something that doesn't require a whole rehab center, except for those who are motor morons, or won't do home exercise. I think that these are relatively simple ideas that are learnable for both the practitioner, as well as by the patient.

Marc Hellermheller@...987 Siskiyou Blvd.Ashland, OR 97520541-482-0625

-----Original Message-----From: AboWoman@... [mailto:AboWoman@...]Sent: Sunday, October 21, 2001 1:22 PM Subject: question on dynamic lumbar stabilizationListmates, A local MD is asking about something he heard about that chiropractors do for spinal canal stenosis. He said it was called 'dynamic lumbar stabilization'. Anyone familiar with this phrase as a specific technique? Minga Guerrero DC Portland Oregon

[Guest guest]

Agreed Marc I've started a limited remodel job at my clinic which will include a rehab.room for this very purpose.

Vern

RE: question on dynamic lumbar stabilization

The key issue here is getting the patient to know how to use their spinal stabilization muscles in synchronization, including the transverse abs, the multifidi, and the pelvic floor.

If you go to Craig Liebenson's columnist site for Dynamic Chiropractic, Craig has done a whole series of articles on this, he often calls it abdominal co-contraction, heres the link, good articles. The link will take you to his latest article, on the thoracics, which is not relevant to this discussion, use the search engine here to find his whole list of articles.

http://www.chiroweb.com/columnist/liebenson/

As others have said, this is taught is nearly all rehab programs, WSCC, LACC, etc, as well as my Basics of Rehab.

Here's a plug. If you want to learn the basics of this, free, and you are a chironet member, I am doing a 4 hour presentation on low back pain at the Chironet annual meeting Oct 27 in Eugene, and Nov 3 in Portland. The first 2 hours of this 4 hour presentation will focus on spinal stabilization.

I think that this is a basic and key skill for chiropractors!. It helps people that manipulation alone cannot solve the problem, especially discs, both DJD and bulged/herniated. i think that everyone with chronic or recurrent low back problems should know how to do this, and this is one of the few things that has great literature support. We all should either learn this, or know who in our community does this well. Palates (?spelling) exercise programs use this same concept, and are an excellent way to train these muscles.

PS- I think that this is something that doesn't require a whole rehab center, except for those who are motor morons, or won't do home exercise. I think that these are relatively simple ideas that are learnable for both the practitioner, as well as by the patient.

Marc Hellermheller@...987 Siskiyou Blvd.Ashland, OR 97520541-482-0625

-----Original Message-----From: AboWoman@... [mailto:AboWoman@...]Sent: Sunday, October 21, 2001 1:22 PM Subject: question on dynamic lumbar stabilizationListmates, A local MD is asking about something he heard about that chiropractors do for spinal canal stenosis. He said it was called 'dynamic lumbar stabilization'. Anyone familiar with this phrase as a specific technique? Minga Guerrero DC Portland Oregon