Assuming lumbar flexion is a hazard of some kind (which we will explore more), we need to examine the relative amount of exposure required to create a significant risk. Battie MC, Videman T, Gibbons LE, Mannien H, Gill K, Pope M, Kaprio J. This is the research that has supported the major trends in veering away from flexing the trunk, favoring the neutral spine instead. Not necessarily, but it may be in some instances. Along with that, there has been an effort to educate people of the danger of lifting without a perfectly “neutral” back. The stabilizing system of the spine. Digging into the literature, we come to a number of discussion points on this topic: First thing: A quick summary of some important anatomy and terminology for this topic. Despite the strong convictions and assertive claims often made, the evidence is not quite as clear as people believe. While this is a necessary component of researching variables, we should consider that this is not directly applicable to real life. The disc can become weakened through this and is then more likely to herniate. You might have someone “hamstring curl the floor” and exhale to maintain the cylinder on a bench press for general pop, but if they’re powerlifter in competition, there’s a definitive advantage to extension. Porter RW, Adams MA, Hutton WC. I think you misread. A spondylolysis can progress to a spondylolisthesis, in which the vertebral body slides forward/backward (respectively to the segment you reference). Of these injured specimens, 14 came from the group that was exposed to 300% of the neutral zone, whereas 9 came from the regular neutral zone. It is fair to say that while in passive flexion, the spine might be slightly rounded depending on the flexibility of the back body. In yoga practice, spinal flexion is another way to refer to forward bends. Methods: Previously taken lumbar spine x-rays of 103 patients in the neutral and full-flexed positions were reviewed. What is interesting to note is that one of the primary injuries that arose was a fracture of the pars interarticularis of the superior vertebrae (spondylolysis), which is most associated with hyperextension – not flexion. Each side of the disc has a vertebral endplate which acts as a means to connect the disc to the bone. Usually you will then get annular tearing that may have no symptoms just stiffness in the low back from activation of the small nerves innervating the disc. In all of these studies examining spinal flexion as a mechanism of injury, we are left with an unrealistic situation for the disc to be able to adapt. For example, Contreras & Schoenfeld made an excellent point: “cadaveric tissue does not have the capacity to remodel.” In contrast to our deceased comrades, we are able to adapt and improve. This is considered to be the global range of motion for the lumbar spine, with each segment having its own intervertebral range associated with it. This region generally shows 40-50° flexion, 15-20° extension, 5-7° rotation, and 20° lateral flexion. Callaghan JP, Mcgill SM. Flexion of the Cervical Spine. This. Holm & Nachemson found that the intervertebral discs had increased aerobic metabolism in the outer parts of the annulus and nucleus pulposus following spinal movements. Along with that, there has been an effort to educate people of the danger of lifting without a perfectly “neutral” back. In contrast, within the moderate- and high-load groups, there was a significantly greater number of herniations occurring – particularly with the high-load group. And the sad truth is, most people don't move their spine in the extension and flexion positions, much less side bending or rotation. A disc herniation is when the disc begins to push outward beyond its normal confines between the vertebrae. Subjects maintained the neutral position (phase 1) for approximately 2 s, fully flexed the neck with the goal of approximating their chin to their upper chest (manubrium) within 5 s (phase 2), maintained full flexion for 5 s (phase 3), and extended their neck to the neutral position within 5 s … – we see the spine deviate from a set position and undergo varying degrees of lumbar flexion and extension. is where there is disruption of the endplate, generally on the aspect of the endplate-bone interface. , we see that there was actually a higher incidence of endplate fractures than there was with disc failure with flexion. These injuries range from the tears within the end plate adjacent to the transition zone, tears at the inner annulus, tears at the mid annulus regions, micro-structural damage, disc herniation, and end plate fractures. While this definition is very specific, it does not serve as a clinically applicable term, nor does it fit the format in which the terms are commonly used in a clinical setting. Flexion . Shark attacks are a hazard, but if you never enter water where sharks are, you are not exposed to them, leaving you with little risk of being exposed to a shark attack. Occupational driving and lumbar disc degeneration: a case-control study. In most of the studies, there was a range of continuous cycles between 5000 and 86,400. Starting position Patient is in side-lying facing therapist. Post was not sent - check your email addresses! However, this doesn’t mean we should disregard all findings. Stabilize the throrax to prevent thoracic spine invovlment. Patient position: Sidelying; spine in flexion and L SB, locking L5S1 into L rotation. Testing Position: Sitting with thoracic spine and lumbar spine stabilized by a chair.. Local pain at 0-35 is S/I S/S or Lower lumbar spine axial rotation is reduced in end-range sagittal postures when compared to a neutral spine posture. As we have discussed, even if an individual has some form of “abnormality” on imaging, it does not mean it is associated with flexion or their current pain experience. (usually only effective in disk) In particular, we are seeing more information showing that many of these “abnormalities” are more an aspect of aging than an association of pain. Is intervertebral disc pressure linked to herniation? There are two sides to this spinal flexion vs neutral spine debate. When examining many of the above papers looking at flexion, we should keep in mind the methods of the studies. Their results demonstrated that the neutral spine is not safe from injury; in fact, the neutral segments experienced a higher percentage of disc failure during both impulse and gradual pressurization. The lumbar spine has a range of pathologies that are associated with it, but we just want to touch on a few of the major ones related to this discussion. This is part of the scientific process, and many points can be inferred from these spinal models; however, there are distinct things that limit our capabilities of inferring knowledge from these studies. In Wade et al. Hutchinson MR. Low back pain in elite rhythmic gymnasts. The phenomenon appears between 72.6 and 76.3% of maximal cervical flexion and disappears during the return to neutral position between 91.9 and 93.1% of maximal cervical flexion. From the flexed back of a cyclist to an extended back of a gymnast, sporting demands require inherently different postures and capacities. is when the disc begins to push outward beyond its normal confines between the vertebrae. Assessment: Lumbar (Trunk) Flexion (MUSCLE Rectus Abdominus) Patient Position: Supine, no pillow under head Therapist Position: Standing STABILIZE None Method: PALPATION Anterior aspect of the trunk lateral to the midline ; RESISTANCE None ; Alternative Method: None. Position of human lumbar vertebrae (shown in red). I agree with you that flexion of the spine is normal esp with certain lifting movements squat, dead lift or pulls. between pathoanatomical signs, pain, and relatedness. Beyond the need for it in activities of daily living and sports, lumbar flexion offers benefits to the spine that may not be achieved through a neutral position. Flex patient’s cervical spine (∼ 45 degrees). Said another way: if you walk / stand all day at your job, can we ignore that when thinking about how much mileage you should run in training? Analogies can really help explain this concept. This is an excellent step in the right direction for research, but we must remember a major caveat: This is not living and responsive tissue. A spondylolysis is where damage occurs to the pars interarticularis (in essence a fracture). Or 166 minutes for that matter? 1. If we examine the majority of training programs for athletic development, physique enhancement, or rehabilitation, the overwhelming majority would likely consist of activities focusing on a neutral spine (planks, deadbugs, etc.). Varlotta GP, Brown MD, Kelsey JL, Golden AL. This goes back to Farfan, et al decades ago and Adams and Hutton in the 1980s!! Then, the disc was pressurized to a specific level (8MPa), allowed 12-14 seconds to settle and be observed for failure, and then more pressure was added progressively. Of 5 bones, from the top down, and relatedness is one of the danger of lifting a. Annular wall CT Scans their chest in mid lumbar flexion present as an inherent dangerous.. 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