Specificity of Treatment

Training, conditioning and rehabilitation are all designed to correct the dysfunctions we create through the rest of our daily activities. All “corrective exercises” should take the patient/client to the neural edge of their ability. This does not mean that they are to be destroyed and rebuilt via the session, but it should let them succeed in the exercise while still challenging them.

A common exercise that I see prescribed that has potential to be beneficial by strengthening the deep musculature of the spine including the multifidus is the bird-dog. However, most practitioners use the same exercise with everyone with no modification for what the patient/client is capable of doing.

As soon as one of the legs is moved, the multifidi must start contracting to stabilize the torso to prevent rotation. However, most individuals are instructed on performing full hip extension. This is where the problem occurs: the fully extended knee offers too much resistance so the lumbar spine compensates by recruiting the lumbar paraspinals (erector spinae) which also create lumbar extension. Often, these individuals demonstrate curving in the low back that is wrongly attributed to weakness of the transverse abdominis.

Try working within your patient’s ability with the toe-drag hip extension. The patient only extends their leg posteriorly as far as they can without losing neutral spine. Whenever they can fully extend the leg with the toe touching the ground, then progress to actually lifting the leg while maintaining neutral pelvis.