Lumbar StenosisRehabilitation Using the Resistance Chair

a. Description

Lumbar spinal stenosis is a term used to describe a narrowing of the spinal canal. Thenarrowing leads to compression of the nerves supplying the legs and back, leadingto pain. It is thought to be primarily caused by age-related degenerative changes andis recognized as a common disability in the older adult population. Poor posture andweak core musculature can contribute to symptoms. Exercises to stretch the lower backregion and strengthen the muscles which support the spine can reduce the compressionof the spinal nerves. Symptoms of central spinal stenosis are usually worse when aperson is standing or walking and better when sitting. Therefore, the Resistance Chairis the perfect rehabilitation and exercise tool for patients with lumbar stenosis.

b. Symptoms

People affected by this condition usually describe pain radiating from the low backor buttocks into both legs. Standing or walking for prolonged periods of time oftenexacerbates this condition while sitting or lying down usually relieves this pain. Often,patients report relief of symptoms with forward bending or leaning over something suchas a shopping cart.

c. Diagnosis

The diagnosis of lumbar spinal stenosis requires the presence of typical symptoms asdescribed above along with special imaging studies such as an MRI showing structuralnarrowing of the spinal canal. Electrodiagnostic studies may also be considered toassess possible nerve root damage.

d. Management

Management of lumbar spinal stenosis may involve nonsteroidal anti-inflammatory drugs (such as Ibuprofen) and pain medications, therapy modalities (heat, cold,electrical stimulation, ultrasound), and a specific rehabilitation program. Some patients who do not respond to conservative treatment may be candidates for a steroid injection(epidural) or may require surgical evaluation.Amajority of patients do show considerableimprovement with an exercise based rehabilitation program.

PRODUCTS HELPING PEOPLE HELP THEMSELVES!

Page 1 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com

e. The Resistance Chair Solution

Aerobic conditioning, specific strengtheningand stretchingexercisesaremainstaysofconservativetreatmentforlumbarstenosis(1).Onerecentstudyshowedpatientswithstenosistreatedwithanexerciseprogramachievedsignificantimprovementsby6weeks(2).Thegoalsofconditioningareincreasedmuscularstabilization(especiallyinabdominalmusculature)andimprovementofposture.Otherspecifictypesofexercisessuchasbicyclingmayalsohelptorelievesymptomsofspinalstenosis.TheResistanceChairSolutionaddressesallthesefactorsbyincorporatingafocusedexerciseprogramandstationarybicyclingforthemanagementoflumbarspinalstenosis.Thefollowingarespecificexercisestoimprovemobilityandstrengthofthelowerbackandtrunkinordertoreducethesymptomsoflumbarstenosis.TheSolutionalsoenablespatientswith lumbar stenosis to improve upper and lower body strength and endurance insittingwithoutexacerbatingsymptomsoflumbarstenosiswhichareusuallyworsewithstandingandwalking.

References:

1.Rittenberg,JD,Ross,AE.Functionalrehabilitationfordegenerativelumbarstenosis.PhysicalMedicineandRehabilitationClinicsofNorthAmerica2003;14:p111.2.Whitman,JulieM.etal.AComparisonBetweenTwoPhysicalTherapyTreatmentProgramsforPatientsWithLumbarSpinalStenosis:ARandomizedClinicalTrial.Spine2006;31(22),pp2541-2549.

3.Simotas,AlexanderC.etal.NonoperativeTreatmentforLumbarSpinalStenosis:ClinicalandOutcomeResultsanda3-YearSurvivorshipAnalysis.Spine2000;25(2),p197.ntswithlumbarstenosiscanalsostrengthentheirupperbodieswhilesitting.

Trunk Flexion Stretch

Goal:Tostretchthemusclesofthelowerback.

1.Beginsittinguprightinchair.Roundyourbackasyoubendforwardtoreachyourchesttowardsyourthighs.(FigureA)

2.Contractyourabdominalmusclesasyourollbackuptostartingposition.

3.Holdpositionfor20seconds.Repeat3times.

FigureA

Page 2 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com

Abdominal Curls

Goal:Toimproveabdominalstrength.

1.Situprightinchair.2.Withupperpulleysextendedoveryour

shoulders,interlockyourfingersinfrontofyourchestbypullingthetwohandlestogether.(FigureA)

3.Contractabdominalmusclesasyoubendforwardatthewaistasfarascomfortablypossiblewhileroundingyourback.(FigureB)

4.Slowlyreturntostartingposition.5.Repeat10timesandperform2sets.

Techniquekey–Makesurethatwhileroundingyourbacktheabdominalmusclesarepullinginward,notpushingoutward.

FigureA FigureB

Chair Squats

Goal:Toimprovelegstrengthandabilitytogetin/outofchair.

1.Sittowardfrontofchairwithhandsonthighs,feetfirmlyonfloor.(FigureA)

2.Leanforward,transferringweighttolegsasyouliftyourbottomoffthechair.(FigureB).

3.Slowlyreturntoseatedposition.4.Repeat10timesandperform2sets.

Techniquekey–Practiceholdingpositionatstable,comfortableheights. FigureA FigureB

Trunk Twist Stretch

Goal:Toincreaserangeofmotionofback.

1.Situptallwhilefacingsidewaysinchair.2.Twistrightandgraspbackofchairwithhands(FigureA).3.Holdposition20secondswhilecontinuingtobreath.4.Repeat2timesoneachside.

Techniquekey–Toincreasestretch:Crossleftlegoverrightwhilestretchingtotheleftandrightlegoverleftwhilestretchingtotheright.(FigureB).

FigureA Page 3 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com

Oblique Strengthening

Goal:Toimprovetrunkstrength.

1.Sitonsideofchairasshown.2.Graspuppercablehandleandholdin

frontofsternumwithbothhands(Fig.A).3.Sittallwhiletwistingfromyourwaistaway

fromthepulleyanchor.Keepweightevenlydistributedbetweenrightandleftbuttocksasyoutwist(Fig.B).

4.Slowlyreturntostartingposition.5.Repeat10timesandperform2sets.

Techniquekey–Maintainpulleysdirectlyinfrontofsternumthroughouttwist. FigureA FigureB

Hamstring Stretchwith Sciatic Nerve Glide

Goal:Tostretchbackoflegandincreasemobilityofsciaticnerve.

1. Sittallinchair.2. Extendonelegoutasstraightasyou

canwithoutincreasinglowerbackpain.(FigureA)

3. Pointandflexankle10timesineachdirectionwhilekeepingyourlegextended.(FigureB)

4. Repeat2timeseachside.

Techniquekey–Pointandflexfromankle,nottoes.

FigureA FigureB

Quadricep Stretch

Goal:Tostretchthefrontofthigh.

1.Standatrightsideofchair.Faceawayfromchairandholdbackofchairforbalance

2.Placerightfootonchairseatasshown(FigureA).3.Squeezebuttocksandabdominalstotuckpelvisunder.Keepthighs

together.Feelstretchinfrontofthigh.4.Repeat2timeseachside.5.Holdstretchforatleast20seconds.Recommendholdingfor60-90

seconds,ifpossible.

Techniquekey–Keepthighstogether.

FigureA

Page 4 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com

Hip Flexor Stretch

Goal:Toincreaseflexibilityofhipsanddecreasestraintolowerback.

1.SitsidewaysonthechairwithonekneeontheHealthStepandoppositearmholdingthebackofchairforsupport.(FigureA)

2.Squeezebuttocktofeelastretchinfrontofyourkneelinghip.3.Holdstretchforatleast20secondseachside.Recommendholding

for60-90secondsifpossible.4.Repeat2timeseachside.

Techniquekey–Maintainmostofweightonchairandpadunderkneeifneeded.Stretchkneebehindyoutoincreasestretchinfrontofthigh.

FigureA

Hip Flexor Stretch - Alternate Technique

1.StandfacingbackofchairwithhandsonBalanceBarforsupport.

2.Steponefootbackwardsapproximately12inches.3.Maintaininguprightposture,tuckpelvisunderwhile

squeezingbuttockmusclestofeelastretchinfrontofyourhip(FigureA).

4.Toincreasestretchgentlylungeweightforwardontofrontleg.

FigureA

Page 5 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com

Symptomsoflumbarstenosisareusuallyexacerbatedwithstandingorwalking.TheResistanceChairoffersthesepatientsanexcellentwaytoconditiontheirbodieswhilesittingwithoutpain.Thefollowingaresomesuggestedupperbodyexercises.

Additional Upper Body Exercises

Chest Press

Goal:Toimprovestrengthofchestandshouldermuscles

1.Sitinchair.2.Graspuppercablesatchestlevel.(Fig.A)3.Pusharmsforward,returnslowly.(Fig.B)4.Repeat10timesandperform2sets

Techniquekey–Keepwristsstraightthroughoutexerciseandshouldersrelaxed,awayfromears.

FigureA FigureB

Forward Raises

Goal:Toincreasestrengthoffrontofshoulders.

1.Sitinchair.2.Grasplowercablesineachhandas

shown.(FigureA)3.Withthumbspointingupward,palmsfacing

inward,raisebotharmsinfronttoshoulderlevel,lowerslowly.(FigureB)

4.Repeat10timesandperform2sets.

Techniquekey–Maintainshouldersrelaxed,downawayfromears,asyouraiseyourarms.Keepwristsstraight.Exhaleasyouraisearmsinhaleasyoulowerarms.

FigureA FigureB

Page 6 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com

Side Raises

Goal:Toincreasestrengthofsidesofshoulders.

1.Sitinchair.2.Grasplowercablesineachhand.(Fig.A)3.Raisebotharmsouttosideasshown.

Lowerslowly.(Fig.B)4.Repeat10timesandperform2sets.

*Caution:Donotraisehigherthanshoulderlevel.

Techniquekey–Maintainshouldersrelaxeddownawayfromearsasyouraiseyourarms.Keepwristsstraight.Exhaleasyouraisearms,inhaleasyoulowerarms.

FigureA FigureB

Combined Forward/Side Raises

Goal:Toincreasestrengthofrotatorcuffandshoulders.

1. Sitinchair.2. Grasplowercablesineachhand.(Fig.A)3. Withthumbspointingupward,palmsfac-

ingtogetherraisearmstoshoulderlevelasshown.Lowerslowly.(Fig.B)

3. Repeat10timesandperform2sets.

Techniquekey–Maintainshouldersrelaxeddownawayfromearsasyouraiseyourarms.Keepwristsstraight.Exhaleasyouraisearms,inhaleasyoulowerarms.

FigureA FigureB

Bent-Over Reverse Flys

Goal:Tostrengthenupperbackmusclesforpostureandshoulderalignment.

1.SitinChair,foldforwardsochestrestsonthighs,handsreachtowardfloor.(Fig.A)

2.Squeezeshoulderbladestogetherasyouraisearmsouttothesides.

3.Hold5seconds.(Fig.B)4.Relaxarmstofloor.5.Repeat12times.

Techniquekey–Lookdowntomaintainneutralpositionofyourneck(neckstraight).

FigureA FigureB

Page 7 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com

Bicep Curl

Goal:Toincreasestrengthoffrontofarms.

1.Sitinchair.2.Grasplowercablesineachhand,palms

facingforward.(Fig.A)3.Bendelbowsandslowlystraighten.(Fig.B)4.Repeat10timesandperform2sets.

Techniquekey–Keepshouldersstableasyoubendelbows.

FigureA FigureB

Tricep Pulldown

Goal:Toincreasestrengthofbackofarms.

1.Sitinchair.2.Graspoverheadcablesandpulldownto

startingpositionasshown;elbowsatsidesandbentto90degrees.(Fig.A)

3.Pushcablesdowntosidestostraightenarms.(Fig.B)

4.Slowlybendelbowsto90degrees.5.Repeat10timesandperform2sets.

Techniquekey:Keepelbowsclosetosidesofribs(orsidesofbody),andkeepwristsstraight.

Techniquekey–Keepelbowsclosetosidesofbody.

FigureA FigureB

Page 8 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com

Advanced Upper Body Exercises

Bent Over Reverse Flys with Pulleys

Goal:ToStrengthenupperbackmusclesforpostureandshoulderalignment.

1. SitinChair,foldforwardsochestrestsonthighs,handsgrasplowerpulleys.(Fig.A)

2. Squeezeshoulderbladestogetherasyouraisepulleysouttothesides.(Fig.B)

3. Hold5seconds.4. Relaxarmstofloor.5. Repeat12timesandperform2sets.

Techniquekey–Lookdowntomaintainneutralpositionofyourneck(neckstraight).

FigureA FigureB

Bent-Over Row (One Arm Row)

Goal:Strengthenupperbackandshouldermuscles.

1. Beginexercisebybendingoverandsup-portingyourselfwithonehandandonekneeonthechairseat.

2. Graspthelowercablewithyourarmreachingdownstraight.(FigureA)

3. Pullthecablestraightupsothatyourhandendsupnearyourchestwithyourelbowbentandpointingupwardsasshown.(FigureB)

4. Repeat12times;perform2setseacharm.

TechniqueKey:Keepyourabdominalscontractedasyouperformtheexerciseandlookdowntomaintainneutralpositionofyourneck(neckstraight).

FigureA FigureB

Page 9 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com

Exercises with the Freedom Flex

Abdominal Crunches

Goal:Toincreaseabdominalandcorestrength.

1. PositiontheSaddleHooksothattheresistancecablesarewithinarmsreachwhileyouaresittinginthechair.

2. Grasptheoverheadresistancecablesineachhand.(FigureA)

3. Pullthecablesasyoucurlforwardfromyourwaistandtightenyourabdominalmuscles.Exhaleduringthisphaseoftheexercise.(FigureB)Thehandlesremaininfrontofyourforeheadthroughouttheexercise.

4.Inhaleasyoureleasethecontractionandreturntotheuprightsittingposition.

5. Repeat12times.

FigureA FigureB

Abdominal Crunch with Single Leg Lift

Goal:Toincreaseabdominalandcorestrength.

1. PositiontheSaddleHooksothattheresistancecablesarewithinarmsreachwhileyouaresittinginthechair.

2. Grasptheoverheadresistancecablesineachhand.(FigureA)

3. Simultaneouslyliftyourleftkneeasyoupullthecablesandcurlforwardfromyourwaist.Tightenyourabdominalmusclesandexhaleduringthisphaseoftheexercise.(FigureB).

4. Inhaleasyoureleasethecontraction,loweringyourlegandreturningtotheuprightsittingposition.

5. Repeat12timeswitheachleg.

TechniqueKey:Roundyourbackasyoucurlforward.

FigureA FigureB

Page 10 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com

Latissimus Pulldown

Goal:Toincreasestrengthofbackmuscles.

1. PositiontheSaddleHooksothattheresistancecablesarejustwithinarms’reachwhileyouaresittinginthechairwithyourarmsextendedaboveyourhead.(FigureA).

2. Sittallasyoupullthecablesdowntowardsyourshoulders,elbowstothesides.(FigureB).

3. Slowlyextendyourarmsupwardtothestartingposition.

4. Repeat12timesandperform2sets.

FigureA FigureB

Front Pulldown

Goal:Toincreasestrengthofthebackandarmmuscles.

1. PositiontheSaddleHooksothattheresistancecablesarejustwithinarmsreachwhileyouaresittinginthechairwithyourarmsextendedaboveyourhead.(FigureA).

2.Witharmsinfrontofyou,elbowsfacingforward,palmsfacingyou,pullcablestowardyourwaist(FigureB).

3. Slowlyextendarmstowardthestartingposition.

4. Repeat12timesandperform2sets.

FigureA FigureB

Page 11 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com

NOTES

•Engageabdominalswithallexercises.•Remembertobreathewitheachrepetition.•Start rehabilitationprogramslowly, onlyworking throughminimaldiscomfort levels. If

painincreases,decreaseresistanceleveland/orrepetitions.• Consult your physician if you experience increased pain, weakness, numbness,

palpitationsorsevereshortnessofbreath.

CAUTION:Beforebeginninganyexerciseprogrampleaseconsultahealthcareproviderforappropriateexerciseinstructionsandsafetyprecautions.

LUMBAR STENOSIS PROFESSIONAL NOTES

1. Seatpatientinchair.Usefootrestifneededtostabilizepatient.

2. Use posture support unless patient has long legs, as this will place them too farforwardinchair.

3. Startwith trunk flexion stretch to open vertebral canal and stretch posterior trunkmuscles.

4. Ifthepatienthasmoderatetosevereosteoporosis,avoidexcessivetrunkflexion.

5. Seatedabdominalcurlsareanexcellentwaytoincreaseabdominalmusclestrengthwithoutstressingtheneck.Cuethepatienttofirstcontractthetransversusabdominusmuscleandtoexhaleandpullthebellyinwhilecurlingforward.Makesuretheyareperforming themovementbyflexing the trunk,notbypulling thecableswith theirarms.

6. Chairsquats:Instructpatienttosittowardthefrontofthechairwithbothfeetfirmlyplantedonthefloor.Havethepatientpracticeshiftingtheirweightforwardontotheirfeetwhileliftingtheirbuttocksoffoftheseat.Makesurethepatientmaintainsneutrallowerextremityalignmentwiththekneespointingdirectlyoverthefeet.Forsafety,cuethepatienttofeeltheseatofthechairbehindtheirlegspriortoreturningtotheseatedposition.

Page 12 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com

7. TrunkTwist:Havethepatientsittallandmaintainuprightpostureastheytwist.Usecautionorexcludethisexerciseifthepatienthasmoderatetosevereosteoporosis.Ifthepatienthasforaminalstenosis,avoidrotationifitreproducesradicularsymptoms.

8. Obliquestrengthening:Thisexerciseisextremelyeffectivewhendoneproperly.Themovementisverysmallandisinitiatedbycontractionoftheobliquemuscles.Makesurethemovementcomesfromthetrunktwistingandnotfrompullingwiththearms.Thecablehandlesshouldremaininfrontofthecenterofthepatient’sbodythroughoutthemovement.

9. HamstringStretchwithSciaticNerveGlide:Exclude thisexercise if itelicits lowerbackpain,numbnessortingling.

10. Quadriceps and Hip flexor stretches: Tight rectus femoris and iliopsoas musclescauseincreasedlumbarlordosisandanteriorpelvictilt.Therefore,stretchingthesemuscles isaneffectiveway to reduce the lumbarextensionmoment to thespine.Cuethepatienttofocusonperformingaposteriorpelvictiltinthestretchingposition.Ifthesemusclesareverytightsuchthatthepatientisunabletoattainneutralpelvicposition,thisstretchmaybetoodifficultforthepatienttoperformwithoutaggravatingsymptomsoflumbarstenosis.

11. AdditionalUpperBodyExercises:Manypatientswithlumbarstenosishavelimited

tolerance to standing and walking. Therefore, exercises in sitting are a safe andeffectivewayforthesepatientstostrengthentheirupperbody.RemovethePostureProp back support if it puts the patient in too much extension.The Posture Propisbeneficialtoassureimprovedscapulohumeralpositioningforasaferupperbodyworkout.Cuethepatienttoexhaleuponexertionandtocontractabdominalmusclesforincreasedtrunksupport.

Page 13 Copyright © 2007 Continuing Fitness, Inc. www.wheels-of-fitness.com