Lumbar Flexion

by Nancy Lim

Description of Motion¹
The lumbar spine bends forward to allow an individual to be able to tie their shoes or pick up a bag of groceries from the floor.
The primary muscles involved with producing lumbar flexion are the Rectus Abdominis, internal oblique, and external obliques.
The nerves that innervate the Rectus Abdominis are the Intercostals (7-11) and Subcostal (T12). The Internal Oblique is innervated by the Intercostals 7-11, Subcostal (T12), and the L1 nerve root. The External Oblique is innervated by the Intercostals (7-11) and Subcostals (T12).

Mobilizing - Increasing Range of Motion

Prone Extensions
Patient will lie prone with elbows flexed. Patient will extend elbows to come onto their wrist, feeling a stretch on the abdominals. Hold the position for 10 seconds and then slowly flex the elbows to come back down to the mat. Repeat the stretch 10 times for 10 seconds each.

Hip Flexor Stretch
Patient will lie supine on the edge of the mat. Patient will pull the knee that is not against the edge of the mat to their chest. Allow the other leg to hang off the mat. Hold the stretch for 30 seconds while feeling a stretch in the hip flexors. Bring the hanging leg back up the the mat. Slide to the other side of the mat to repeat on the other leg. Perform the stretch on both legs for 30 seconds.

Stability Ball Stretch
Patient will sit on a stability ball and slowly roll the ball onto their backs. Patient will continue to arch back onto the ball while feeling a stretch in their hip flexors. Hold the position for 30 seconds and then roll the ball back towards the starting position. Perform the stretch 10 times for 30 seconds each.

Indications for Stretching

A lumbar flexion mobilization can be done to improve lumbar flexion range of motion, passive physiological movements, and passive accessory movements. It may also help with the patient's level of pain. ²

Refer to the following link to learn more about treatments and indications for stretching with different lumbar pathologies:
https://www.princeton.edu/uhs/pdfs/Lumbar.pdf ³

Strengthening

Supine Marches
Patient will lie supine and pull their belly towards their spine. Then, lift and alternate legs as if marching. Repeat the exercise for 3 sets of 10 repetitions. Progress the exercise by having a patient do the same exercise while sitting on a stability ball.

Pelvic Tilts
Patient will lie supine and press their low back into the mat. Instruct the patient to put one hand under their back and push their back into their hand. Repeat the exercise for 3 sets of 10 repetitions. Progress the exercise by having the patient do pelvic tilts while sitting on a stability ball.

Bridges
Patient will lie supine. Instruct the patient to pull their belly towards their spine. Holding this position, have the patient lift their hips off of the mat and slowly lower back down. Repeat the exercise for 3 sets of 10 repetitions. Progress the exercise by having the patient bridge up and lift one leg up at a time, as if marching.

Potential Clinical Syndromes or Etiologies

Lumbar spinal stenosis is a frequent pathology often requiring rehabilitation of the lumbar spine into flexion. This involves stretching tight muscles around the lumbar spine and strengthening muscles that are weak to provide more stabilization. ⁴

Refer to this link to learn more about other clinical syndromes related to the lumbar spine: http://morphopedics.wdfiles.com/local--files/week-ten/McKenzie%20Philosophy%20in%20Treatment%20of%20the%20Lumbar%20Spine%202012.pdf ⁵

Additional Web Based Resources

1. https://www.princeton.edu/uhs/pdfs/Lumbar.pdf ³
2. http://morphopedics.wdfiles.com/local--files/week-ten/McKenzie%20Philosophy%20in%20Treatment%20of%20the%20Lumbar%20Spine%202012.pdf ⁵
3. http://umm.edu/programs/spine/health/guides/rehabilitation-for-low-back-pain ⁶

References (AMA Format)

1. Muscles. NYU Langone Medical Center Web Site. http://hjd.med.nyu.edu/spine/patient-education/spine-anatomy/muscles-and-ligaments/muscles. Accessed November 25, 2014.
2. Fundamentals of Maitland Mobilizations. Morphopedics Web Site. http://morphopedics.wikidot.com/fundamentals-of-maitland-mobilizations. Accessed December 5, 2014.
3. Lumbar/Core Strength and Stability Exercises. Princeton University Athletic Medicine. https://www.princeton.edu/uhs/pdfs/Lumbar.pdf. Accessed December 3, 2014.
4. Standard of Care: Lumbar Spinal Stenosis/Physical Therapy Management. Brigham and Women's Hospital, Inc. Department of Rehabilitation Services. Published 2008. Accessed December 5, 2014.
5. The Lumbar Spine. Morphopedics Web Site. http://morphopedics.wdfiles.com/local--files/week-ten/McKenzie%20Philosophy%20in%20Treatment%20of%20the%20Lumbar%20Spine%202012.pdf. Accessed December 3, 2014.
6. Rehabilitation for Low Back Pain. University of Maryland Medical Center. http://umm.edu/programs/spine/health/guides/rehabilitation-for-low-back-pain. Accessed December 3, 2014.