Chapter 17



“The ability of the spine under physiologic loads to limit patterns of displacement so as not to damage or irritate the spinal cord or nerve roots, and in addition, to prevent incapacitating deformity or pain due to structural changes.”{5}

A. Clinical instability - when the joint loses enough stability to prevent it from adequately providing the mechanical functions of protection. The surgeon may choose joint fusion, ligamentous repair or reconstruction, or joint immobilization with bracing or casting .

B. Functional instability - when the stabilizing effect of the joint components is reduced but continues to permit function. The patient with this type of instability can benefit from “functional stabilization training”.

C. Functional Stabilization Training - The joint is placed and held in an anatomically correct position to remove excessive loads placed on the injured tissue. The patient trains the surrounding tissues to provide support to the joint while the ligaments, discs and cartilage receive blood flow and nutrition to assist with healing. In some instances, the patient cannot maintain the correct joint position and therefore, the therapist must brace the joint and utilize load eliminated or load reduced positions for training.


A. Discs
B. Ligaments
C. Vertebra
D. Muscles


A. Increased joint play
B. Pain response
C. Muscle guarding/spasm
D. Inflammation
E. Degenerative changes at joint surfaces
F. Further injury to stabilizing components


A. Definitions

1. Function — performance required of a person in the course of work{2}
2. Stabilize - to make steady or firm{2}
3. Train - to guide the growth or development of{2}

B. Goals

1. Education

a. To avoid reinjury
b. To change movement disorder{3}
c. To improve quality of life

2. Function

a. To return to work
b. To resume previous activity or hobby

C. Training postures of the spine

1. Explore spinal movement’
2. Find “neutral spine” — proper anatomic alignment of the spinal column or that position closest to neutral with fewest symptoms’
3. Perform an abdominal bracing technique’

a. Instruct patient to palpate the abdominal region during coughing
b. Recreate the abdominal contraction without coughing
c. Maintain abdominal contraction and continue normal breathing pattern

4. Maintain the “neutral spine” position with abdominal bracing while moving through developmental sequence

5. Utilize external bracing or support if unable to maintain the “neutral spine” position with abdominal contraction


A. Monitor load tolerance

1. Begin with “below body weight” or “below head weight” technique during training
2. Progress into full body or head weight postures during training

B. Progress from supported to less supported positions

1. Progression of training positions

a. Supine/prone
b. Incline lying
c. Sitting
d. Quadruped
e. Standing
f. Kneeling

2. Progression of support

a. Full support
b. Partial support
c. Unsupported
d. Even surfaces
e. Uneven surfaces

C. Progress the type of movements

1. Progress the direction of movement

a. Simultaneous movements in frontal planes
b. Reciprocal movements in frontal planes
c. Unilateral extremity movement in diagonal planes
d. Bilateral extremity movements in diagonal planes
e. Multi-component movements to simulate functional activities

2. Progress the size of movement

a. Gross patterns of movement
b. Small, isolated patterns of movement

3. Speed of movement

a. Slow
b. Moderate
c. Quick

4. Type of training

a. High repetition
b. Light resistance/load


  Next: Chapter 18