Exercise therapy
Back ache
Z. Rozkydal

1. Lumbago
2. Chronic lumbalgia
3. Sciatica
Disc- degeneration, protrusion, hernia
Discogenic pain-  radicular syndrom –bellow knee
                               psedoradicular  syndrom- up the thigh
Facet joints
Spinal stenosis
Spondylolistesis
Ancylosing spondylitis
Osteoporosis
Infections
Tumors

Developement correct movements
Rebuild fixed stereotypes  in various postural situations
Cortical components of the movement system
Plasticity of CNS
Relaxation is necessary
Body image
Deep sensation
To form truly economical movements stereotypes
Breathing pattern

Stabilisation of muscle function
Acute x  chronic – different approach
Acute stage- medicine,   rest
Chronic stage
specific exercise, individual intensity
change the posture
ergonomic  meassurement
supportive bracing
strengthenig of trunk muscles:
Th and L spine, thorax, pelvis  muscles

Spinal stabilisation  function:
Not only  flexion and extension.
Not according origin and insertions
Upright alignment
To  reinforce segments with other muscles
Coordination during muscle activation

Spinal extensors- deep extensor first !!
                               then  superficial  extensors
Synergy between diaphragma, abdominal muscles
and pelvic floor muscles- play a crucial  role
Pelvic tilt is important
Intraabdominal pressure  is increased
The patient should not be a pasive recipient of the therapy
but active participant of the therapy

Other modalities
Mobilisation techniques
Influencing of trigger points
McKenzie therapy
CT guided facet denervation
CT guided periradicular therapy (morphium, marcain, local corticoids)
Analgetics
NSAID
Anticonvulsion drugs- muscle relaxant
Antidepresant drugs
Drugs for peripheral nerve regeneration
Surgery