Spinal-Exercise Prescription in Sport: Classifying Physical Training and Rehabilitation by Intention and Outcome

Abstract

Context: Identification of strategies to prevent spinal injury, optimize rehabilitation, and enhance performance is a priority for practitioners. Different exercises produce different effects on neuromuscular performance. Clarity of the purpose of a prescribed exercise is central to a successful outcome. Spinal exercises need to be classified according to the objective of the exercise and planned physical outcome.Objective: To define the modifiable spinal abilities that underpin optimal function during skilled athletic performance, clarify the effect of spinal pain and pathologic conditions, and classify spinal exercises according to the objective of the exercise and intended physical outcomes to inform training and rehabilitation.Design: Qualitative study. Data Collection and Analysis: We conducted a qualitative consensus method of 4 iterative phases. An exploratory panel carried out an extended review of the English-language literature using CINAHL, EMBASE, MEDLINE, and PubMed to identify key themes and subthemes to inform the definitions of exercise categories, physical abilities, and physical outcomes.An expert project group reviewed panel findings. A draft classification was discussed with physiotherapists (n ¼ 49) and international experts. Lead physiotherapy and strength and conditioning teams (n ¼ 17) reviewed a revised classification. Consensus was defined as unanimous agreement.Results: After the literature review and subsequent analysis, we defined spinal abilities in 4 categories: mobility, motor control, work capacity, and strength. Exercises were subclassified by functionality as nonfunctional or functional and by spinal displacement as either static (neutral spinal posture with no segmental displacement) or dynamic (dynamic segmental movement). The proposed terminology and classification support commonality of language for practitioners.Conclusions: The spinal-exercise classification will support clinical reasoning through a framework of spinal-exercise objectives that clearly define the nature of the exercise prescription required to deliver intended physical outcomes.Key Words: spine, back, classification Key PointsThe spinal abilities underpinning optimal function during skilled athletic performance have been evaluated, and a comprehensive framework of exercise and physical outcomes has been established. The framework provides a basis for clinical reasoning in spinal-exercise prescription and establishes a platform for shared understanding to enable interdisciplinary efforts within a diverse spectrum of musculoskeletal practice.

Clinical reasoning framework for thoracic spine exercise prescription in sport: a systematic review and narrative synthesis

“…They subsequently classified exercises according to key parameters of function/non-functional, segmental, pillar or whole-body, dissociation or stabilisation, etc. The framework 1 provides the basis to develop and evaluate region-specific exercises to support precision of exercise prescription in sport. Coined the 'Cinderella' region, 2 the thoracic spine is pivotal to sporting performance.…”

“…The aim, therefore, of this study was to review exercise prescription in the thoracic spine using the evidence-based spinal exercise classification. 1 Objectives ► To identify prescribed thoracic spine exercises in sport. ► To evaluate exercises according to aim, mobility, motor control, work capacity and strength.…”

“…Additionally, selection included both functional and nonfunctional exercises, where functional exercises describes weight bearing or sport-specific exercises which can be performed in multiple planes of motion involving several joints 1 and non-functional exercises describes exercises performed in partial weight-bearing positions moving in a single plain of motion involving few joints. 1…”

“…The synthesis allowed subclassification for static and dynamic exercises, functional and non-functional exercises, segmental, spinal, whole-body stabilisation/dissociation, pillar or segmental conditioning, pillar strength, stiffness or power development. 1 resulTs From 2348 sources which included social media, database searches and other sources, exercises were identified and stored. Some studies from the databases included more than one exercise for consideration.…”

“…These mutually exclusive classification systems do however create confusion for practitioners to inform their evidence-based exercise prescription in practice as a focus on functional performance is required. To assist decision-making in spinal exercise prescription in sport, Spencer et al 1…”