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Neutral spine vs. neutral zone ? is the difference all that significant?
Craig Phillips, B.App.Sc (Phty), Dr of ClinPhysio candidate, University of Melbourne, Victoria, Australia
Purpose
The concept of exercising with a neutral spine became popular in the early 1990?s with evolving research on spinal stabilisation. The rationale was that exercising specific muscles in a neutral spine position, rather than in a variety of positions, would best train the deep stabilising musculature of an injured individual to control the unstable central region. This concept may in fact be flawed.
Considerable research since has shown specific exercises lead to improvement of low back pain more effectively than general strengthening. More recent research may allow us greater specificity with exercises. Patients are a heterogeneous group that may not necessarily all respond to the current range of homogeneous spinal stabilisation exercises.
Approach - reviewing the literature
Recent literature has compared directionally specific exercise programmes with those generally given to low back pain patients. The difference being one group could be seen to work in a neutral spine with some improvement while the group working in a more neutral zone implicating a patient specific bias, fared significantly better.
Discussion
While neutral spine is generally considered exercising in a sustained lumbar lordosis, it does promote a relatively rigid position. Panjabi?s concept of neutral zone allows for movement around a neutral point. This can help cater for pathological preferences. Exercising with a direction preference relates well to movement asymmetries that are a major feature of most injury presentations. This adds a further tool to the clinicians repertoire to assist in differential diagnosis and determining the relevance of radiological findings.
Conclusion
This paper will link past work on spinal stability concepts with more recent research that may further enhance specificity and efficacy via directionally specific stability exercises around the neutral zone to accommodate pathological preferences. Pilot data will also be presented that demonstrates recordable differences in performance with implication of correct and incorrect bias vs neutral spine.