Advanced Lumbar Spine Overuse Rehabilitation

Pain rated ≤3/10 at rest with verbalNumericRatingScale,Able to maintain neutral lumbar spine during static standing,Lumbar flexion range of motion >30 degrees without symptom exacerbation,Demonstrates proper hip hinge mechanics during sit-to-stand, Able to activate multifidus and transversus abdominis independently,No neurological deficits: negative straightlegraise test for sciatic nerve involvement

→ Advance to: Week 3 - Stabilization Phase

Pain ≤2/10 during activities of daily living,Able to maintain lumbar spine neutral during prone lying with limb loading,Demonstrates isolated psoas and quadratus lumborum recruitment,Can hold abdominal bracing for 10 seconds in hooklying position,Lumbar extension range of motion ≥15 degrees symmetrically,Sacroiliac joint stability confirmed with standing flexion test

→ Advance to: Week 5 - Strengthening Phase

Pain-free during resisted lumbar extension and rotation exercises,Able to perform birddog exercise maintaining lumbar spine neutral for 30 seconds,Hip abduction strength 4/5 assessed with break test,Lumbar lateral flexion range of motion within 10 degrees of contralateral side,No provocation of facet joint symptoms during loaded extension activities,Erector spinae endurance >30 seconds in prone extension hold

→ Advance to: Week 7 - Functional Return Phase

Able to lift 10kg from floor maintaining lumbar spine neutral with hip hinge,Tolerance of prolonged sitting >45 minutes without discomfort,Negative slump test indicating no nerve root mechanosensitivity,Return to pre-injury activity level at 80% intensity,Core endurance passes Biering-Sorensen test >60 seconds,No sacroiliac joint provocation with stork test

→ Advance to: Discharge - Maintenance Program