• Supine:
Hook-lying flexes the lumbar spine; legs extended extends the spine. A pillow under the head flexes the neck; a small roll under the neck stabilizes a mild lordosis with the head neutral.

• Prone:
Use of a pillow under the abdomen flexes the lumbar spine; no pillow extends the spine. To maintain the cervical spine in neutral alignment without rotation, a split table or a small towel roll placed under the forehead provides space for the nose so the patient does not turn the head.

• Sitting:
Usually causes spinal flexion, especially if the hips and knees are flexed. To emphasize flexion, the feet are propped up on a small footstool; to emphasize extension, a lumbar pillow or towel roll is placed in the low-back region. To unweight the spine, the arms are placed on an armrest, or a reclining chair is used.

• Standing:
Usually causes spinal extension; to emphasize flexion, one foot is placed on a small stool.

Muscle Performance: Core Muscle Activation and Basic Stabilization
Whether the patient has a cervical or lumbar problem, as soon as tolerated the patient is taught how to activate the core muscles.

Lumbar Region—Core Muscle Activation
For the lumbar region, the “drawing-in” maneuver is used to activate the transversus abdominis and a gentle bulging contraction of the multifidus muscle. Facilitation techniques may be necessary.

Cervical Region—Core Muscle Activation
For the patient with cervical pain, gentle head nods and slight flattening of the cervical lordosis in the supine position are used for core activation of the longus colli and multifidus.

Basic Stabilization
Once the patient learns to activate the core muscles, simple upper and lower extremity motions with the spine stabilized are added to the intervention. Passive prepositioning is used if the patient is unable actively to maintain his or her functional position. For both cervical and lumbar problems, the patient is instructed first to do the drawing-in maneuver followed by gentle arm motions within a range that does not exacerbate symptoms. Leg motions require greater lumbopelvic control and are introduced if the patient is able to demonstrate pelvic control and the symptoms are not exacerbated with the movements.

Basic Functional Movements
The patient is taught to perform simple movements for ADLs while protecting the spine in the functional position. These movements include rolling from prone to supine and reverse, lying to sitting and reverse, sitting to standing and reverse, and walking.

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