Supine Bridge Exercise for Low Back Pain: A Fascial Approach for Movement Impairment Syndromes (Part II)

The supine bridge exercise (SBE) is widely used in rehabilitation for individuals with low back pain (LBP) due to its ability to enhance spinal stability and neuromuscular control. This second installment of a three-part review builds on previously discussed biomechanical principles to offer a functional rationale for applying the SBE to LBP subgroups identified through the Movement Impairment Syndromes framework. A novel interpretative model is proposed in which the SBE is reconceptualized not solely as a muscular strengthening tool, but as a method to increase passive fascial stiffness and promote segmental spinal stability. Emphasis is placed on the relationship between lumbar curvature, fascial tension, and motor control, with distinct execution strategies recommended for flexion-based and extension-based LBP. In flexion-related cases, the goal is to activate lumbar paraspinals while minimizing hamstring involvement; in extension-based presentations, limiting lumbar extension, engaging abdominal control, and promoting posterior pelvic tilt are prioritized. This article highlights the value of individualized, evidence-informed protocols that integrate fascial and biomechanical considerations to optimize rehabilitation outcomes for patients with LBP.