Self Help

The following is a copy of the guidance sheet I often give to patients to help with their (lower back problem) rehab. It is provided here for information, not as advice or recommendation without knowledge of your particular situation. Please use with caution!

Low Back Exercises –guidance notes & instructions.

No single exercise is ideal. To gain maximum benefit from the exercises requires a significant commitment of time and effort. You will need to make these exercises part of your daily routine. Normal (cardio-vascular) exercise is beneficial if performed 3x per week. However low back exercises are best performed every day. When performing these exercises ‘no pain-no gain’ is not true, - if it hurts, ease off. To maximise the benefit of these specific low back exercises, regular cardiovascular exercise (e.g. fast walking, with arms swinging) should also be performed.

There are 3 main aspects to good spinal health –Endurance, Strength, & Flexibility.

· The most important is Endurance. Low effort, but long duration exercises are best for rehab and prevention. This means that the following exercises should be performed progressively, i.e. start with only a few repetitions of each exercise, and gradually increase the exercise duration.

· Absolute strength is not important for good back health. However, muscle groups (front, back and side) should be balanced.

· Flexibility should not be emphasized until the other aspects are sorted out. Flexibility exercises should be performed without any loading (weights). Avoid maximum flexion (bending forwards) exercises for at least one hour after getting up in the morning.

Exercise 1 - Abdominal Bracing (The foundation for all the following exercises)

This involves tensing the muscles of the abdominal wall, without actually causing any movement. To isolate the correct muscles, imagine drawing in the tummy button towards the spine, then trying to lift it up towards the rib cage – all without any movement! Continue breathing freely. This exercise can be done at any time, (in the car, watching TV, walking the dog etc), not just at exercise time. The more the merrier!

This bracing should be performed while doing all the following exercises.

Exercise 2 - Cat and Camel

This is a loosening up exercise. While on all fours, arch the back up (while the head droops), then let the back droop while the head rises. If arching the back is uncomfortable, don’t do it! You should not push at the end range, rather just go through the motion. Repeat 5/6 times.

Exercise 3 - Lunge

Stand with hands on hips. Take one (half) stride forward while keeping the back upright. Bend the trailing leg at the knee. Return to an upright position, then repeat with the other leg.

Exercise 4 - Flossing (Use only if you have sciatica (pain down the back of the legs))

Start by sitting, with your legs able to swing freely clear of the floor. Lower your chin onto your chest. Gently lift your head to look at the ceiling at the same time as raising your foot up by bending the knee (only move the leg effected by sciatica). The action is similar to using a child’s swing. Repeat the combined head / leg movement. Start very gently, and discontinue if the pain gets worse.

Exercise 5 - Curl ups

To gain the benefit without stressing the spine, good technique is vital. Lie on your back with your hands under the small of your back. Bend one knee to 90°. Brace your abdomen (exercise 1). Leave your elbows on the floor and raise up your head & shoulders so they are just clear of the floor. Hold for 6-8 seconds. Your body should bend around the shoulder blade area, and the head & neck should remain as a rigid block. It is important that the neck does not bend (no chin tucking or jutting). If you find your neck is uncomfortable, try placing your tongue on the roof of your mouth behind the front teeth. To make this exercise harder, raise your elbows just off the floor.

Exercise 6a - Side bridge

Lie on your side propped up on your elbow & hip. Keep your thighs in line with your body but bend your knees 90°(most people find this an 'unusual' position). Place your ‘spare’ (upper) hand on the opposite shoulder. Brace your abdomen (exercise 1). Raise your hip off the ground until your back is straight. Hold for 6-8 seconds.

Exercise 6b - Side bridge

Start as above but without bent knees (top foot in front of the other). When your hips are lifted off the ground you are supported on your feet and one elbow. This is much harder than the first stage. Gradually introduce rolling forwards and backwards.

NB if the shoulders cannot cope with this exercise, lie on your side and lift your legs off the ground. Do not bend forward at the hips.

Exercise 7 - Birddog

Start by crouching on all fours, arms and thighs vertical, head in line with spine (looking at your hands). Brace your abdomen. Raise one arm or leg at a time to be parallel to the floor. Hold for 6-8 seconds. Don't twist your spine, i.e.keep your buttocks level.

To progress this exercise you should lift one arm and the opposite leg at the same time. You can then describe a square with each limb.

When doing both these exercises try to ensure your hips and neck remain horizontal – either ask someone to check, or possibly do them beside a mirror.

Finally –Be patient, but be persistent. Progress depends on many factors, including the severity of your problem, how well the exercises are performed, and your commitment.

For further detailed notes and explanations please refer to “Low Back Disorders – Evidence based Prevention & Rehabilitation” By Prof Stuart McGill. ISBN 0-7360-4241-5