What most people don't know about low back pain... Low back pain (LBP) remains the most common cause of disability and lost work time among working-age adults in industrialized countries. Studies have shown that approximately 90% of people will experience some degree of [...]
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What most people don’t know about low back pain…
Low back pain (LBP) remains the most common cause of disability and lost work time among working-age adults in industrialized countries. Studies have shown that approximately 90% of people will experience some degree of LBP in their lifetime. So, it’s understandable that patients with LBP comprise the largest percentage of people seeking care from a Physical Therapist.
Lower back pain can come in many different forms. It can present as a relatively simple muscle strain/spasm or disc degeneration, herniated disc, spinal stenosis, SI joint dysfunction, facet joint arthropathy, or any other scary medical terms you may have been diagnosed with in the past. No two patients with LBP are the same and therefore PT treatment plans must be specifically catered for each individual’s needs.
COMMON DENOMINATORS IN EVERY TYPE OF LOWER BACK INJURY
However, with any type of lower back injury, research has shown drastic atrophy (or loss of muscle mass / weakness) in the spinal multifidi musculature. The multifidi are the deepest of your spinal musculature and are the primary spinal stabilizers. So, as you can imagine, as your multifidi weaken after an injury you subsequently lose spinal stability which often results in further pain. Also, various studies have pointed to a loss of spinal mobility (“stiffness”) and core weakness as a factor in prolonged lower back pain. So, although it is true that no two patients with LBP are the same and should be treated as such – performing exercises that improve spinal mobility and lower back (specifically multifidi) / core strength helps to improve overall stability thus reducing pain.
WHAT EXERCISES CAN I PEFORM TO HELP IMPROVE LOWER BACK STIFFNESS AND CORE/ SPINAL STRENGTH?
So, whether you currently have LBP, have a history of LBP, or are being proactive and want to reduce the risk of developing LBP in the future – Check out these 3 exercises below to help improve spinal mobility and lower back / core strength and stability.
1. CAT / CAMEL:
A stiff back = a painful back. A GREAT way to improve lower back stiffness is with the CAT / CAMEL exercise as seen in the video below.
Instructions: Start on hands and knees with knees directly under hips and hands under shoulders. Start in a neutral spine position. Next, allow your stomach to sink towards the floor, creating a “valley” or “arch” in lower back. As you sink your stomach towards floor, slightly extend your head and neck up (if tolerable). Then, round your back up towards the ceiling and curl your chin towards chest (looking down towards your knees). Hold each position for 8-10 seconds to allow for the appropriate stretch. Perform 2 sets of 8-10 reps pending your tolerance.
2. POSTERIOR PELVIC TILT (ABDOMINAL BRACING)
This exercise is great for improving activation of your transverse abdominus muscle. This is your primary and most important abdominal stabilizer that often gets ignored with typical abdominal exercises that focus on your pool side 6 pack.
Starting position: Lying on back with knees bent up and feet planted on surface.
Place your index and middle fingers just inside your front pelvic bones (ASIS) and gently draw your belly button towards spine. If done correctly, you feel a muscle (transverse abdominus) gently pop up under your fingertips.
Next, roll your hips / pelvis backwards as to flatten your back against the surface (table, floor, etc). However, do not allow your hips / buttocks to lift off surface.
Hold for 3-5 seconds. Perform 2-3 sets of 10.
Level 2: Posterior Pelvic Tilt with marches:
While maintaining TA contraction and posterior pelvic tilt as described above (L1), perform 3 marches in a row. This = one set. Perform 8 or 10 sets per tolerance.
Level 3: Posterior Pelvic Tilt with leg extension:
While maintaining TA contraction and posterior pelvic tilt as described above (L1), alternate extending legs out towards the surface on which you are laying. 3 extensions in a row = 1 set. Perform 8-10 sets per tolerance.
Level 4: Posterior Pelvic tilt with toe taps:
While maintaining TA contraction and posterior pelvic tilt as described above (L1), lift both legs up in 90/90 position (knees over hips , lower legs parallel with floor). Then, slow and controlled, alternate taping toes to surface. 3 taps in a row = one set. Perform 8-10 sets pending tolerance.
Level 5: Posterior Pelvic Tilt with bicycle
While maintaining TA contraction and posterior pelvic tilt as described above (L1), lift both legs up in 90/90 position (knees over hips, lower legs parallel with floor).
Alternate lowering left and right leg down towards floor while extending hip and knee. The further you can lower the leg while maintaining pelvic tilt, the more difficult / challenging it becomes. Only perform within your tolerance.
3. MULTIFIDI QUADRUPED HIP HIKE
As mentioned earlier in this blog, the multifidi muscles are your deepest lower back muscles which are also your primary spinal stabilizers. To strengthen these muscles and improve spinal stability, see video below.
Starting position: Patient starts on hands and knees with knees directly under hips and hands directly under shoulders. One knee should be elevated on a bolster, thick towel, or pillows, etc (~ 4 inches). Initiate the hip hike from the hip to align your spine in a neutral position. Do not simply lift knee and foot off the mat. Perform 2-3 sets of 8-10 per tolerance (perform on both sides)
To progress this exercise, maintain hip hike and neutral spine position while extending hip. Perform 3 hip extensions in a row and then take break. This = one set. Perform 8-10 sets, per tolerance (perform on both sides)
To further progress this exercise, maintain hip hike and neutral spine position while lifting opposite leg and arm. Attempt to fully extend if tolerable.
Perform 3 in a row and then take break. This = one set. Perform 8-10 sets, per tolerance (perform on both sides)
If you have pain with any of the exercises in the videos, please do not proceed with such exercise. If your symptoms persist and/or you would like to be further examined / evaluated for a more specific treatment plan including hands on manual please contact one of our two offices in Baton Rouge and Zachary, LA.