Lower back pain exercises

Lower back pain presents in so many different ways.  On the contrary, two people with the same set of symptoms may respond to completely different treatment plans.  Perhaps the one thing all of us have in common, is our fight against gravity.  We are all subject to the compressive stress of gravity and therefore, the overwhelming majority of us may benefit from spinal decompression.

The following set of exercises, is an easy-to-do at home routine that will unload your spine from the compressive stress experienced during prolonged sitting, standing and existing on planet Earth.

More information about spinal decompression exercises and how to use a back block.

Spinal Decompression Exercises

Each and every one of us, for the rest of our lives, will be engaged in the battle against gravity.  It is a constant force applied to us every single day.  Coupled with the hours we sit, the sports we play, and the unexpected trips and falls we might endure, this translates to massive compressive forces placed upon the spine.

To deal with this, the spine has ‘discs’ between each vertebra.  They are fluid-filled shock absorbers and prevent bone-on-bone friction.  Since they do not have a blood supply, nourishing the discs occurs via osmosis.  Movement throughout the spine is thus vital to preserve and feed these structures, so that the discs can prevent excessive wear and tear to the vertebral column.

Incidental spinal movements throughout the day create a physical pumping effort which shunts nutrient-bearing fluids in, and stale fluids out.  Well-hydrated discs become plump which gives better bony separation and ultimately renders the spine more able to accommodate compression, impact and jarring.

The force of gravity means the discs naturally lose fluid throughout the day – people can lose up to 2cm in height by the end of the day.  Sleeping horizontal at night allows the natural fluid exchange within the discs to be carried out – fresh nutrients are drawn in, whilst stale fluid is expelled.

Prolonged sitting is a risk factor for maintain healthy discs.  In the first two hours of sitting, one can lose up to 10% of intradiscal fluid. Slumped sitting is particularly bad for the discs, as is any low activity posture.

The majority of back pain that exists today, is often due to compressive forces applied to the spine. In the age of chronic sitting, performing spinal decompression exercises daily may serve the overwhelming majority of back pain sufferers.

Using a back block is an easy and effective way to perform spinal decompression.  Lying backwards passively over a block exerts lumbar traction and both stretches the compressed disc wall and passively elongates tight local muscles and ligaments that have tethered and contracted the spine down.  This method works by stimulating pressure changes within the intervertebral discs by alternately loading and unloading the discs within their physiological range.  The physical separation of the spinal segments also counters the fluid loss and the slow deflation of the discs.

Using the back block

  1. Lie on the floor on your back with your knees bent so that your feet are touching the floor.
  2. Lift your backside off the floor and slide the block, on its flattest edge, to rest lengthways under your sacrum (the hard flat bone at the base of your spine).
  3. Straighten your arms above your shoulders to rest on the floor, then straighten out one leg at a time until both legs are relaxed.
  4. Remain in this position for 60 seconds only.  Expect some initial discomfort as your body adapts to the position.
  5. For a greater effect, you may progress to using the block on its second highest edge on subsequent sets.  Always start using the lowest edge first.
  6. After 60 seconds of lying over the back block, bring your arms back down to your sides.  Then return your legs, one at a time, to the starting position (take care as this can be uncomfortable).
  7. See the following pictures to reference the correct positioning of the block.

 

The challenge when in the final back block position, is to let go of all muscular tension.  If you are suffering back pain, your body may resist completely relaxing your back over the block.  Take your time.  With each exhale, attempt to let the muscles around your pelvic floor, hip flexors and lower back give way, so that you can begin to feel the traction sensation building up through your spine.

Pelvic rock

  1. Lie on your back with your knees bent and feet on the floor. In this position note that your lower back is somewhat raised (or arched) off the floor.
  2. Flatten your back against the floor (push fairly hard) and then relax.  Do this fairly quickly for about 30 seconds, aim for 30 repetitions.

Having just followed the back block routine, your back may now be feeling slightly sensitive.  Traction through the spine is a force we are not usually accustomed to. It can be a mildly painful experience following this decompression exercise.  The pelvic rock is a gentle way of alleviating any immediate discomfort experienced through the lower back after using the back block.

Knees rocking

  1. Raise your knees, one at a time, towards your chest so that your thighs are parallel to the floor.  Cross both ankles and relax your knees outwards.
  2. Place your hands around the outside of each thigh to hold your knees so that all the weight of your lower body is held in your hands.
  3. Gently oscillate your knees towards your chest for 30 seconds, do this rhythmically as if rocking a baby to sleep.

The knees rocking movement is an excellent way to restore lumbar flexion range of motion.  This helps to loosen the large lumbar erector spinae muscles of the lower back and facilitate further, the imbibition of fluid into the intervertebral discs.

Reverse curls

  1. Start in the same position as for the knees rocking exercise but instead, interlace your fingers behind your head.
  2. Using your lower abdominals, bring your knees towards your chin, attempting to lift your backside off the floor.
  3. Try to keep your stomach pulled inwards as you lower your legs perpendicular to the floor.  Ensure your thighs do not pass beyond this return point (90 degrees).  This will cause your back to arch and potentially become painful.
  4. Do 15 repetitions.

The reverse curl exercise activates the abdominal corsetry that serves to lift your spinal segments off one another.  In this way, the lower abdominals act as the body’s own spine sparing function enabling spinal decompression.

Child’s pose

  1. Start on all fours, then sit your backside onto your heels.
  2. Keep the knees pointing outwards at roughly 45 degrees, then lower your torso forwards with the arms stretched out in front of you.
  3. Relax in this position for up to 30 seconds.

This yoga pose has many benefits but is used in this instance as another means for spinal decompression.  If you have a history of hip, knee or ankle injuries, you may struggle to morph your body into this position.  If so, some simple forward bending off the edge of a seat, or toe touches will suffice.  See the below suggestions.

Forward bending (below left), Toe touches (below right)

 

Since compression builds up in our spines throughout the day, the best time to perform this routine is at the end of the day.  You can however follow this routine as many times as you like.  Remember, in the mornings after sleep, you would have already been somewhat decompressed throughout the night.  It would thus be less effective doing these exercises upon waking.  Ideally, you would attempt to do this routine between 12 and 3pm, and just before going to bed.

Back blocks are available for purchase at Cartwright Physcialtherapy.

The Importance of a Strong Core

Recently a patient of mine, Adam, was diagnosed with an inguinal hernia. A hernia is the protrusion of an organ or tissue through its surrounding walls, in this case the lower abdominal wall towards the groin. Patients typically present with pain or discomfort when coughing, exercising or during bowel movements.

Mechanical causes of this condition include improper heavy weight lifting, hard bouts of coughing, sharp blows to the abdomen, and incorrect posture. Furthermore, conditions that increase the pressure of the abdominal cavity may also lead to hernias such as obesity, over-straining during bowel movements or urination, and chronic lung disease. Hernias are also more likely to occur in people with weakened muscles as a result of poor nutrition, smoking and overexertion. Sometimes hernias can be left alone, but in this particular case, Adam required surgical repair to avoid untreated complications.

Adam returned for chiropractic care two and a half months post surgery. I was surprised to hear from him that he had received no recommendation to undergo any exercise or core strengthening program. With my understanding that hernias almost always co-exist in individuals with compromised abdominal and core strength, it seemed vital that some sort of rehabilitation should be undertaken.

I was concerned for Adam as he clearly did not have the knowledge of the seriousness of his condition, and how engaging in some sort of corrective strengthening program should be mandatory in order to prevent future complications. Adam’s experience, emphasises that the treatment aspect of a condition, be it surgical or conservative therapy, is really only a small part of the process of healing a patient. Educating patients about their conditions plays a central part in healing. The more patients understand their conditions, the more the mode of treatment of their condition makes sense to them, and most importantly, the more likely they are to comply with any post-treatment advice (exercise prescription, nutrition, rest, etc).

In Adam’s case, it was clear to me that he should be engaging in core strengthening exercises to tighten up his abdominal wall and thus prevent any future hernias or complications thereof. My first challenge was to help him understand what exactly the core is, and why a strong core would be the best remedy.

For me, the best definition of the core musculature, is that of Dr Stuart McGill’s, professor of spine biomechanics, University of Waterloo, Canada. He describes the core musculature as all the muscles that exist between the shoulder and hip joints. The core thus comprises many muscles and is not simply just your abdominal muscles. Its function is to create stiffness along the length of the spine. Sometimes I refer to the core as the “seatbelt of the spine”. It’s a useful analogy when explaining to patients the core’s function, which is to brace the spine for any impact it is about to experience. This might be resisting movement throughout the spine when bending over to pick up an object, landing after jumping, or even fending off an annoying sibling trying to poke you in the stomach.

Do you remember the famous Olympic sprinter, Michael Johnson? One of my favourite video clips demonstrating one application of core strength is some footage of Michael sprinting. You can watch it below, take extra special note of his running form from 1:00 to 1:12.

People often recall Michael’s running style to be unorthodox, or at least, very distinct. Today our understanding of the core’s function however, helps us realise that it was this distinct style that enabled Michael to run so fast, so efficiently. I know from my own limited experience in sprint training, that the faster you want to move your legs, the faster you need to pump your arms. It is impossible to run [with any efficiency] in such a way that your arms and legs move non-synchronously.

Remaining completely stiff through the torso whilst sprinting as fast as you can, sees the least amount of energy leak between the arms and legs, thereby improving efficiency. In other words, if you want to run really fast, you need to develop the skill of maintaining a very stiff core whilst moving your arms and legs as fast as you can. There is of course, a lot more detail to coaching sprinting and running technique, the point here is simply to illustrate where the core’s function fits in.

A stiff core essentially provides a stable foundation from which to operate other parts of your body safely and efficiently. In sport, a strong core is always beneficial as it enhances your ability to move, jump, throw, swing, lift, etcetera. If youre not a sportsman however, a strong core is still essential. Daily activities like lifting, dressing, cleaning, sitting and climbing and descending stairs, often see us moving our bodies into awkward and compromising postures and positions. If we do not have the ability to adequately brace and protect our spine, we can cause injury to this region, if not our other appendages.

Adam is a desk worker, and doesn’t exercise a great deal. He acknowledges this aspect of his life needs some attention, so I decided to set some achievable goals for him. It can be daunting for someone who isn’t in the habit of exercising, to suddenly embark upon a full exercise program. I gave him two core exercises to practice every other day, for two weeks: the plank and the side plank. These two exercises require absolute stiffness throughout the core in order to be performed properly, they also work the vast majority of muscles between the shoulder and hip joints, and so are very applicable to the objective.

Adam reported back to me two weeks later. His feedback was that whilst he could manage the exercises, performing them for the recommended duration was more challenging than he thought. More importantly though, doing the exercises combined with a deeper understanding of hernias, and their relationship to the abdominal wall and core strength, he is now motivated to integrate exercise and core strengthening into his weekly routine.

Obviously, there are a multitude of exercises available to facilitate a stronger core. The plank and the side plank are two simple-to-teach exercises which I feel most people should be able to perform well. In practice, if I find people are unable to hold a front plank for at least 30 seconds, and a side plank for at least 15 seconds, it is my opinion that they may be in danger of injuring their spine.

The topic of core strength is very detailed and there is much debate as to its definition, function and methods for training. The purpose of this article is simply to provide the lay person with a basic understanding of why core strength is important, and a starting point for training. Please refer to some other useful information on Core Strength and Sit ups are bad for you.

If you suspect you have a weak core and/or have been suffering any pain throughout your spine, book online with one of our therapists NOW.

Pain relief for powerlifters

The sport of power or weight lifting has certainly had an impact in the health and fitness industry. Gyms are adding more weight plates, squat racks and dead-lifting platforms to their floors. Despite this, it seems gym-goers almost have to form a cue to use all of this gear as it has become so popular, almost faddish in the gym community. Whether you are a competitive power lifter or someone who regularly incorporates power lifting exercises into your weekly workout routine, there are some vital therapeutic exercises you should consider doing to prevent injury.

Powerlifting revolves around three primary lifts: the squat, the bench press and the deadlift, but powerlifters incorporate many more movements into their exercise programs. These may include shoulder pressing, front squats, sumo deadlifts, clean and jerks, and the list goes on.

The three fundamental exercises of powerlifting share a common risk factor with regard to joint health in the body compressive force. The squat and the deadlift produce large amounts of compression through the spine, whilst the bench press creates compression mostly through the shoulders.

The following exercises are designed to unload those joints most affected by the exercises involved in powerlifting. Doing these exercises post training or in-between training sessions will ensure greater longevity in the sport.

Exercises

1. Back block

Position the back block under your sacrum about level with your bottom. Extend your arms and legs one at a time. Lying backwards over the block passively opens up the lumbar spine, like pulling open an accordion. This exercise creates a traction, or pulling, force between the vertebra which is opposite to what the spine experiences during squatting and dead lifting. Lie like this for two minutes.

 

2. Pelvic rock

After using the back block, it is common to feel sensitive through your lower back. Bring yourself to a position where your knees are now bent so that your feet are flat on the floor. Repetitively flatten and relax your back against the floor as if trying to squash your lumbar spine against the floor.

This is only a very gentle decompression movement that is more so a bridging exercise to progress the person from the back block to knees rocking which is more intense.

 

3. Knees rocking

Hold your knees with your hands so that the weight of your lower body is held entirely in your hands. Your ankles should be crossed and your knees spread apart wide. Pull your knees toward your chest repetitively but without tugging or bouncing. In addition to teasing out tight muscles and ligaments in your back, this exercise creates flexion movements between the lumbar vertebra.

 

4. Reverse curl

Perform 15 reverse curls for every minute spent on the back block. Doing these stimulates the lower abdominals which help to support the lower back. Failure to do this after the preceding exercises will perpetuate lower back stiffness and soreness.

 

5. Hanging

Hanging can help decompress the spine but depending on how your spine is put together, there may be a more effective way. When you hang, try bringing your head forward towards your chest whilst at the same time, bringing your knees towards your chest. This curling whilst hanging will open up your entire spine just a little more. This is particularly true in the lumbar region where straight-legged hanging may see your pelvis extending slightly and thus not really aiding decompression force very much.

 

6. Childs pose

The childs pose [from yoga] is a fantastic spine opening and decompressing posture. To add more effect, have a partner apply pressure over your lower back to increase the stretch.

 

7. Toe touches

These may seem controversial to the informed athlete. Toe touches involve a rounding of the back whilst bending forward and down. Contrary to what most lifters may think, forward bending with a rounded back is not harmful to the lower back, at least, not with ones own body weight. Again, this exercise merely opens up the lumbar spine and is a useful alternative to do throughout the day.

Whilst the above exercises may seem simplistic, rest assured there is quite a lot of science behind how and why these exercises help the spine. The purpose of this article is not to delve too deeply into this science but rather to provide people with an easy spinal decompression routine that does not require too much equipment.

 

Treatment

If you feel that your lifting of heavy weights has caused more injury than can be relieved by these simple strategies, there are some very effective conservative treatment options available.

1. Manipulation

Restoring range of motion to the joints where they have become restricted from repetitive lifting will alleviate almost instantaneously some causes of spinal pain as well as dramatically increasing ones ability to lift. Special attention to the sacroiliac joints [SIJs], hips and thoracic spine will see the most impressive results.

Improving range of motion at the SIJs and hips helps with the depth of squatting. Freeing up the thoracic spine will enable a more comfortable bar position during squatting, as well as enabling better posture during squatting and dead lifting.

2. Mobilisation

Mobilisation techniques are similar to manipulation techniques in that they improve joint range of motion. Mobilising the hip joints will provide a very beneficial stretch to the joint capsule. When addressing lower back complaints, a lack of hip motion can cause compensatory motion in the lumbar spine which in turn leads to increased shear stress and load to the spinal soft tissues.

3. Active Release Technique

This gold standard of soft tissue treatment is extremely effective for treating muscles, ligaments and nerves throughout the body. There are areas within the body which when treated, will greatly enhance performance of powerlifters in their sport. Treating the latissimus dorsi in combination with the lumbar erector spinae and lumbopelvic fascia will reduce tissue immobility and tightness. It also restores any irregularity in the normal functioning of these structures that can cause imbalances at the lumbopelvic region.

4. Massage

The dreaded tightness that follows tough workout sessions in the gym is a phenomenon powerlifters know all too well. Discomfort experienced when trying to tie shoe laces, bending forward or even moving to sit down on a chair can become very frustrating. This tightness can also be the reason for not returning to the gym sooner. A regular massage can help flush the body of the metabolic by-products of exercise and see you returning to the weight lifting room earlier and with reduced potential for incurring injury.

Competitive powerlifters in particular, should seriously consider receiving regular treatment from a health practitioner. In the same way that your car needs servicing every six months or 10,000kms (whichever occurs sooner), so too does your body. You probably use your body more so than your car so book it in for a tune-up regularly and reap the benefits of preventative therapy that keeps you lifting longer and stronger.

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.

Low Back Pain – What should I do?

Low Back Pain – What should I do?

What to do straight away if you have really painful lower back pain

If you’ve just hurt your back, and you’d describe it as “really bad”, there are three things you should do straight away:

  1. Rest – this means avoid the activity or movement that caused your back pain. Also, because your back is in a worse state, it needs time to heal. Take frequent periods of rest lying face down on the floor with your head turned to one side. This will allow the lower back to rest in a safe position where the muscles can relax on their own accord.
  2. Walk – Your body craves movement and whilst some movements will aggravate your condition, most people report that walking relieves their low back pain somewhat. This moderate amount of movement will ensure enough nutrients is delivered to your intervertebral discs [IVDs]. The IVDs serve an extremely important biomechanical function to your spine. As they do not have a blood supply, nutrients must be delivered by osmosis through the activity of the surrounding muscles.
  3. Do not bend – bending is an extremely important movement that all spines should be capable of performing pain free. However, low back pain is commonly an injury to the posterior part of the spine. Thus, forward bending movements tend to aggravate low back pain complaints. If you’ve ever cut your finger across the joint line, you’ll know that bending it causes the wound to split open even further. Naturally, you’ll keep your finger relatively extended until the wound heals. At this point, you can start bending your finger again to strengthen the new tissue in the direction that it needs to maintain tensile strength. The same applies to the treatment of low back pain, forward bending is an important part of rehabilitation, but there’s a time factor to respect before doing this.

Expect a three to four day period of pain and discomfort in the area before any noticeable improvement. Don’t aggravate the situation by being overly active – perform light duties only. Remember, walking is better than standing, which is better than sitting.

Mornings will be particularly bad. This is because of the resultant inflammatory process that occurs when you injure a part of your body. Inflammation serves to heal the injury but it has a tendency to run out of control at night-time. Inflammation loves heat and lack of movement, two things which happen when you’re wrapped up cosy in bed at night. If your low back pain is “really bad”, see someone about it immediately. The above information will help the majority of people but there’s no telling of the extent of your injury without a professional opinion. Through examination and possible medical imaging (xray, CT scan or MRI), your therapist may uncover an underlying problem predisposing you to successive injuries. He or she should also provide you with therapeutic home exercises so that you can “self-treat” your condition. The McKenzie method for treatment of back pain may also be of great help for your back pain.

Do not adopt the attitude, “I will just leave it alone and everything will be alright”. If you neglect to service your car regularly it won’t function at its best, the same applies to your spine.For any injury, pain or discomfort, be it in your lower back or elsewhere, always get some professional advice. Speak to your therapist now – the sooner the better!

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.