Simple Back Exercises Performance
The reasons and aims of doing routine lumbar spinal exercises have been explored in a previous article and now I explore the use of specific lumbar exercises and give an indication of how they should be performed. Performing the exercises carefully and smoothly with steady timing is the aim, holding at the end of joint range for a few seconds. An acceptable amount of pain is difficult to determine, but some pain during the performance should be accepted if it does not last for more than 15-20 minutes and is not too severe. Self management of low back pain involves repeated performance of lumbar exercises daily.
Pulling one leg to the chest Lying down on the bed, get hold of one knee and pull it up towards the chest, holding it at the full bend for a short time. Keep the other leg flat down. This exercise mobilises and stretches the sacroiliac, hip and low back joints, muscles and ligaments.
Both knees to chest exercise Lying on the back, pull both your knees up to your chest, holding the top position for two seconds. This exercise stretches the hips and sacroiliac joints less than the previous one but increases the flexion stretch on the lumbar spinal structures.
The Pose of a Child Kneel on the floor and allow the trunk to curl forward to lie on the fronts of the thighs with the back stretching out into flexion. This flexes the whole of the spine because the bodyweight increases the force of the stretch.
Squatting This is a much more forceful movement which can be very useful after a lot of sitting. We are often taught to perform extension movements after a period of flexion such as sitting, but this movement can be just as successful in restoring spinal comfort after a lot of sitting down.
Squat right down until your thighs are against your calves, using a block under your heels if you need to maintain balance. Staying down in that position for half a minute, allowing the lumbar spine to flex out, can be performed at times or three times in a row with rests between.
As this is a relatively severe exercise it would be useful to work at the earlier flexion exercises in lying first before tackling this.
Prone Lying Lying on the front puts the lumbar joints and discs into a significant level of extension, making it a suitable and simple exercise for starting off treating an extension dysfunction. Other movements may be too severe until this one has been achieved.
Prone Lying Leaning on Elbows Once the patient can maintain prone lying easily they can progress to leaning up on the forearms and looking forwards. This pushes the lumbar spinal structures into further extension but can be stressful for the back so should be limited to short periods of time.
Repeated Extension in Lying (REIL) This is part of the McKenzie technique of treatment and is mainly aimed at disc derangement or dysfunction. The patient lies on their front with their hands around shoulder level, pushing up to straighten the arms whilst allowing the hips to remain on the bed. This arches the lumbar spine significantly.
This exercise is known to be aggravating in certain patients as it forces the facet joints together so needs to be tested by a physiotherapist to ensure effectiveness.
Knee rolling for lumbar rotation In supine the knees are bent up with the feet flat on the bed and the knees kept together as they are rolled to each side, allowing as much range of movement as the joints are comfortable with. The lumbar joints have little rotation range but soft tissues structures may be tight and respond to stretching.
Mobilisation stretches of the lumbar spine. This is a strong stretch of the lumbar spine and could aggravate the pain if easier stretches have not been performed earlier. The patient holds onto one bent up knee with the opposite hand and pulls the knee over towards the hand side, allowing their shoulders to remain flat so the stretch is concentrated on the low back