An internet search on exercises for low back pain will bring up a variety of strengthening and stretching exercises, but will they benefit you?
Read our blog below for our feedback and tips on the most common exercises for lower back pain.
At Milton Village Physiotherapy, we complete a thorough assessment on every patient before creating a tailored treatment plan for them which includes exercises suited to their condition and ability.
PRESS UP BACK EXTENSIONS
For people who spend lengthy periods of time in flexed or slouched postures, this exercise may provide relief by working on range of motion in the opposite direction ie: extension. Leaning through your elbows (Image 1) is less aggressive than pressing up through your hands (Image 2). This exercise may not be beneficial for people who already demonstrate increased extension range of motion or who’s symptoms are related to stenotic (narrowing) changes in their lower back. If pain or aggravation of symptoms occur, then cease this exercise and seek professional guidance as to which exercises you should be performing.
This stretch not only targets your piriformis muscle but also other deep rotator muscles of the hip and your gluteal muscles. It also places your lower back in a position of unloaded flexion which, in itself, may actually relieve a persons’ symptoms.
The piriformis muscle often gets blamed for aches and pains in the buttock, leg and lower back region and, while this can be true in some cases, it can be over-represented as a diagnosis.
If the piriformis is “tight” or has increased tone, this could be due to it working hard to compensate for strength deficits in the region. These deficits would need to be addressed with appropriate strengthening exercises.
LUMBAR SPINE ROTATIONS
This exercise is a basic mobility exercise and is commonly prescribed early on in a person’s rehabilitation. It is to be performed pain-free, so only rock your knees over within comfort levels.
Once a person’s symptoms have settled, their exercises are usually progressed beyond lumbar spine rotations to include strengthening and/or stretching.
KNEES TO CHEST
This is a simple exercise, often utilised when a person has a flare up of their lower back pain. It places the lower back in an unloaded flexed position and can be particularly useful for people who have stenotic (narrowing) changes in their lower back.
Once a person’s symptoms settle however, it is recommended to progress beyond this exercise and address any strength and mobility deficits.
HIP FLEXOR STRETCHES
Technique is very important when performing hip flexor stretches. Many people unknowingly compensate with increased lumbar spine extension (arching), which will result in a less effective stretch and unwanted extension loads through the spine (Image 2). You may inadvertantly be doing more harm than good.
It is advised to keep a flat lower back by tucking the hips under like a pelvic thrust (Image 1). From my experience, 90% of patients don’t perform this stretch as effectively as they could without proper guidance.
Strengthening your gluteal muscles can be beneficial for many conditions, including lower back pain.
Depending on their level of function, this exercise might not be challenging enough for some people and therefore not have the desired strengthening effect.
Technique is important when performing any exercise.
When bridging, arching through your lower back could aggravate your symptoms (image 1).
Avoid arching your back and lift up solely through the hips (image 2).
FRONT AND SIDE PLANKS
Front and side planks work a variety of muscle groups including your abdominal, trunk, shoulder, shoulder blade and lateral hip muscle groups. When performing a front plank, it is important not to sag down through your lower back (Image 1). This may indicate a lack of abdominal muscle control and may result in lower back pain. Image 2 shows a person performing a front plank with proper technique.
With the side planks, keep your legs and trunk in a straight line (Image 4) and avoid dropping the hips down or rotating your trunk forward (Image 3).
THE DOUBLE STRAIGHT-LEG-RAISE (SLR)
The double SLR is a high-level exercise that often cannot be tolerated by most people with low back pain or poor abdominal and/or hip flexor muscle strength and control. The closer the legs are to the floor, the greater the load through the lower back.
There are modified versions of this exercise that place far less loads through the spine. If done correctly, these exercises can be performed pain free and still provide a great work out for your abdominal muscles.
CHILD’S POSE/BOTTOM TO HEELS STRETCH
This exercise can be beneficial for people who have stenotic changes in their lower back. “Stenosis” means narrowing. Spinal stenosis can occur due to a variety of factors eg: loss of disc height, disc protrusions, arthritic changes in the facet joints or a combination of the above.
Narrowing of the neural foramen (the tunnel through which the nerve roots pass) means there is less room for the exiting nerves, which can result in referred pain into the leg. Many people exhibit these changes on MRI/X-ray however, yet are asymptomatic.
THE BIRD DOG EXERCISE
The Bird-Dog Pose works your hip, shoulder and back muscles (image 1). Careful attention to technique is required so that inadvertent, compensatory lumbar spine extension or rotation does not occur.
People who lack strength and/or flexibility might compensate by over-arching their lower back or twisting their hips (image 2).
Apart from not achieving the aims of the exercise, aggravation of lower back symptoms may occur as a result.
BANDED HAMSTRING MUSCLE STRETCH
The first question I would ask is “Does this person actually have tight hamstring muscles?”. Just because you have lower back pain doesn’t automatically mean you have tight hamstrings.
Stretching your hamstrings, as depicted in the below image, places your neural tissue on stretch as well. If you have irritated neural tissue, then this stretch can actually aggravate your symptoms.
There are a variety of ways to stretch your hamstring muscles and the best option for you might be different to the next person.