A common question a patient will ask after a bout of low back pain is “What exercises are recommended to prevent further occurrences?” Many ask if Yoga or Pilates would be helpful to increase their flexibility and strengthen their “core.” The answer, first and foremost before exercise, involves ensuring that your body is balanced and in correct alignment.
The therapists at BioSynchronistics®, using gentle hands-on therapeutic techniques, assess and help patients & clients correct their posture such that the pelvis is level and not rotated, the weight is correctly over the feet, and the head and trunk are correctly balanced over the pelvis. In addition, the arms and legs are balanced to the body.
When this process is complete, abnormal postural stresses on the body are reduced or eliminated. It is reasonable and logical to conclude that adding exercises prematurely, before this process is complete, will likely cause pain and dysfunction because the body is compromised and working harder than it needs to just doing normal every day activities. So before adding any new exercises, consider this important first step. Only then should exercises be carefully added and advice given to reduce stress (or loading) on the spine when carrying out our activities of daily living (ADLs) and work tasks.
From the moment we arise from bed in the morning (and even in bed) and go through our day, our spine is experiencing varying levels of spinal loading. We can’t avoid it nor do we want to. What is spinal loading? It is stress to any tissue in the spine (discs and ligaments) as a result of bending, extending, or twisting the spine or from axial stress (such as landing hard on your feet, or driving on a very bumpy road with no shocks). Loads can be static such as holding a stooped position, or repetitive such as bending over multiple times to pick objects up from the floor.
Our individual tolerance to spinal loading varies widely due to a number of factors such as age, our sex, medical history, activity level, what kind of job we do, our adherence to good body mechanics, and the flexibility of our hips, legs, and shoulders. Note that flexibility of the spine is not included here because studies have shown it has an inverse effect on tolerance.
If the loading stays within your tolerance level; that is neither too much nor too little, and there is adequate rest to recover from the loading, the tissues will adapt resulting in increased loading tolerance and injury avoidance. The increased tolerance may be small for some and more significant for others but most will see some kind of progression in a positive direction.
We will look at 3 important areas that we will call strategies to “spare” your spine. Remember these strategies are most effective after the posture and alignment are corrected as explained above. The first strategy that will be covered is learning how to decompress or reduce spinal load with some simple exercises or postures. The second focuses on increasing spinal stability and flexibility of legs, hips, and shoulders in a safe way. The third article explores ways to “work smarter” to reduce spinal loading when we do our everyday activities (ADLs) and work tasks.
This article and those that follow will provide you a framework from which to explore improving your spinal health. It will require care and attention on your behalf and best achieved working with your physical therapist, but it will be well worth the effort. Remember to always check with your physician before beginning any new exercise program
Decompressing the spine
Since many of us sit for many hours a day, simply standing up with your hands by your side rotating your thumbs outward, then progressing to reaching overhead, then pushing the hands upward with a deep inhalation is helpful. This counteracts the forward bending, or spinal flexion, sitting puts us in. You may have to start slowly and progress only if there is no pain. You should repeat this after 20-30 minutes of sitting.
A second post-sitting exercise is to gently lengthen the front of the hip. There is a muscle, called the hip flexor, which attaches to our hip at one end and to the inside of our lumbar spine (or lower part of the spine) at the other. After habitually sitting for a prolonged period of time it becomes shortened and pulls on the low back. It is important to lengthen it by standing up and lunging forward so that the front foot is over the ankle, the heel of the back leg lifts off the floor, and the back stays straight.
Raise your arm that is on the same side as the back leg and reach up and in toward the leg in front. You will feel a slight pull in the front of the hip and lower abdomen. Repeat on each side, then lunge walk 5-6 times on each side holding the lunge for a couple of seconds. This can be repeated many times a day if you are sitting a lot (including long car rides, plane trips, etc.)
A third exercise is done on the floor or on a firm mattress if you are unable to get on the floor. This exercise, called the 90-90 position, is especially helpful at the end of the day when there may be some low back discomfort but can be performed anytime during the day if you feel back strain. Lie on a carpeted surface (or folded blanket) or firm mattress; support your head so that the chin is level. Bring the legs up on a sofa, chair surface, or ottoman so that the angle of the hips and knees is 90 degrees. The arms can be supported with cushions or folded towels to unweight them if that feels more comfortable. Maintain this position for 5-15 minutes. Yoga practitioners will recognize this posture as one variation of Savasana or yoga’s relaxation pose.
If after standing or walking you experience low back pain you can try the following. You will need to use the back of a bench, railing or sturdy surface that is level or higher than your waist. Place your hands on it with the thumbs forward. Push down with the heels of the hands, keeping the arms straight and close to your body so you are carrying your weight down your arms. Move your hips inward and close to whatever you are holding onto. The feet will be unweighted but still in contact with the ground while you extend your spine. Hold for up to a minute; there should be a decrease in pain or a complete elimination of pain.
If you are unable to do the above exercise you can try wall walking. It is also effective if you are having difficulty standing up straight after prolonged sitting. Stand with your feet about 12-18 inches from a wall and place both hands on the wall. Slowly “walk” your hands up the wall and move your hips forward toward the wall until you are fully extended. Be careful not to bring the hips too far forward so as to pinch the low back.
It is recommended you review all of the above exercises with your physical therapist to ensure you are doing them correctly. The final 2 strategies from above will be covered in depth in upcoming articles. Stay tuned!
By: Charlene Pilon