Strengthening exercise program for low back pain relief
The next few exercises are examples of some basic stabilization exercises
that aid in low back pain relief. Having strong midline support
is critical to decreasing the stresses placed upon the lumbar spine (lower
back) and pelvis. It should be noted, however, that often muscles
that appear to be weak may actually be inhibited by an antagonist muscle
(muscle on the opposite side of the joint) or by faulty lumbar facet
joint mechanics. Generally, an inhibited muscle will not respond
to resistance training. Therefore, if low back pain or hip pain
is being experienced, it is important to first see a spine therapist
in order to screen for muscle inhibition. Attempting to strengthen
an inhibited muscle may cause a substitution pattern that only reinforces
a painful movement pattern. In general, it is advisable to see
a spine specialist who specializes in back pain prior
to beginning any exercise program.
In addition, unlike stretching exercises, it is important to take a
few days off per week from strengthening exercises to allow the body
to rest and build strong muscles. A licensed physical therapist
can help design a strengthening exercise program to fit an individual’s
specific needs and help with pain relief. In general, a spinal
stabilization exercise program usually includes strengthening the abdominal
muscles in the front and the gluteal muscles in the back.
Transversus
Abdominis muscle strengthening (abdominal exercise)
Many
people think of performing abdominal crunches or
situps to strengthen the abdominal muscles. While “six pack abs” look
nice to some, it is more important to work the Transversus
Abdominis (TVA) through abdominal exercise to achieve
spinal stability. When retraining the TVA, it is
important to maintain a neutral lumbar spine (don’t
try pushing the back all the way into the floor).
The back is most often in a neutral spine position,
so it makes less sense to strengthen the back in
a flexed or extended position. Lie on one’s back
with the knees bent. Knees and feet should be shoulder
width apart. Draw the belly button toward the spine
while maintaining a neutral spine. Upon exhalation,
reach toward the ceiling as if trying to grab a trapeze
overhead. Then raise the head and shoulders off the
floor, just to the point where the shoulder blades
are barely touching the floor, and hold 1-2 seconds.
Inhale upon return and repeat at the end of the next
exhalation. Continue until it is not possible to
maintain a neutral spine or when fatigued.
See
Figure 4.
- Hold 1-2 seconds
- Repeat until fatigued
- 1 time per day
- 4-5 days
per week
Gluteus Maximus muscle strengthening (buttock exercise)
To
strengthen this muscle, lie on the stomach with
the hips and legs off the end of a table or bench.
Tighten the buttock on one side and extend the leg
up toward the ceiling while maintaining a neutral
spine. Movements should be slow. Initially, it is
common to only be able to perform a few repetitions
at a time. See
Figure 5.
- Hold 5 seconds
- 4-10 repetitions per side
- 1 time per day
- 4-5 days per week
Gluteus Medius muscle strengthening (hip abductor exercise)
This
muscle (the hip abductor) is used to raise the
leg laterally at the hip and also supports the pelvis when standing
on one leg (single leg stance). If this muscle is weak or inhibited, the opposite
pelvis will drop when single leg stance is performed. Functionally,
single leg stance is performed whenever someone walks. A weak gluteus
medius will result in the opposite hip dropping during the gait cycle
and can cause an increase in low back pain and hip pain with walking. To
strengthen the gluteus medius, lie on one’s side with the back
against the wall. Draw the belly button in while maintaining a
neutral spine. Raise the upper leg with the toes slightly pointed
toward the ceiling and the heel maintaining contact with the wall. Perform
slowly with a 2 second hold at the top.
- 10 repetitions per side
- 1 time per day
- 4-5 days per week
Optimizing exercise programs for pain relief
As with all exercise
programs, these low back stretching and strengthening exercises should
be preceded by warm-up and followed by cool-down activities, such as
walking and gentle stretching. It is advisable to always
consult a medical professional prior to beginning any
exercise program, and if pain, such as low back pain or leg pain, is
felt or aggravated, it is best to consult a spine specialist and/or physical
therapist that specializes in these types of exercise programs.
By: Robert J. Daul, MPT
June 27, 2005
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