Exercises for Back Pain

Exercises for Back Pain

In my last post, I discussed general information, causes, and basic self-treatment for back pain.  In this post, I will go into more detail about some exercises for low back pain.  As a reminder, seek medical attention if you have the following conditions:

  • Pain is worsening or is not getting better after 4-6 weeks with self-treatment
  • Pain prevents you from sleeping or makes it difficult to move
  • Pain, numbness, or tingling radiates into one or both legs
  • You have had a recent injury that could have caused a fracture/broken bone
  • You have decreased bowel, bladder, or sexual function or your back pain is accompanied by nausea, vomiting, or abdominal pain
  • You have a history of osteoporosis or cancer
  • You have an unexplained weight loss

 

**As I said before:  this blog is not intended to diagnose or prescribe specific treatment for individuals.  If you have a history of serious medical problems, questions, or other concerns, consult an appropriate medical professional.**

 

In the spirit my earlier recommendation  to “keep moving”, stretching and exercise can be very beneficial.  Gaining and maintaining sufficient flexibility is key to both treating back pain and preventing its recurrence.  In particular, restrictions in the upper back and hips can cause compensation in the low back.  This compensation overworks the low back and is often the source of low back pain.

But fundamental to any good stretching program (or any fitness program for that matter) is proper breathing.  There is a tendency to “brace” around an injury to limit movement and possible further injury.  This is also known as guarding, and it changed breathing patterns.  Learning to relax the muscles around an injury helps promote healing and reduce pain.  Relaxed breathing is also known as “diaphragmatic breathing.”  The opposite of this is “chest breathing.”  In relaxed breathing, the stomach should gently expand both front-to-back and side-to-side as the lungs fill.  You should be able to comfortably breathe this way in any position.  Keep this type of breathing in mind as you perform any stretches or exercises.  To check whether your are breathing correctly, try this exercise:

90/90 Breathing–Lie on your back with hips and knees at 90 degree angles.  You can place your feet on a wall or prop your calves on a chair.  Rest your hands on your stomach or one on your stomach and the other on your chest.  As you breath, your hand on your stomach should gently rise and fall.  The hand on your chest may slightly rise also, but it should be much less than your stomach.  To see what this looks like, check out this video at Functional Movement Systems: 90/90 breathing

 

Once you can perform relaxed breathing, there are some stretches to try for an acute episode of back pain, flare-ups, or to develop better flexibility for your low back.  When doing stretching exercises, one goal is to coordinate it with your breathing.  To do this, focus the more intense part of the stretch with your exhale (breathing out).  Be sure to use good diaphragmatic breathing like done in 90/90 breathing above.  Below are examples of simple exercises you can do at home.  (There are 9 total, 6 stretches and 3 strength exercises, plus one modification of the last one in case it’s too hard)

Angry cat—Start on your hands and knees.  From this position, tuck in your tail and arch your back like an angry cat.  Hold for 5 seconds.  Repeat 20 times.

Child’s pose—From hands and knees, sit back on your heels.  Keeping hips on heels, lower your chest to the floor.  Hold 5-30 seconds.  Repeat 20 times (reduce the repetitions for longer hold times)

 

Hamstring stretch—wrap a belt/band around your foot or ankle.  Keeping your knee straight, raise the leg until you feel  a stretch.  Use the belt for extra stretch.  Hold 5-10 seconds.  Repeat 20 times.

Piriformis stretch –lay on your  back with knees bent.  Cross one ankle over the opposite knee and pull it toward your chest.  Hold 5-10 seconds.  Repeat 20 times.

Hip flexor stretch–get into the “football kneeling position” (AKA half kneeling).  You are down on one knee with the other foot in front, hip and knee bent to 90 degrees.  Contract your stomach, slightly tucking your pelvis under.  Hold that pelvic position, keep your chest high, and gently rock your hips forward.  Hold this position for 5-10 seconds.  Repeat 20 times.

Pelvic tilt—imagine your pelvis as a bowl.  Rock it toward your head so that the bowl would spill into your belly button.  Your low back should press into the floor but your hips should not come up.  This will flatten out your low back and press it into the floor or bed.  Hold 5-10 seconds.  Repeat 20 times.

As pain lessens, the following strengthening exercises are beneficial for the back:

Bridge—lay on your back with your knees bent.  Perform a pelvic tilt and raise your hips up.  Try to make a straight line from your shoulders to hips to knees.  Hold 5-10 seconds.  Repeat 15 times.

Bird dog—starting from hands and knees, find a “neutral spine” by sagging and arching your back.  Hold this neutral position and raise one leg backward.  At the same time, raise the OPPOSITE arm.  A stick or rolled up towel placed across the low back can give you feedback about whether you are stabilizing your back well.   Hold 5 seconds.  Repeat 15 times per diagonal.

Plank—Lay face down with your arms bent and elbows under your shoulders.  Hands should be straight forward, not turned in.  Flex your toes down into the floor.  Rise up on your elbows and toes.  Hold 5-10 seconds.  Repeat 10 times.  Do not let your hips sag or form a teepee.

If this is too difficult then try this version:

 

If you do not notice improvement in your back pain after 4-6 weeks of trying these exercises, it is time to consult a medical professional.  A physical therapist is a medical professional who is trained to evaluate and treat problems with muscles, joints, and nerves.  After a thorough evaluation, a PT will develop a treatment program to address your specific problems.  A PT who utilizes a manual therapy approach can be very beneficial.  Manual therapy involves techniques including soft tissue mobilization, trigger point release, joint mobilization, dry needling, and others.

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