Wednesday, 29 September 2010

Back Pain: Part II (Strengthening Exercises)

Continuing from Back Pain: Part I (Stretching/Mobility Exercises), this article will look at some strengthening exercises for the back. 

Much of the latest research on back pain have focused on the importance of two muscles: transverse abdominus and multifidus, and their roles in back pain. This is because both of these muscles lie deep in the spine, forming the functional core of the body. The multifidus muscle stabilises the joints at each segmental level of the spine. Hence you may have heard physiotherapists emphasising the importance of retraining your 'core' stability. 

Research has shown that in people with back pain, these two muscles are weakened, their recruitment patterns are altered and their ability to stabilise the spine is impaired. If these problems are not addressed, evidence suggests that the chances for recurrence of back pain would be increased. 

Strengthening these deep core muscles and retraining their activation patterns during functional activities are two essential components of all back rehabilitation. 

Here are some gentle strengthening exercises to start with. Begin with 5 repetitions x 2 sets, slowly increasing to 10 repetitions x 2-3 sets as tolerated. (NB. There should be no pain with any of these exercises. If you experience any discomfort at any stage, stop the exercise.)

1. Transverse Abdominus
  • Lie on back in neutral spine (comfortable position for you), knees bent and feet flat on floor
  • To feel these deep muscles working, place your hands on your lower tummy, just inside your hip bones
  • Breathing normally, gently draw your tummy in and pull your navel towards your back (you should also feel your pelvic floor muscles working)
  • Hold for 3-5 seconds whilst continuing to breathe as normal, do not hold your breath.
  • Repeat 5x, progressing to 10x.
  • NB. This is a 'muscle control' exercise - therefore when you activate your deep abdominals it should be a gentle contraction, not a strong brace

      This exercise can also be performed in different positions, such as:
  • On all fours
  • Sitting 
  •  Standing

 2. Back Strengthening - Arm Lift
  • Start on all fours (hands and knees), hands directly under shoulder, knees under hips. 
  • Gently pull up tummy and stabilise core
  • Slowly raise one arm up, repeat 5x whilst maintaining a stable trunk and core. Then repeat with the other arm.

3. Back Strengthening - Leg Lift
  • Start on all fours (hands and knees), as per diagram above.
  • Gently pull up tummy and stabilise core
  • Slowly extend one leg out behind you, keeping the other knee on ground. Repeat 5x whilst maintaining a stable trunk and core. Then repeat with the other leg.

4. Back Strengthening - Superman Exercise
  • Start on all fours (as per previous), tighten tummy and stabilise core.
  • Slowly raise up one arm (eg. left) and at the same time, extend the opposite leg (eg. right).
  • Ensure a stable trunk and core at all times. Repeat 5x. 
  • Repeat with the other arm (eg. right) and opposite leg (eg. left). Repeat 5x.
  • Progress by increasing repetitions and speed of the movement.

       This exercise can also be performed using a swiss ball.

There are of course many more exercises that are available for strengthening and retraining of the core stabilisers. If you would like more exercise suggestions suitable for your condition, please feel free to contact me.

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