Treat Your Own Back

Another article has covered the goals and rationale behind setting and observing a lumbar exercise programme and in this article I go over the specifics of lumbar exercises and their performance. Exercise performance varies greatly between patients but the aim is smooth movement with steadily timed motions, moving through the full ranges and holding at the end of the movements for a short time. Pain is to be expected to some extent with exercising but this should not be more than moderate nor should it last for too long afterwards. Successful exercise programmes involve daily repetition over a long period.One leg to chest exercise Lying on the back, pull one of your knees up to your chest and hold it there for two seconds, letting the other leg remain flat on the bed. This will move and stretch tightness in the sacroiliac joint on the same side and in the hip and lumbar joints, ligaments and muscles.Both knees to chest exercise Lying on the back, pull both your knees up to your chest, holding the top position for two seconds. This exercise stretches the hips and sacroiliac joints less than the previous one but increases the flexion stretch on the lumbar spinal structures.Stretching in the Child Pose This pose stretches out the whole of the spine by using the bodyweight to stretch the back out over the bent thighs in a kneeling down position, ending up in a curled up position with the face near the ground.Squatting down This movement involves a greater degree of force than previous ones and can be useful to counteract the effects of sitting for too long. Extension movements are often recommended to restore the lumbar curve after sitting too long but flexion can be just as helpful in relieving discomfort.Use a block under your heels if you need it to maintain your balance and then deep knee bend until you are in a full squat. The lumbar spine will stretch at the bottom of the movement as you let it go, performing the movement for a half minute at a time. Stretching out at the bottom of the movement, the back is kept in this position for half a minute or so at a time.Prone Lying Lying on the front puts the lumbar joints and discs into a significant level of extension, making it a suitable and simple exercise for starting off treating an extension dysfunction. Other movements may be too severe until this one has been achieved.Lying Prone with Elbow Support In this exercise the person is lying on their front and gets up onto their forearms as if they are on a beach and looking out to sea. The lumbar joints are pushed further into extension in this exercise, which should not be kept up for longer than 30 seconds at a time to avoid overstressing the back at any one time.Repeated Extension in Prone McKenzie technique is aimed at disc related problems such as derangement and dysfunction and is thought to affect the disc mechanics. Lying on the front in the press up position the patient straightens the arms and allows the back to assume a highly extended position by keeping their hips down on the surface.This exercise is known to be aggravating in certain patients as it forces the facet joints together so needs to be tested by a physiotherapist to ensure effectiveness.Knee rolling for lumbar rotation In supine the knees are bent up with the feet flat on the bed and the knees kept together as they are rolled to each side, allowing as much range of movement as the joints are comfortable with. The lumbar joints have little rotation range but soft tissues structures may be tight and respond to stretching.Lumbar Rotation Mobilisation The patient lies on their back and leaves their shoulders on the ground as they bend one leg up so the opposite hand can get hold of the knee and pull the leg over the body, stretching out the back. This stretches the facet joints and soft tissue structures strongly so other stretches might be more appropriate before progression is made to this exercise.