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  Treatment       Exercises - Low/Mid Back, Abdominal      
 
 
Rachel Walker in training for the Edinburgh Marathon
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Before You Start

Before you start trying to get relief using these pain clinic stretches and exercises, please read Before You Start.

Some of the exercises require you to use a piece of Thera-Band for muscle strengthening. If required you can buy it from Physio Med. I would suggest red for the upper limb exercises, and green for the lower limb exercises. Depending on your physical capabilities, you may need to go higher or lower in the treatment range.

Think about trying the Pain Gone Pen - a simple low-cost non-drug self-help pain device for home use.

Flexion (lying)

This is a stretch to encourage Flexion in the lower lumbar spine.

Basic Stretch

  1. Clasp your hands in front of your knees, interlacing your fingers together. Make sure your neck is comfortable on a pillow.
  2. Keep your knees together and gently use your arms to pull your knees towards your chest, stopping when you feel a tightness in your lower lumbar region. This is the barrier point.
  3. You can now gently use your arms to move you knees backwards and forwards, in and out of this barrier point, for 5 minutes. Gradually you will feel that your knees are able to move closer to your chest as your back muscles begin to increase in length. A good tip is to breathe out as you pull your knees up, preventing your muscles from going into spasm. 
  4. The end point to this stretch is when you can get your knees right up to your chest, whilst raising your tail bone in the air.
  5. If you can get your knees all the way up to your chest without any pulling sensation in the lower lumbar spine, then you have no significant muscle spasm in the lower lumbar area.
  6. If it is too painful to clasp both your hands in front of both knees, try doing it with just one knee at a time, alternating between knees. alternatively try the MET stretch below first.
  7. These stretches may not be suitable for those with severe hip arthritis as it may cause pain in the groin. Those with large stomachs and/or breasts may find it hard - but this should not be an excuse not to try!!

MET stretch

  1. Clasp your hands in front of both of your knees, interlacing your fingers together. Make sure your neck is comfortable on a pillow.
  2. Keep your knees together and gently use your arms to pull your knees towards your chest, stopping when you feel a tightness in your lower lumbar region. This is the barrier point.
  3. At the barrier point, take a breath in and hold it (don't let it go), push your knees against your hands for FIVE seconds, at about 25% maximum effort, not letting your knees move away from you. N.B. You are contracting your back muscles when you push against your knees like this.
  4. Breath out quickly through your mouth, and relax all your muscles, but don't let your knees move away from you. During the next THREE seconds, use your arms to move your knees 1-2 cm closer to your chest. Stop when you feel a pull in the back, this is your new barrier point. Hold your knees there using your arms, and don't let your knees drift away from you.
  5. Go to No.3 and start again. Go round this loop for 5 minutes, and you will find that gradually you will be able to get your knees all the way to your chest.
  6. Those with severe back spasm will only be able to move their knees closer to their chest in small jumps, taking several days to achieve the goal. It is sometimes useful to try this technique with one leg at a time, and then progress to both legs. Those with lesser spasm will be able to achieve their goal more rapidly.
Flexion (Kneeling)

This is a powerful stretch to encourage Flexion in the thoraco-lumbar spine.

  1. Kneel on the bed with your knees together, and with your feet and bottom over the edge of the mattress. Be careful not to fall off.
  2. Whilst breathing out, curl up in a ball, with hands out in front of you on the bed, and your face tucked down towards your knees - like "Praying to Mecca". Hold this position for several minutes, using gentle breathing to aid relaxation.
  3. You can make this a much more powerful stretch by clasping your hands in front of your shin bones, and using your arms to increase the amount forward flexion. Again hold this position for a few minutes, using gentle breathing to aid relaxation.
Rotation (Lying)

These are stretches to encourage rotation in the lower thoracic spine and around the thoraco-lumbar junction. In the neutral position the lumbar spine will not rotate due to bony facet joint locking.

Easy Stretch

  1. Lie on your back with your feet and knees together, knees bent to 90 degrees and feet flat on the bed. 
  2. Whilst breathing out, let your knees drop to the left until they reach the bed, keeping your shoulders flat. Don't hold your breath or close your voice box on the way down, as this will encourage the back muscles to tighten. Don't rotate your upper trunk with your knees, as this will not produce any stretch at all.
  3. Bring your knees back up again, and try the same thing to the right, again whilst breathing out.
  4. When you are more confident, try swinging your knees from side to side rhythmically like a pendulum. If you can do this easily, then move on to the harder stretch.

Harder Stretch

  1. Lie on your back, flexed at the hip with your thigh bones perpendicular, knees bent, and with your feet together not touching the bed. Have your arms away from your body at 90 degrees (like Jesus on the cross), holding on to the edge of the mattress, to help stabilise the upper trunk.
  2. Whilst breathing out, let your knees drop to the left until they reach the bed, keeping your shoulders flat. Don't hold your breath or close your voice box on the way down, as this will encourage the back muscles to tighten. Don't rotate your upper trunk with your knees, as this will not produce any stretch at all.
  3. Bring your knees back up again, and try the same thing to the right, again whilst breathing out.
  4. When you are more confident, try swinging your knees from side to side rhythmically like a pendulum. If you can do this stretch easily then you don't have significant thoraco-lumbar spasm.
Side Bending (Lying)
  • This is a stretch to encourage side bending in the lumbar spine.
    1. Lie on your back with your legs flat, knees and feet together.
    2. Bend your elbows and fix your thumbs on top of the bony prominences on the front of your hip bones, and place your other fingers backwards around your hips/buttocks. You are trying to hold your pelvic bone in both hands.
    3. Push down with your left hand trying to make your left leg longer than the right, whilst hitching your right hip upwards. Don't let your knees bend.
    4. Then push down with your right hand trying to make your right leg longer than the left, whilst hitching your left hip upwards. Again don't let your knees bend.
    5. Try doing alternate movements smoothly and rhythmically, so that you end up doing a "buttock shuffle".
    6. Women seem to be more coordinated at this than men for some reason !!

Quadratus Lumborum

Basic Stretch

This stretch helps encourage side bending in the lumbar spine.

  1. Lie on your side (bad side uppermost) with your head supported on a pillow.
  2. Place a rolled up towel in the gap between your ribs and hip bone.
  3. Bend your lower leg up at the hip and knee, allowing your upper leg to drop down.
  4. Raise your upper arm over your head encouraging side bending in the lumbar spine.
  5. Try doing it on the other side as well.
Extension (Face Down)

This is a stretch to encourage Extension of the lower thoracic and lumbar spine. It will also produce stretching of the abdominal muscles. People with spinal stenosis, foraminal stenosis, or an acute disc should not perform this stretch unless they have been instructed to do so by their doctor or physiotherapist.

  1. Lie on your front with your feet together.
  2. Prop yourself up on your elbows, arching your back and gently tipping your head backwards.
  3. This stretch can be made more powerful by propping yourself up on your arms, either with the elbows bent, or the elbows straight. At all times your pelvis should be in contact with the surface of the mattress. Hold this stretch for a few minutes, using gentle breathing to aid relaxation.
Active Extensions

These exercises are to strengthen the back and buttock muscles.

Back Extensions

  1. Lie on your front with your feet together.
  2. Hold hands behind your bottom.
  3. Move your hands downwards, whilst lifting your head and upper trunk off the bed and hold for FIVE seconds, dropping back down on to the mattress afterwards. You may need someone to hold on to your ankles for you.
  4. Rest for a moment, before trying No.3  again.
  5. Set an initial target of 10 repetitions, increasing the number by an extra 10 and so on, when you feel confident.

Leg Extensions

  1. Lie on your front with your head resting on your forearms.
  2. Lift your left leg backwards behind you, keeping the knee straight, and pointing your toes.
  3. Hold for FIVE seconds, dropping back down on to the mattress afterwards.
  4. Rest for a moment, before trying No.3 again.
  5. Do the same sequence for the right leg.
  6. Set an initial target of 10 repetitions for each leg, increasing the number by an extra 10 and so on, when you feel more confident.

General Co-ordination

  1. Get onto your hands and knees on the mattress, keeping your arms, thighs and back fairly straight.
  2. Hold your left arm out in front of you horizontally in line with your body, as well as extending your right leg behind you horizontally in line with your body, ending up balancing on the mattress supported on your right hand and left knee (just like a lizard in the desert standing on hot sand !!)
  3. Hold this for FIVE seconds, releasing the position so that you end up on your hands and knees again.
  4. Hold your right arm out in front of you horizontally in line with your body, as well as extending your left leg behind you horizontally in line with your body, ending up balancing on the mattress supported on your left hand and right knee (mirror image of No.2 above).
  5. Set an initial target of 10 repetitions for each version, increasing the number by an extra 10 and so on, when you feel confident.
Abdominal Muscles

These exercises are to strengthen the muscles of the abdomen. About 50% of the support for the spine comes from these muscles, and they also have a very important role during lifting. Therefore strong abdominal muscles are crucial to prevent the spine being vulnerable to injury.

For abdominal muscles stretches look at Extension (Face Down).

Upper Abdominal Exercises

  • Part 1
    • Lie on your back with your feet and knees together, knees bent to 90 degrees and feet flat on the bed.
    • With your arms out stretched place your finger tips on your knees.
    • Hold this position for FIVE seconds, dropping back down on to the bed afterwards.
    • Pause for a moment, before trying it again.
  • Part 2
    • Do the same exercise placing your right finger tips on your left knee.
    • Hold this position for FIVE seconds, dropping back down on to the bed afterwards.
    • Pause for a moment, before trying it again.
    • Do the same exercise placing your left finger tips on your right knee.
    • Set an initial target of 10 repetitions for each of the three exercises, increasing the number by an extra 10 and so on, when you feel confident.

Lower Abdominal Exercises

  • Easy
    1. Lie on your back with your legs flat and feet together.
    2. Slowly bring your knees up together, so that your hips and knees are each bent at 90 degrees, with your thigh bones perpendicular to the mattress.
    3. Whilst breathing out, slowly lower your legs down to the mattress over about FIVE seconds, keeping your knees together, ending up with your legs straight, being careful not to arch your back.
    4. Set an initial target of 10 repetitions, increasing the number by an extra 10 and so on, when you feel confident.
  • Hard (don't do this one if you have moderate / severe back pain)
    1. Lie on your back with your legs flat and feet together.
    2. Slowly raise both legs up together with your knees straight, until they are pointing up at the ceiling, bent 90 degrees at the hip.
    3. Whilst breathing out, slowly lower your legs down to the mattress over about FIVE seconds, keeping your knees together, ending up with your legs straight, being careful not to arch your back.
    4. Set an initial target of 10 repetitions, increasing the number by an extra 10 and so on, when you feel confident.

CAT Exercise

Designed to train Transversus Abdominis the deepest abdominal muscle, important for spinal stability and strength.

  • Part 1
    • Get onto your hands and knees on the mattress, keeping your back fairly straight. Relax your back and abdominal muscles, allowing them both to sag  downwards as much as possible, and hold for a few seconds. Don't let your arms bend.
  • Part 2
    • Next arch your back upwards "like an angry cat", whilst trying to suck your abdominal muscles upwards. Tip - try closing your voice box and breathing in at the same time. Imagine that you are trying to make your tummy button touch your spine. Hold for a few seconds then relax.
    • Repeat Parts 1 and 2 in sequence, setting an initial target of 10 repetitions, increasing the number by an extra 10 and so on, when you feel confident.

Pelvic Tilts

  1. Lie on your back with both feet on the floor, knees and hips flexed, hands palm down beside you.
  2. Push you bottom into the floor arching your lower back as far as possible, and hold for a few seconds.
  3. Do the reverse movement by lifting your bottom off the floor whilst thrusting you pelvis forwards, and hold for a few seconds. Keep as much of your lower back in contact with the floor as possible, this concentrates the exercise around the lumbo-pelvic junction.
  4. Go to No.2 and repeat.
  5. Set an initial target of 10 repetitions, increasing the number by an extra 10 and so on, when you feel confident.
  6. When you are confident try developing a continuous continuous movement from no.2 to no.3 without pausing in between.
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