Exercise is an integral part in treating chronic lower back pain. Most chronic pain arises from repetitive stress on the area, a degenerative condition or structural damage to the lumbar spine. A typical exercise program consists of McKenzie (extension) exercises, dynamic lumbar stabilization and stretching and low impact aerobic exercise. Back pain arises from a combination of weakness, tightness and deconditioning. These exercises can be administered by a physical therapist or a certified exercise specialist during the initial acute phase of pain and then continued at home once cleared for unsupervised exercise.
McKenzie Exercises
Back extension: Lie on your stomach, prone, with palms facing down by your shoulders. As you inhale, lift your chest off the ground. Lift your chest using your upper and middle back muscles, not your hands. Exhale and return chest to the floor. Repeat five to 10 times.
Swimming: Lie on your stomach, prone, with arms stretched overhead, palms facing down, neck lengthened. Lift your right arm and left leg then alternate in a dynamic swimming motion. Continue for 30 seconds.
Dynamic Lumbar Stabilization
Pelvic tilt: Lie on your back with feet flat on the floor and knees bent. Cause your lower back to lengthen toward the floor by drawing the navel toward the spine and contracting your abdominal muscles. The tailbone tilts toward the ceiling and the abdominal muscles contract. Then release the back from the floor as your pelvis tilts back to neutral, creating a small space between the lumbar spine and the floor in a small gentle rocking motion. Repeat five to 10 times.
Bridging: Lie on your back with feet flat on the floor and knees bent. As you inhale, peel the spine off of the floor one vertebrae at a time beginning at the tailbone and traveling up until you are supported by the shoulders in a bridge position. Exhale and roll down towards the floor in reverse from the shoulders to the tailbone. Repeat three to five times.
Stretches
Hamstrings, back of the legs: Usually people with lower back pain have tight hamstrings. Modifications for hamstring stretches include using a chair or performing the stretches against a wall for additional support. Stand tall and hinge from the hips, allowing hamstrings to stretch. Another approach can be to do the same standing forward bend with the hands against a wall. Or sit in a chair, extend one leg straight out at a time, with other leg bent and the foot on the floor for support, and bend forward from the hips to stretch the back of the leg.
Piriformis, deep in the middle of the buttocks muscles: Lie on your back with feet flat on the floor and knees bent. Cross the right ankle over the left knee, hold your left thigh with your hands, and pull left knee toward the chest. Keep the neck lengthened and lower back to the floor. Hold for 30 seconds and do the other side.
Cat Stretch: On all fours, round your spine like a cat toward the ceiling as you exhale. Inhale and flatten the back. Repeat sequence in a fluid motion five to eight times.
Low Impact Aerobic Conditioning
Aerobic conditioning is important for overall health benefits for chronic lower back pain patients. Benefits include increased blood flow and nutrients to the discs, weight maintenance, and enhanced mood. Good examples of low impact cardiovascular activities are walking, seated bicycle, step mill, elliptical trainer, and swimming. Cardiovascular training is recommended for 30-60 minutes most days of the week for best results.
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