Introduction[edit | edit source]
Today, exercise is recognized for its importance to healthy lifestyles, longevity, quality of life, mental health, and the management of many chronic diseases, including low back pain. Exercise is the best way to increase functional capacity and prevent health-related problems.
- For the acute back pain patient, early activation towards normality that includes exercise should begin in the primary care setting. Unfortunately, a large percentage of primary care physicians do not recommend exercise to their back pain patients.
- Good evidence supports the use of exercise-directed therapy for patients with chronic back pain. When compared with other therapeutic approaches, exercise demonstrates positive results by itself and in combination with cognitive interventions eg CBT approach to chronic low back pain.
Physiotherapy[edit | edit source]
In response to physical inactivity, skeletal muscles go through a process called adaptive reductive remodelling. This results in a loss of muscle mass and changes in muscle composition, leading to a decrease in muscle strength (see sarcopenia). The paraspinal muscles (erector spinae, transversospinalis and abdominal muscles) change in response to physical inactivity ie atrophy and increased in fat content, increasing the risk of low back pain.
Following an assessment of back function, we formulated a treatment plan. This includes prescribing specific and progressive strengthening exercises. With exercise, physiotherapists aim to improve the strength of the injured and surrounding areas by increasing the tolerance and capacity of the trunk to take load and control movement.
Below are a selection of back exercises, choose to be client-specific.
Abdominal bracing[edit | edit source]
- Abdominal bracing with heel slides
- Abdominal bracing with leg lifts
- Abdominal bracing with bridges
- Abdominal bracing with standing row exercise
- Abdominal bracing with walking/standing
Erector Spinae/Lumbar Multifidus[edit | edit source]
The multifidus muscle and Erector spinae are important in spinal stability. Weakness and atrophy of these muscles are associated with chronic low back pain. Core stabilization programs are suggested to decrease low back pain.
- Quadruped arm lifts and bracing
- Quadruped leg lifts and bracing
- Quadruped alternate arms and legs with bracing
Back Stretches[edit | edit source]
Pilates and Low Back Pain[edit | edit source]
Pilates as a rehabilitation programme is used in the treatment of chronic low back pain (CLBP) and its results could be compared to exercise program results. Pilates consists of isometric contraction of abdominal muscles, pelvic floor muscles, gluteus maximus and multifidus. Exercises consisted of 5 min of warm-up (breathing and mobility exercises), 50 min of Pilates exercises (stretching and strengthening exercises for muscles of the trunk and lower and upper limbs) and 5 min of cool down (relaxation exercises and massage with ball). 
Extension Based Exercises[edit | edit source]
Mckenzie Exercise is an exercise regimen used in the treatment of low back pain and sciatica, prescribed according to findings during mechanical examination of the lumbar spine and using a combination of lumbar motions, including flexion, rotation, side gliding, and extension. It is sometimes referred to as McKenzie extension exercises, but this is a misnomer because the regimen involves movements other than extension.
Flexion Based Exercises[edit | edit source]
Williams' flexion exercises is a therapeutic exercise regimen used in treating low back pain; it seeks to reduce lumbar lordosis through flexion of the lumbar spine and strengthening of the abdominal musculature.
This 5-minute video is titled Williams Flexion Exercises for Lumbar Spine and outlines the specifics.
Lumbar Stabilization Exercise[edit | edit source]
Lumbar stabilization exercise programs are used to improve the strength, endurance and/or motor control of the abdominal and lumbar trunk musculature. The stabilizing exercises focus on the re-education of a precise co-contraction pattern of local muscles of the spine. Stabilizing exercises along with routine exercises help with the reduction of pain intensity while increasing functional ability and muscle endurance and are recommended in the treatment of patients with lumbar segmental instability. The following videos are examples demonstrating progressions of spinal stabilization exercises that can be used for patients requiring this technique.
Proper Lifting Techniques[edit | edit source]
- Plan The Lift: Know how heavy the object is. Clear a path and know where the object is to be placed.
- Lift Close to the body: This will make the body stronger and more stable. Ensure there is a firm hold on the object and balance it close to the body.
- Feet shoulder width apart: This allows for a solid base of support.
- Bend the knees while keeping the back straight: Avoid any twisting motions.
- Tighten the stomach muscles: This will hold the back in good alignment and prevent excessive force on the spine. Avoid breath-holding.
- Lift with the legs: The leg muscles are stronger than the back so use them.
- Avoid straining, get help: Get help if the object is too heavy or it is in an awkward position.
Squat - Remember to:
- Keep back straight
- Knees behind toes
- Keep knees parallel
- The Golfer’s lift is another lifting technique that is useful for picking something off the floor
- This works best when using something like a chair or table for support when bending
- Kick out the unsupported leg - This helps to keep the back straight
- Stand with one foot slightly in front of the other and distribute the weight evenly between both legs
- This is a preferred position over straight-standing
- Avoid putting all of the weight onto one leg while standing.
Aerobic Activity[edit | edit source]
Aerobic exercise is an important part of fitness, elevating the heart rate and improving circulation. Aerobic exercise can help relieve back pain by decreasing stiffness and improving blood flow to the spinal structures, which increases the amount of nutrients reaching the spine.
Lack of exercise increases the risk of obesity and other co-morbidities which can lead to increased pressure on the spine and decreased flexibility.
Low-impact aerobic exercise can elevate the heart rate without jarring the spine and worsening back pain. Low-impact aerobic exercises include: Walking, cycling, swimming, climbing, steppers, elliptical machines, ski machines, low low-impact aerobic dance. This type of aerobic exercise may be a preferable option for those with back pain. 
Conclusion[edit | edit source]
In order to obtain the best outcomes, exercises should be prescribed by physiotherapists or healthcare professionals based on the cause and intensity of pain, as some exercises might further aggravate back pain.
Back exercise programmes that combine strengthening exercise, flexibility and aerobic fitness are beneficial for the rehabilitation of low back pain. Improving the muscular strength and flexibility of surrounding tissues assists in increasing the range of motion and assists with the patient’s functional movement.
References[edit | edit source]
- Dreisinger TE. Exercise in the management of chronic back pain. Ochsner Journal. 2014 Mar 20;14(1):101-7. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963038/(accessed 10.2.2022)
- Radiopedia Paraspinal muscles Available: https://radiopaedia.org/articles/paraspinal-muscles?lang=us(accessed 11.2.2022)
- Goubert D, Van Oosterwijck J, Meeus M, Danneels L. Structural changes of lumbar muscles in non-specific low back pain. Pain physician. 2016;19(7):E985-99.Available:https://pubmed.ncbi.nlm.nih.gov/27676689/ (accessed 18/11/2023)
- Kliziene I, Sipaviciene S, Klizas S, Imbrasiene D. Effects of core stability exercises on multifidus muscles in healthy women and women with chronic low-back pain. Journal of back and musculoskeletal rehabilitation. 2015 Jan 1;28(4):841-7.Available:https://pubmed.ncbi.nlm.nih.gov/25881694/ (accessed 18/11/2023)
- Medical dictionary Exercise Available: https://medical-dictionary.thefreedictionary.com/McKenzie+exercise(accessed 10.2.2022)
- Physical Therapy & Hand Clinic of Hillsboro. McKenzie Method for Low Back Pain & Sciatica - Extension in Lying. Available from:https://www.youtube.com/watch?v=6K7e-n9f1LA[last accessed16/11/2023]
- Ccedseminars. Williams Flexion Exercises for Lumbar Spine. Available from: http://www.youtube.com/watch?v=757ucsakxoc[last accessed 21/5/2020]
- Physiopedia Exercises for Lumbar Instability Available:https://www.physio-pedia.com/index.php?title=Exercises_for_Lumbar_Instability&redirect=no%3Futm_source%3Dphysiopedia&utm_medium=search&utm_campaign=ongoing_internal (accessed 10.2.2022)
- daney20. 09 Spinal Stabilization Abdominal Levels 3 to 6. Available from: http://www.youtube.com/watch?v=zJ63XJQbp7k [last accessed 24/04/2022]
- daney20. 11 Spinal Stabilization Erector Spinae with Limb Loading. Available from: http://www.youtube.com/watch?v=bsJ7smHAyJk [last accessed 24/04/2022]
- Thompson WR, Gordon NF, Pescatello LS, eds. ACSM's Guidelines for Exercise Testing and Prescription. 8th ed. Baltimore: American College of Sports Medicine; 2010.
- Spine Health Low-Impact Aerobic Exercise Available: https://www.spine-health.com/wellness/exercise/low-impact-aerobic-exercise(accessed 10.2.2022)
- Gordon R, Bloxham S. A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare. 2016 Apr 25;4(2):22.Available:https://doi.org/10.3390/healthcare4020022 (accessed 18/11/2023).