Core exercises consist of movements incorporating the lumbar, abdominal, gluteal, and hamstring muscle groups.  When these muscles are sufficiently strengthened, the core itself is strengthened.  When your core is strengthened you will be able to move more efficiently with improved stabilization and balance.  You will also discover you will have better coordination with the ability to move more symmetrically.  With all of these benefits of core training, your risk of injury when participating in sports will inevitably be reduced.  

    Those cast-iron or steel balls which look like small cannonballs with a thick metal looped handle on top can be useful for working on joint flexibility as well as functional-type movements (e.g., deadlifts).  One of the key benefits of working with kettlebells is the possibility to work the entire body for a powerful and efficient workout.  Other benefits include increasing strength (including core strength), power, endurance, flexibility, mobility and cardiovascular capacity.  You can achieve a strenuous workout in less than thirty minutes.  
     Standard kettlebell exercises should incorporate four basic movements:  the press, the pull, the squat, and the deadlift.  Examples include shoulder press, bent-over row, sumo squat, and Romanian deadlift.  Swinging the kettlebell (e.g., single- or double-arm swings) is another example of a pulling movement that makes the kettlebell uniquely beneficial for training purposes.  The end result is the incorporation of more muscle groups, including your core muscles (i.e., abs, lower back, glutes, and hamstrings), being worked.  Studies have shown that using kettlebells can improve coordination and balance in addition to increased muscle strength and endurance.  By swinging one or two kettlebells, you will be able to target your hips, back, glutes, shoulders, and legs.  An additional benefit is increasing grip strength.
     If you minimize the rest periods between sets, you can also get a cardiovascular workout with kettlebells.  Be sure to start out with lighter weights in order to get a feel for the movements and an understanding of how to properly control the weights.  The risk of injury (i.e., torn muscle, tendon, ligament) increases greatly if the kettlebells are too heavy, are swung incorrectly (i.e., away from the sagittal plane) or are swung too strenuously.  Focus on using good form by improving your technique.  Sloppiness is a recipe for injury.  
     The benefits of kettlebell training include:

• Efficient, quick workout incorporating many fitness components (i.e., strength, endurance, power, flexibility, cardiovascular)
• Requires minimal space
• Relatively inexpensive
• Excellent way to condition your body for sports due to functional movements
• Ideal tool for gaining core strength

     The drawbacks of kettlebell training include:

• Limited weight capacity
• Fixed weights

Bottom line:  Kettlebells can be useful for anybody but should be utilized as a complement to your workout program rather than your exclusive workout program.  Kettlebells should be thought of as a tool in conjunction with dumbbells, barbells, machines, and cables as another means to enable yourself to gain strength, balance, coordination, endurance, and good cardiovascular conditioning.  

    The best thing you can do for your body is to exercise because moving is good for your back.  The purpose of performing exercises for lower back is twofold:

1. To lessen pain
2. To strengthen your core (i.e., lower back, abdominals, gluteals, and hamstrings)

Here are exercises that are NOT RECOMMENDED:

• Toe Touches

    This exercise may actually increase back pain because it places greater stress   on the disks and ligaments of your spine.

• Sit-ups

    This exercise primarily works the hip flexors and may place excessive pressure on your spinal disks.

• Bilateral Leg Lifts

    This exercise may also increase back pain because  it places greater stress on the spinal disks.   Better to perform unilateral leg lifts where you slowly lift one leg up while the other is bent at the knee and the foot is flat on the floor.


Here are exercises that are RECOMMENDED:

• Partial Crunches

    This exercise can help to strengthen your back and stomach muscles.  To perform this exercise properly, lie down with the knees bent and feet flat on the   mat and with the finger tips behind the head, gently tuck your abdominals inward as you raise only your shoulders off the mat. Perform 3 sets of 15 to 25 reps.

• Lying Hamstring Stretch

    This exercise requires you to bend one knee with the foot flat on the mat and raise the other leg before gently straightening the lifted leg  (note:  a towel or band is recommended for wrapping around the lifted leg in order to provide leverage and allowing for increased stretch).  Perform 3 sets of 30-second stretches for each leg.

• Wall Sits 
  

    This exercise is an isometric exercise which entails standing about a foot away from a wall, leaning back so that your back is flat against the wall, and slowly sliding down until your knees are at a 90-degree angle.  Hold this position for as long as you can before rising upward.  Repeat 3 times.

• Half-Cobra Stretch

    Lie on your stomach with palms down and elbows under the shoulders.  Push your elbows downward and hold for a moment before relaxing.  Repeat 3 times.

• Bird Dog

     Kneel on hands and knees before lifting one arm and opposite leg upward.  Be sure to keep the hips level and the elbow and knee of the lifted limbs as straight as possible.  Hold the lifted position for a moment and alternate limbs.  Perform 3 sets of 12 to 15 reps per side.

• Knee-to-Chest Stretch

    Lie on your back with bent knees with feet flat on the floor.  Now lift one leg and pull the knee toward your chest.  Be sure to keep the lower back pressed into the floor while doing this position.  Hold the stretch for up to 30 seconds and then switch sides.  Perform this stretch 3 times on each side.

• Pelvic Tilts

    Lie on your back with knees bent and feet flat on the floor.  Tighten your stomach and pull your belly button toward your spine.  Your lower back should be pressing into the floor as you do this while your hips and pelvis should rock back and forth.  Hold each position for a moment and release.  Perform 3 sets of 8 to 12 repetitions of this exercise.

• Bridging

    Lie on your back with knees bent and heels into the floor.  Now push your heels downward, squeeze your butt,  and lift your hips off the floor.  Your shoulders, hips and knees should be lined up at the top position.  Hold the position briefly and release.  Perform 3 sets of 8 to 12 repetitions of this exercise.

• Light Weight Lifting 
  

    A personal trainer can provide guidance in terms of which exercises are best to avoid aggravating back pain.

• Cardio Exercise

    Best exercises are walking, biking and swimming.  Swimming is highly recommended due to the buoyancy of water to allow for back support.

     Poor posture is usually indicative of weak and/or tight core muscles (e.g., weak erector spinae, weak gluteals, weak abdominals, and especially tight hamstrings).  Your posture is tremendously affected by how you "hold" your body throughout the day.  If you slump in your chair most of the day with your shoulders hunched over and your lower back in perpetual excessive stretch, your body will respond accordingly (i.e., sunken chest, chronic lower back pain).  It is essential to strengthen as well as stretch your core muscles to alleviate the tendency to assume bad posture.  The solution to alleviating lower back pain does NOT come in a pill.  You must strengthen your core muscles, especially your abdominals and lumbar.  
     Some key aspects to focus on while performing the following exercises include:

• Draw in your naval toward your spine
• Move s-l-o-w-l-y but purposely
• Breathe evenly and do NOT hold your breath

     Here are some recommended exercises to get you on the right path toward having better posture:

• Single knee tuck

          Execution:  Lie on your back and pull in one knee while extending and elevating the other leg to about 45 degrees.  Flatten your lower back against the floor and draw in your navel toward your spine.  If your lower back arches, raise the elevated leg higher.  Perform 12 to 15 leg raises per side.

• Curl-up

          Execution:  Lie on your back with knees bent and feet flat on the floor.  Flatten your lower back against the floor and draw in your navel toward your spine.  Now press each hand against your thighs while lifting your head and shoulders off the floor.  Hold the top position briefly before s-l-o-w-l-y lowering your back against the floor.   Ideally, only your lower back should contact the floor on the descent.   Perform 12 to 15 curl-ups.

• Sit-up

           Execution:  Lie on your back with legs extended and flat on the floor.  Flatten your lower back against the floor and draw in your navel toward your spine.  Now raise your arms (elbows straight) over your shoulders with thumbs interlocked while lifting your head and shoulders off the floor.  Continually raise your body, one vertebra at a time until you are in a full sit-up position.   Perform 12 to 15 sit-ups.

• Bicycles

            Execution:  Lie on your back with one knee tucked in and the other leg extended and elevated.  Flatten your lower back against the floor and draw in your navel toward your spine.  Now place your hands behind your head and rotate one elbow to its opposite knee.  Rotate to the other side as you draw in the other knee while extending the opposite leg.  Perform these movements in a s-l-o-w fashion to achieve the most benefit.  Perform 12 to 15 rotations.

• Cobra with hyperextension

           Execution:  Lie on your stomach with palms flat on the floor beside your ribs and legs extended.  Draw in your naval toward your spine and lift your chest and legs off the floor without bending your knees.  Pause in the top position before s-l-o-w-l-y lowering your body to the floor.  Perform 12 to 15 reps.

• Plank

           Execution:  Get down onto the floor with hands/elbows and knees with palms/elbows under the shoulders.  Extend both legs behind you with toes pointed toward the floor (i.e., initial push-up position).  Drop your hips to achieve an alignment while drawing in your naval toward your spine.  Be sure to look only slightly ahead but still in a downward direction.  Hold this position for a duration of one minute.  Perform this posture 2 to 3 times. 

    Correct posture is absolutely essential when executing resistance exercises such as overhead presses, bench presses, squats, etc.  Improper form when lifting will undoubtedly detract from an efficient workout that maximally targets the intended muscles.  The key to safely and effectively engage your muscles is to assume stability in your body when lifting.  In order to do this, you need to practice and adhere to the following fundamentals of posture no matter your body position in space (e.g., standing, sitting, supine):

• Eyes focused on a reference point in front of your head
• Shoulder blades squeezed
• Chest out
• Abs tucked in
• Lower back arched so that your butt is to the rear (anterior pelvic tilt) 

      Note:  Most clients have trouble assuming the anterior pelvic tilt posture but it is absolutely essential in order to effectively target muscles such as the hamstrings or gluteals when performing an exercise like the deadlift.  To practice, try lying in a supine position (i.e., face up) on a floor and arch and flatten your lower back repetitively for up to 25 reps for 3 sets daily.  Be sure to feel your lumbar contact and lift off the floor as you flatten and arch your lower back.  Next, practice performing the same maneuver of arching and flattening your lower back while standing sideways to a mirror.  Be sure to observe the action while looking at your profile to ensure it is done properly.  

• Knees slightly bent (applies primarily to standing posture)
• Feet at least shoulder width apart   
  
• Bench press:  feet should be pressing into the floor at all times!

    In addition, be sure to always inhale when performing a pulling action and exhale when executing a pushing action.  For example, when performing a bench press, inhale as the weight is lowered to the chest and exhale as you press the weight upward.  Another example, when executing a squat, inhale as you bend your knees and exhale when straightening your knees as you press upward.  
    By following the aforementioned recommendations you will find you will be much more successful in achieving your fitness goals.  Remember to always work smarter, not harder!

    Nearly 80% of adults will experience some sort of back pain in their lifetime.  Back pain is a phenomenon and is therefore not clearly understood because any number of underlying factors may be involved (e.g., unhealthy spinal posture, lifting too much weight, lifting while twisting, sedentary lifestyle, being overweight, etc.).   Here's the vicious cycle:  poor posture may contribute to back pain which in turn may worsen poor posture.  Once your back starts hurting, the vicious cycle begins with the end result being worse posture than before back pain.  By the way, the invention of the computer certainly has not helped in terms of improving human posture.  
    Poor posture is exhibited by misalignment of the cervical, thoracic and/or lumbar curvatures of the spine (e.g., rounded shoulders, protruding buttocks and abdomen, excessive arch of the lower back).  This imbalance of spinal alignment may cause associated ligament and muscle strain as well as compressed nerves.  Poor posture over the long-term may increase wear on joint surfaces, contributing to the development of osteoarthritis.  Thus, to reduce back pain it makes sense to readjust the spinal curvatures into balanced alignment so as to lessen muscular strain and nerve compression.    
          
MYTH: 

"I shouldn't do any physical activity if my back hurts"

FACT: 

The above statement is a myth because physical activity can reduce back pain by increasing muscular strength and spinal flexibility.  In fact, it may be due to muscular weakness that is a root cause of back pain.   If necessary, follow your doctor's recommendation to get one or two days of bed rest only if the pain is debilitating.  In general, acute and chronic pain require up to 2 days and 2 weeks of rest, respectively.  Be sure to get up and about soon afterward since lying in bed for an extended period of time may actually exacerbate back pain due to increased stiffness.  Remember, staying in bed and relaxing is NOT the best cure or treatment for back pain--the sooner you get moving, the better.

SOME BACK PAIN PREVENTION TIPS:

• Maintain proper posture by sitting on a stability ball while at your desk (it's hard to slump while sitting on the ball)
• Perform core stability exercises daily (e.g., ball hyperextensions, glute kickbacks, supine ball hamstring curls, ball abdominal crunches)
  
• Take a Yoga and/or Pilates class to increase muscular flexibility, particularly at the spine and hamstrings
• Stretch your muscles daily (esp. hamstring stretch)
• Decrease your bodyweight
• Stop smoking
• Wear comfortable footwear and avoid high-heels and worn-out shoes
• Walk with your chest out, abdomen in, and buttocks tucked in
• Practice abdominal contractions throughout the day
• Shift your bodyweight periodically from one foot to the other when standing for prolonged durations or simply rest one foot on a stool
• Avoid sitting for long periods of time  (this is a big one!)
• Put a small lumbar roll against your lower back for additional support while sitting
• Sleep with a pillow under your waist while on your side
• Avoid wearing a heavy backpack or shoulder bag for long periods of time

TREATMENT OPTIONS FOR BACK PAIN:

• Thermotherapy  (e.g., ice pack for acute injury to lessen inflammation, heat pad or hot bath for chronic injury to relax tight muscles)
• Cryokinetics (e.g., ice pack immediately followed by knee-to-chest stretch)
• Acupressure
• Acupuncture
• Nerve stimulation (e.g., transcutaneous electrical nerve stimulation (TENS) may block incoming pain signals)
• Chiropractor (e.g., manual manipulation, spinal realignment)
• Massage (esp. deep-tissue)
• Psychologist  (cognitive behavioral therapy to target how one thinks about physical activity)
• Biofeedback  (train your brain to control your response to pain)
• Spinal injection (e.g., corticosteroid helps relieve inflammation)
• Flexibility (e.g., knee-to-chest stretch, cat-dog stretch, child's pose)
• Exercise  (e.g., swimming, walking, yoga)--bed rest is the worst thing you can do and may make your back pain even worse!!
• Sleep with plenty of pillows  (i.e., when on your back:  position pillow under your knees; when on your side:  position a pillow between your knees and another one under your waist)
• Physical therapy (i.e., learn how to properly sit, stand and move without causing back strain; learn core exercises)
• Medication(s):   NSAIDs, acetaminophen (e.g., Tylenol)
• Surgery:  should ALWAYS be the last option  (e.g., discectomy to remove disc material to lessen nerve pain caused by bulging disc; spinal fusion to help stabilize the spine)

Here are the recommended guidelines for training the back:

• F:  resistance training:  2 to 3 days/wk; cardio training:  3 to 5 days/wk 

• I:  resistance training:  less than 80% 1-RM; cardio training:  40 to 65% HRR

• T:  resistance training:  15 to 30 mins; cardio training:  20 to 40 mins

• T:  resistance training:  perform core isometric exercises (e.g., lumbar extension); cardio training:  walking, swimming, cycling

• STRETCHING:  perform gentle lumbar flexion stretches

    Despite the lack of knowledge regarding the etiology of back pain, it is possible to prevent or at least reduce the onset of back pain.  The bottom line is you should make every effort to keep your spine limber and your muscles strong and flexible in order to reduce spinal curvature misalignment and the resulting back pain.  

     Lower back pain is usually caused by one or a combination of the following:

• Poor posture throughout the day (i.e., slouching your shoulders while sitting)
• Lengthy periods of sitting, shortening the hamstring muscles which pulls the pelvis downward
• Improper lifting technique (i.e., curving the back and/or twisting the torso)

    Lower back pain prevention starts with incorporating plenty of pillows to support and align the spine while sleeping. Whether you prefer to sleep mostly on your back or on your side, you should place pillows under and around the body (e.g., supine position:  under the pelvis; side-lying position:  under the hip and between the legs).  Be sure to stretch before getting up in the morning (e.g., knee-to-chest stretch) as well as after you arise out of bed (e.g., prone stability ball stretch). While maintaining good posture (i.e., shoulders rolled back, chest pushed out, pelvis tilted forward), emphasis should be on strengthening your abdominal, lumbar (erector spinae), and gluteal (buttock) muscle groups and stretching your hamstrings.  Back pain is totally preventable provided you perform exercises and stretches which target these core muscles.

Here's a technique you should perform daily to better your posture:    

1. While standing in front of a mirror with your eyes closed, flex your abs for several seconds.
2. Now open your eyes and look at your reflection to check out your posture.  If you need to correct your posture, do so.
3. Sequentially repeat steps one and two until your posture is superb and no correction is needed.    

In addition to the above technique, be sure to practice doing isometric abdominal contractions (i.e., ab flexing) throughout your day to counter lower back strain.  Practice flexing your abs while walking, jogging, biking, and sitting.  Avoid sitting for more than an hour at a time by standing up and stretching (added bonus:  this allows blood to circulate better which may increase your ability to focus and think clearly).  Be sure to lift objects by performing the straddling technique:  feet apart, bend knees with straight back, hips dropped and pointed rearward, and push feet downward while exerting your quads to lift.

BACK EXERCISES

• Superman--prone bilateral hip extension (both arms and legs are raised) while on the floor.
• Swimmer--prone unilateral hip extension (opposing arm and leg raise) while on the floor or on a stability ball.
• Bench back extension--bend forward at the hips and raise torso up.
• Machine back extension--bend rearward against the back pad at the hips.
• Plank hip extension--prone unilateral hip extension (raise one leg) while supported on the elbows.
• Ball hip extension--prone bilateral hip extension (both legs are raised) while on a stability ball with elbows on the floor.
• Ball back extension--prone back extension (torso is raised) while on a stability ball with feet braced against a wall.
• Lateral leg flexion--while lying sideways, perform bilateral lateral leg flexion (both legs are raised) before extending the hips.
• Standing hip extension--use cable handle secured around ankle.
• Bird Dog--kneeling unilateral hip extension (opposing arm and leg raise) while on the floor.
• Bent-leg deadlift--bend forward at the hips with straight back--can be performed with dumbbells or a barbell.

ABDOMINAL EXERCISES

• Abdominal crunches--with fingers lightly supporting the back of your head and naval pulled toward your spine, gently raise your shoulder blades off the floor--can be done on a stability ball.
• Plank--set your body up as if you're about to perform a pushup off the knees (front leaning rest position) and hold the posture for a desired duration--can be done on a medicine or stability ball, a bosu, or just on the elbows or hands.
• Ball tucks--while kneeling, place both elbows on a small stability ball and pull the ball toward you while crunching the abdominals.
• Bicycle--same initial position as abdominal crunch but making sure to pull each knee toward you while rotating the trunk.  Strive to make contact between each elbow and opposite-side knee.
• Hanging leg raise--recommend use straps for bracing the elbows before pulling the legs upward--can be performed with flexed or straight knees.
• Roman chair crunch--with the body elevated and supported with both elbows against a vertical bench, lift both legs upward--can be performed with bent or straight legs.
• Slide curl--in supine position with shoulder blades off the floor, press and slide the hands over the thighs while lifting the torso.
• Rotation crunch--in supine position with arms extended and palms facing upward, perform an oblique crunch and reach for each heel.
• V-ups--while supine, simultaneously lift the upper and lower body while reaching for the legs before returning downward slowly.
• Reverse abdominal crunch--while supine, thrust the hips upward and return slowly for each repetition.
• Leg rotations--in supine position with legs slightly elevated, perform rotations in one direction before switching to the other direction--can be done with a medicine ball between the knees.
• Wipers--similar to leg rotations but instead lifting the legs upward from side to side--can be done with a medicine ball between the knees.
• Russian ball rotations--while supine on a stability ball with arms extended upward and hands together, rotate the torso from side to side--can be performed while holding a medicine ball.

GLUTEAL EXERCISES

• Standing kickbacks--kick rearward with knee in flexion--can be done with cable handle secured around ankle or with ankle weight.
• Kneeling kickbacks--kick one hip rearward with knee in flexion--can be done with cable handle or ankle weight.
• Kneeling hip extensions--extend hip with relatively straight knee--can be done with ankle weight.
• Lateral leg raises--perform sideways lift of the hip while standing--can be done with cable or ankle weight.
• Wide stance ball wall squat--with a stability ball against a wall and placed behind the body at the lower back, assume a wide stance posture and squat as low as possible before pushing upward with the heels.
• Plie squat--assume a wide stance posture and while holding a dumbbell with both hands, squat as low as possible before pushing upward with the heels.
• Walking lunges--take a large step forward and perform a single leg squat, allowing the back knee to almost touch the floor before switching legs.
• Step-ups--use a box to step on and alternate the pressing of each heel on the box.
• Fire hydrants--performed in the kneeling position, simply do hip external rotations.
• Glute kickback machine--place heel of one foot against pedal and press quickly backward before letting the pedal come forward slowly.
• Single-leg press--use leg press machine by placing one foot only on sled and press.
• Single-leg glute press--while lying supine, press one heel into the floor and lift the hips upward.
• Hip raise--while lying supine, press both heels into the floor and lift the hips upward.
• Abduction machine--with knees placed inside the pads, press the knees outward (hip external rotation).

HAMSTRING EXERCISES

• Stiff-leg deadlift--bend forward at the hips while maintaining a straight back--can be performed with dumbbells or a barbell.
• Ball back extension--prone back extension (torso is raised) while on a stability ball with feet braced against a wall.
• Leg curl--knee flexion against a resistance--can be done lying, sitting, kneeling or standing using a machine or cable. 
• Corner wall stretch--while lying supine at the corner of a wall, raise one leg against the wall with the other rested on the floor. Now gradually straighten the elevated leg without raising the other leg off the floor.
• Single-leg bending reach--while standing, bend forward at the hip on one leg without curving the back and reach for the floor--this can also be done while holding a dumbbell or medicine ball.