The North American Spine Society had developed a program consisting of exercises to strengthen the core muscles of the abdominals and lower back. Recommendations include slowly performing each exercise ten to fifteen times, twice daily. Since strengthening the abdominal muscles serves to protect the lower back, the following exercises are recommended: abdominal crunches, single straight-leg raises and abdominal squeezes. Abdominal crunches are done by lying supine with knees slightly bent, tucking the chin, lifting the shoulders off the floor, and stretching the fingertips toward the knees. Single straight-leg raises are done by lying supine with one knee bent, foot flat on the floor while the other leg is straight and slightly elevated. Abdominal squeezes are done by simultaneously pulling the abdominals inward while exhaling. Additional exercises to strengthen the lower back include side leg raises, supine single-leg bent-knee pulls and hamstring stretches.
Daul, R.J. (2005) had written an article, peer-reviewed by medical professionals, which provides exercises to help stretch the piriformis, psoas major and hamstring muscles. These muscles impact the health of the lower back because of their origin of attachment at the sacrum, lumbar vertebrae and pelvis. Hypertonicity in any one of these muscles may cause lower back pain. The piriformis stretch is done by lying supine, crossing one leg over the other and gently pulling the knee toward the chest until a stretch is felt in the gluteals. Tightness of the psoas major muscle may lessen lower back mobility and cause pain after standing for extended periods of time. The psoas major stretch is done by kneeling on one knee, rotating the kneeling leg outward, and leaning forward until a stretch is felt in the front of the kneeling hip. The hamstring stretch is done by lying supine, lifting one leg behind the knee, and gently pulling the leg while straightening it. Each of these stretches should be held for thirty seconds and repeated several times.
There is an interesting dichotomy of pain being a restriction to exercise and yet physical activity is the best thing one can do to lessen pain and keep the back healthy. The muscles of the back need to be conditioned by exercise in order to remain functional and pain free. This is why a sedentary lifestyle is conducive to the chronic lower back pain felt by many sufferers. Stretching, aerobics and strength training have been suggested as a means to maintain lower back health. Recommended stretches include the supine single bent-knee stretch in which one leg at a time is gently pulled toward the chest and the cat-camel stretch in which one is on all fours, rounds the back upon inhalation and arches the back upon exhalation. Each of these stretches should be held for at least fifteen seconds and performed several times daily. Low-impact aerobic exercises (i.e., walking, biking and swimming) have been recommended for those with back problems. Those people who are beginning an aerobic exercise routine should start slowly at a 15-minute duration and progress about five minutes per session each week. Shoes should be replaced every six months or 300 to 400 miles, whichever comes first. Strength training of the core muscles (i.e., abdominals, hips and thighs) serves to maintain support for the lower back. Recommended exercises include prone single-leg raises, abdominal roll-ups and standing hip extensions. Each of these exercise should be performed for 12 to 15 repetitions for two sets.
Regular exercise can relieve pain much faster than not doing exercise and strength and flexibility training can reduce the chance of acute lower back pain. Strength and flexibility exercises support, stabilize and protect the lower back from strain. Good posture also minimizes strain during aerobic or resistance training. Recommended strength and stretching exercises include supine curl-ups, arm and opposing leg extensions while on all fours, sitting hamstring stretches, and supine knee-to-chest stretches. Bed rest, narcotic analgesic drugs and surgery have been replaced by exercise as the preferred method of treating lower back pain. Inactivity leads to a loss of strength and conditioning and actually promotes dysfunction, making injury more likely to occur. In addition, immobility may actually prolong pain because of a lack of lubricating spinal fluid to keep the spine hydrated. Exercise provides several advantages to managing lower back pain: treatment of acute pain, reduction of chronic pain and prevention of re-injury. The mechanism of reducing pain via exercise has been attributed to the release of hormones from the brain called endorphins. Flexion and extension exercises are recommended to provide balanced muscular strength of the lower back. Aerobic exercise, particularly walking and swimming, has been recommended for individuals with lower back pain. Physical or occupational therapy may be prescribed for some people who need guidance on how to lift, sit and stand without exacerbating pain.
Designing an exercise program may appear daunting because each individual is unique in terms of the etiology of lower back pain. Generally, low-impact aerobic, core strength and flexibility exercises performed three to five days per week for 20 to 40 minutes per session is recommended for reducing lower back pain and increasing autonomy.
Brian Danley, CFT
"Motivation is what gets you started. Habit is what keeps you going."