I have covered the rationale and aims of performing routine exercises for the spinal joints in a previous article, now I will move on to the performance of the spinal exercises themselves. Patients should follow the exercise instructions and perform the exercises smoothly with even timing through the range, holding for a short period at the end of the joint ranges. A moderate degree of pain may well be acceptable as long as it is not too severe and does not last long after the performance of the exercise. Doing the exercises daily is key to managing a back pain problem.
Leg flexion to the chest In supine hold on to your knee and pull your thigh up to your chest, keeping it at the full extent for a few seconds, with the other leg remaining flat down. The lumbar spinal joints, ligaments and muscles, hip and sacroiliac joints are mobilised during this manoeuvre.
Pulling both knees to the chest Lying down, hold on to both knees and pull them up as far as you can or until the thighs hit the chest. Stretching the sacroiliac joints is less effective with this exercise but it places increased stretching force on the lumbar spine.
The Child Pose Stretch Kneeling forward in a crouch so the knees are fully bent then lean your body forward so the abdomen lies forward on the thighs and stretches the back. The bodyweight increases the stretch on the spine.
Squatting down This movement involves a greater degree of force than previous ones and can be useful to counteract the effects of sitting for too long. Extension movements are often recommended to restore the lumbar curve after sitting too long but flexion can be just as helpful in relieving discomfort.
Squatting down fully into the deep squat position is the aim of this movement, with a raise used under the heel if balance is difficult to maintain.
Stretching out at the bottom of the movement, the back is kept in this position for half a minute or so at a time.
Lying Prone If lumbar extension, the ability to arch the spine, is restricted then the first movement might be to lie the person prone as an initial exercise. This places the lumbar discs and joints in a significant degree of extension and can be the first step if extension is very limited.
Prone Lying Leaning on Elbows Once the patient can maintain prone lying easily they can progress to leaning up on the forearms and looking forwards. This pushes the lumbar spinal structures into further extension but can be stressful for the back so should be limited to short periods of time.
Repeated Extension in Prone McKenzie technique is aimed at disc related problems such as derangement and dysfunction and is thought to affect the disc mechanics. Lying on the front in the press up position the patient straightens the arms and allows the back to assume a highly extended position by keeping their hips down on the surface.
Being a strong passive movement into extension this movement can be aggravating to a back pain problem so needs careful testing to ensure the correct response before prescription.
Lumbar Rotations " Knee Rolling Lying on the back, the knees are bent and both knees are rolled to one side and then another, allowing the movement to go as far as it comfortably can. Although there is little rotation in the lumbar joints some of the spinal structures can be tight into rotation.
Lumbar Rotations " Manipulation Stretch Lying on the back, the hip is bent up so the person can hold the knee with the opposite hand. Leaving the shoulders flat on the bed, the knee is pulled across the body by the opposite hand, stretching the low back. The knee can be pulled right over for a large lumbar stretch but preparatory work would be wise for most people. - 14130
Leg flexion to the chest In supine hold on to your knee and pull your thigh up to your chest, keeping it at the full extent for a few seconds, with the other leg remaining flat down. The lumbar spinal joints, ligaments and muscles, hip and sacroiliac joints are mobilised during this manoeuvre.
Pulling both knees to the chest Lying down, hold on to both knees and pull them up as far as you can or until the thighs hit the chest. Stretching the sacroiliac joints is less effective with this exercise but it places increased stretching force on the lumbar spine.
The Child Pose Stretch Kneeling forward in a crouch so the knees are fully bent then lean your body forward so the abdomen lies forward on the thighs and stretches the back. The bodyweight increases the stretch on the spine.
Squatting down This movement involves a greater degree of force than previous ones and can be useful to counteract the effects of sitting for too long. Extension movements are often recommended to restore the lumbar curve after sitting too long but flexion can be just as helpful in relieving discomfort.
Squatting down fully into the deep squat position is the aim of this movement, with a raise used under the heel if balance is difficult to maintain.
Stretching out at the bottom of the movement, the back is kept in this position for half a minute or so at a time.
Lying Prone If lumbar extension, the ability to arch the spine, is restricted then the first movement might be to lie the person prone as an initial exercise. This places the lumbar discs and joints in a significant degree of extension and can be the first step if extension is very limited.
Prone Lying Leaning on Elbows Once the patient can maintain prone lying easily they can progress to leaning up on the forearms and looking forwards. This pushes the lumbar spinal structures into further extension but can be stressful for the back so should be limited to short periods of time.
Repeated Extension in Prone McKenzie technique is aimed at disc related problems such as derangement and dysfunction and is thought to affect the disc mechanics. Lying on the front in the press up position the patient straightens the arms and allows the back to assume a highly extended position by keeping their hips down on the surface.
Being a strong passive movement into extension this movement can be aggravating to a back pain problem so needs careful testing to ensure the correct response before prescription.
Lumbar Rotations " Knee Rolling Lying on the back, the knees are bent and both knees are rolled to one side and then another, allowing the movement to go as far as it comfortably can. Although there is little rotation in the lumbar joints some of the spinal structures can be tight into rotation.
Lumbar Rotations " Manipulation Stretch Lying on the back, the hip is bent up so the person can hold the knee with the opposite hand. Leaving the shoulders flat on the bed, the knee is pulled across the body by the opposite hand, stretching the low back. The knee can be pulled right over for a large lumbar stretch but preparatory work would be wise for most people. - 14130
About the Author:
Jonathan Blood Smyth is a Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for Physiotherapists in Windsor.
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