Presuming all the above symptoms are not present, pain is more likely to be mechanical and caused by a sprain, strain or poor posture.

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1 Page 1 of 8 View this article online at: patient.info/health/back-pain-exercises Back Pain Exercises Back pain is very common but in most cases is not caused by a serious problem. Most cases of back pain resolve on their own within two weeks, and full recovery is made within four to six weeks. If you have severe back pain, if your back pain has not improved after two weeks, or if you are experiencing any of the following symptoms, you should contact your doctor: numbness in your genital area; pins and needles or numbness/altered sensation down your legs; altered walking patterns, ie losing balance and falling over; unexplained weight loss or gain; or night pain. Presuming all the above symptoms are not present, pain is more likely to be mechanical and caused by a sprain, strain or poor posture. The exercises outlined below are recommended to help relieve pain and increase your active range of movement. It is advised that you complete these exercises for 6-8 weeks to prevent the symptoms from returning. Should pain worsen or persist for longer than two weeks, please contact your doctor for a referral to a physiotherapist for a more detailed assessment. Once your symptoms are controlled it's worth getting into the habit of doing them once or twice a day to reduce the risk of symptoms coming back. The exercises below can also help with relieving the symptoms of sciatica. However there are many more specific exercises which are suitable for this condition. 1. Range of movement exercises a) Lower back rotations Relax arms away from the body - palms facing upwards. Place a pillow in between the knees. Roll both legs over in one direction, whilst turning the head in the opposite direction. Hold this position for 10 seconds and repeat eight times in each direction, twice daily. b) Single leg knee hugs

2 Page 2 of 8 Lie on your back and hug one knee into the chest. Keep the opposite leg either straight or bend it if this position aggravates your back pain. Hold this position for 10 seconds and repeat 10 times, twice daily. c) Double leg knee hugs Lie on your back and hug both knees into the chest. Gently rock side to side, back and forth and in a circular motion to massage out the lower back. Complete for 30 seconds, twice daily. d) Movement exercises in standing Lower back stretches (standing) Stand upright with your arms relaxed on to your upper thighs Start by bending at the hips to slide your hands down your thighs towards the floor as far as possible. Repeat this exercise in side flexion, by placing your hands by your sides and sliding the hand down the outer thigh in one direction. Try to keep the body upright as if in between two panes of glass. Repeat this exercise into extension, by placing your hands on your lower back for support. Arch the lower back slowly and carefully to increase the bend in the lower back. Stop immediately if you experience any pain. Hold all exercises for 10 seconds, before returning to the standing position. Repeat 10 times each.

3 Page 3 of 8 2. Back stretches a) Lower back rotation stretch Relax your arms away from the body - palms facing upwards. With your inner thighs touching, drop both legs over in one direction, rotating your head in the opposite direction. Increase the height of the upper knee by a few inches. Using the opposite hand to knee, apply a light pressure down on the upper knee to increase the stretch in the lower back. Hold the stretch for 20 seconds; repeat three times on each side, twice daily. b) Glute stretch Hook the right ankle over the left knee. Place your hands around the back of the left thigh. Pull your left leg in towards your chest, feeling a deep stretch in the right glute (buttock) muscle. Hold the stretch for 20 seconds; repeat three times on each side, twice daily. c) Camel/cat spinal stretch

4 Page 4 of 8 d) Worship pose Position yourself on all fours with the hands directly under the shoulders, and knees under hips. Complete the cat stretch by taking the eye gaze to the knees; grow tall through the spine and pull the stomach muscles inwards. Reverse this stretch into camel by taking the eye gaze to the fingertips; drop the mid and lower back towards the floor, squeezing the shoulder blades together and keeping the shoulders away from the ears. Repeat 20 times in each direction, keeping the movements slow and controlled. Starting position is on all fours. Drop the bottom towards the heels, resting your glutes on your heels if possible. Then reach your arms forward into the worship pose position. Hold the stretch for 20 seconds; repeat three times, twice daily. If you re unable to touch your bottom to the heels, open the knees wider and place a pillow between the calves and bottom.

5 Page 5 of 8 3. Strengthening lower back, glute and core muscles a) Deep core muscle activation (transversus abdominus) Firstly you need to find neutral spine by completing the following: Practise tilting your pelvis backwards and forwards to flatten the back into the floor (posterior tilt) and forward (anterior pelvic tilt). Repeat 10 times in each direction, keeping the movements slow and controlled. Find neutral spine, which is the point in the middle In neutral spine practise activating the lower core muscles, which are the deep abdominal muscles, located low down where your underwear line would normally sit. These muscles are active when you cough and laugh but are more difficult to activate consciously. A good visualisation is to draw the lower abdominal muscles in as if trying to fit into a tight pair of trousers. b) Single leg stretch Lie with lower back in imprint (flat to the floor). Lift one leg up at a time to tabletop position (90 position - a right angle at the knee and the hip). With both legs up, keep one leg completely still as the other leg drops to tap the toes on the floor. Slowly draw back to the start position. Continue this movement alternating legs. Complete 10 repetitions on each side, twice daily. To simplify this exercise, complete as above but with one leg up in tabletop, as the other leg is down - knee bent and foot on the floor. Complete 10 repetitions on one side; then repeat on the other, twice daily. c) Hundreds Lie flat on your back. Lift one leg at a time into double leg table top position (90 at the hips and knees). Lift the upper body off the floor into a crunch position; take the chin to the chest and hover the arms and hands a few inches from the floor. Pull the stomach muscles in and pump the arms up and down for 100 counts, while breathing in for five counts and breathing out for five. Be sure to keep the body in a crunch position, pulling the core in and moving the arms only. To simplify this exercise, place your feet on the floor and complete fewer repetitions. d) Reverse hundreds Lie on your stomach with your arms resting by the side of your body, palms facing up. Squeeze your shoulder blades together as if to squeeze water out of an imaginary sponge in between the shoulder blades. Lift the arms and hands a few inches from the floor, before lifting your upper body, pulling in the stomach muscles and squeezing the buttocks. Be sure to keep looking down to the floor, to prevent neck strain. Pump the arms up and down for 100 counts, breathing in for five counts and out for five. Keep squeezing the shoulder blades together, shoulders away from the ears and looking down to the floor. To simplify this exercise, keep your upper body down on the floor and complete fewer repetitions.

6 Page 6 of 8 e) Side work series - glute muscles to support the hips Clam exercise Side leg lift Lie on your side with your knees bent, and your ankles and knees touching. Try to create a small gap under your waist by drawing your stomach muscles in and activating the core muscles. While keeping your feet together, open your knees apart in a slow controlled movement before closing them together again. Complete 10 repetitions on each side, twice daily. Be careful to avoid your hips rolling and falling out of correct form. Keep the hips facing forward by pretending you have a full glass resting on your upper hip. To increase the difficulty of this exercise, raise your feet up on to an imaginary stool, keeping the knees on the floor, and repeat the clam exercise. Lie on your side with both legs straight. To avoid lower back strain, check that the lower back is not in extension by making sure you can see your toes when you look down. Try to create a small gap under your waist by drawing your stomach muscles in and activating the core muscles. Place one hand under your head for support and the other in front of you for balance. With the foot flexed, lift the upper leg away from the underneath and slowly lower back down. Complete 10 repetitions on each side, twice daily. To increase the difficulty of this exercise, raise both legs off the floor and repeat the side leg lift exercise. f) Glute max to support lower back Get on all fours, with your hands directly under your shoulders and knees under hips. Complete four cat/camel stretches - 2.c) above - before finding neutral spine. Neutral spine is the point in the middle of cat and camel where your back is flat and you can balance an imaginary tray of drinks on your lower back. Pull your core and stomach muscles in before shifting your body weight on to your left side and lifting your right leg up to 90 at the knee and hip, if able. With your right foot flexed, pump the leg up towards the ceiling, leading with your right heel. Lift a few inches up and down with the leg to complete the donkey kick exercise. Complete 20 repetitions on each leg, twice daily. 4. Postural exercises a) Mid spine and chest opening Roll up a small hand towel into a sausage shape. Lay on top of the towel, positioning it in between the shoulder blades, vertically along the spine. Support the head and neck on a thin pillow. Bend your knees and allow the shoulder blades to fall towards the floor as your chest muscles relax and open. Keep your palms facing upwards. Take deep breaths and hold here for 1-5 mins as the muscles and joints relax. To progress this exercise, take the arms into the stop position, shoulders and elbows at 90 with the palms facing upwards, and repeat postural exercise. b) Shoulder blade setting Lie on your stomach with your arms by the side of your body, palms facing upwards. Squeeze your shoulder blades together as if to squeeze water out of an imaginary sponge in between the shoulder blades. Lift the arm and hands a few inches from the floor. Make sure your shoulders stay away from the ears as you hold this position for seconds, depending on ability. To progress this exercise, lift upper body and complete the 'Reverse hundreds' exercise, as shown in exercise 3d) above. c) Wall postural setting Stand with your back to the wall with four points of contact: heels, bottom, hands and head. Start by squeezing your shoulder blades together, pulling your core muscles in and tucking the chin to the chest, as if holding a tennis ball in the neck. Hold this position for 10 seconds. Progress this exercise by lifting the arms into the stop position, shoulders and elbows at 90 with the palms facing away from the wall; slowly move the arms up the wall for the fingertips to meet above the head. As you feel the shoulders and shoulder blades lose contact with the wall, stop and hold for 10 seconds. Repeat this exercise 10 times. Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.

7 Page 7 of 8 Author: Lilly Sabri Peer Reviewer: Charlene O'Leary Document ID: (v2) Last Checked: 25/09/2015 Next Review: 24/09/2018 View this article online at: patient.info/health/back-pain-exercises Discuss Back Pain Exercises and find more trusted resources at Patient. Patient Platform Limited - All rights reserved.

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