Understanding back pain 2- exercises and stretches for back pain suffere Dr James Tang, MBA, BDS, LDS RCS General Dental Practitioner, Level 3 Personal Trainer (REP registration no R1045463), Sports Nutritionist & Level 3 Sports Massage Therapist, with special interest in postural dysfunction and lower back problems There are many exercises and stretches that you can perform to reverse the problems caused by prolonged sitting, but for simplicity, only those that you can easily practise at home or at work are being introduced in this article. There are numerous other beneficial exercises, but please be aware it is vital to use the correct technique whilst carrying out these exercises and stretches in order to avoid injury. There are many online videos that can help you with your technique. However, you are strongly advised to engage an exercise professional who can both motivate you and help you to implement the correct techniques. For example, many people perform the plank exercise incorrectly; instead of having a straight torso profile from head to toe, they have their bottoms up, thus creating a curved/concave back (excessive lumbar extension and hip flexion), with the abdominals in a lengthened position and shortened lumbar erectors (erector spinae in the lumbar region). This position compresses some of the spinal discs, thereby increasing the risk of injury. Stretches Before beginning, please be warned that muscles should only be stretched once they have been thoroughly warmed up. There are a number of different types of stretches: Dynamic stretches (usually performed prior to exercises as part of the warm-up process) for the purpose of improving flexibility, this type of stretch will not be considered in this article. Proprioceptive neuromuscular facilitation (PNF) a type of stretch carried out during cool-down after an exercise session, usually with an experienced practitioner. Static stretches (can be categorised as developmental and maintenance) these are the stretches that are advocated to improve flexibility. Developmental stretches by holding a stretch for a period of time, the muscle spindles become desensitised which induces relaxation of the target muscle, allowing the stretch to be taken further. Stretch the muscle to a mild point of tension but without pain. If your muscle is tight, it may take a couple of minutes for the tension to be alleviated. When the tension subsides, take the stretch further; hold it until the tension goes and then take the stretch further once more. These stretches are especially important for the following muscle groups: Calf Hamstring Adductor Hip flexor Pectoral
Maintenance stretches The technique used is similar to developmental stretches but you do not need to take the stretch further after the tension subsides. These are particularly suitable for the following muscle groups: Quadriceps Glute Trapezius Latissimus dorsi Deltoid Triceps Examples of developmental stretches 1)Hamstring stretches Developmental stretches are particularly beneficial for the hamstrings. You can stand facing a chair and put your leg up on the seat, keeping it straight with your back upright. Bend your torso slightly forward until you feel the tension in the hamstring. Alternatively, lie on your back, raise one leg off the floor and bring it towards your chest. Keeping your leg straight, place both hands behind it and pull it in slightly closer to your chest until you feel a little tension. Hold this position until the tension subsides and then take the stretch further one more time. Repeat the stretch with the opposite leg. 2) Hip flexor stretches Kneel with one knee on the floor and your other foot in front of you with the knee bent at a 90- degree angle. Push your hip forward and keep your back upright. Hold until the tension alleviates; then, take the stretch further once more until the tension subsides. 3) Piriformis stretches Stretching exercises for the piriformis muscle and other abductors of the hip should be performed in addition to adductor muscle stretches. Lie on your back with both knees bent at 90 degrees. The ankle of the leg to be stretched should be placed on the front of your other knee. Using your hands, the thigh of this leg is then pulled in towards your chest. Hold this position for 20 30 seconds or until the tension goes. Then, take the stretch further until the tension subsides once again.
Exercises to activate your deeper core muscles For your safety, you should not perform any exercises, either cardio or resistance training, until you are able to consciously activate your transversus abdominis (TvA); whenever possible, you need to tighten your core and keep your back upright (maintain a neutral spine) so that your spine is protected during these explosive movements. 1) Activation of the transversus abdominis (TvA) When the TvA is contracted, consciously or subconsciously, the other muscles of the inner unit contract immediately afterwards. Due to years of misuse, poor posture or weakness, contraction of the stabilising muscles of the inner core unit can be very difficult. This can result in a lack of subconscious activation of these muscles. Sitting on a stable surface, such as a chair, for a prolonged period of time switches off these stabilisation muscles as there is no need for them to stabilise the body whilst sitting. There are exercises which are designed to improve the subconscious activation of the inner unit muscles (see below). Research has suggested that only 30 per cent of the maximum contraction capability of the inner unit muscles is required to create sufficient intra-abdominal pressure to stabilise the spine. For the contraction of the stabilising muscles to become autonomous, it is essential to perform conscious practice of muscle contraction on a regular basis. The TvA is one of the muscles responsible for the forced expiration of air when we cough. It is also one of the first muscles to fire when we move and change direction whilst walking or running. The TvA provides a stable base within the centre of the body for activities that are more distal, such as heavy lifting. With this in mind, it would be useful to be able to pinpoint the TvA and consciously activate it. To activate the transversus abdominis lie on your back with your knees bent at 90 degrees and your feet flat on the floor. Relax and try not to flatten your spine against the floor, but rather maintain a normal lumbar curvature. Find a position two inches below the navel and two inches to either side. Press lightly on each side using the first two fingers of your hands (this is the location of the transversus abdominis) then cough. You should be able to feel the contraction under your fingers as the TvA fires.
Breathe out completely, try to draw your navel in as far as possible and tilt your pelvis up very slightly. You should feel the contraction of the TvA. Start breathing normally whilst maintaining the contraction of the TvA. The aim of the exercise is try to replicate the contraction felt whilst coughing but without actually coughing. Once you can contract the transversus abdominis, perform the same actionwithout holding your breath or contracting the rectus abdominis. 2) Glute bridge This is probably one of the most useful exercises ever, but all too often its benefit is negated by poor technique; it is important to remember that you should not use your lower back or your hamstrings to perform this exercise. Lie on the floor on your back. Bend your knees at a 90-degree angle and place your feet flat on the floor. Contract or squeeze your glutes (you should be able to feel them tightening) to lift your hips and thighs off the floor to form a straight line between your knees and shoulders. Keep your back straight at all times; maintain a neutral spine and tighten your core. Once this has become easier, you can bridge with just one leg, keeping your other leg straight this is much more challenging as this introduces unilateral/asymmetrical activation of the glutes. 3) Bodyweight squat The bodyweight squat is an excellent exercise to work the majority of the leg muscles, especially the quadriceps and the glutes. It is a primal movement pattern which means that it is something innate and necessary for human movement, as opposed to fixed exercise machines that one can see in many gyms.
To perform a bodyweight squat stand with your feet at shoulder-width apart and toes pointing forward. Keep your back straight as you initiate movement at your hips. Push your buttocks out behind you and bend your knees (do not let your knees move in front of your toes). Start with shallow squats and increase gradually. 4) Bodyweight lunges To perform a bodyweight lunge step forward with one foot in a long stride. Make sure your feet are in line and pointing straight forward. Keep your back upright as you slowly bend and lower your back knee towards the floor, raising your heel. At the same time, bend your front knee whilst ensuring that it does not go beyond your toes. Do not let your back knee touch the floor before returning to the starting position. 5) Activation of your Glute Medius If you have poor pelvic stability, the rest of the body is drastically affected. Spinal alignment, leg length, posture, shoulder mechanics, knee stability (the list goes on). Most training these days focus merely in the anterior and posterior support for the pelvis. Just as important, however, is lateral stabilisation because a lack of lateral stability is being found to be directly related to knee and back problems.
Lateral stabilisation is required when the pelvis is tilted to the left or right hand side lateral movement. This happens when you stand on one leg and whenever we walk or run. The primary stabilising muscle for this is the glute medius, however, we can also recruit the tensor fasciae latae (TFL) muscle (both of these are abductor muscles), which is attached to the iliotibial tract/band (ITB) down to the lateral side of the leg to the knee. If the glute medius is not performing its job properly, the action will be compensated by increased contraction of the TFL, through the ITB causing excessive lateral pull on the patella, resulting in mal-alignment and finally knee pain. The largest of the three muscles, your gluteus maximus, has the primary role of hip extension (together with the hamstrings). As your hip is not fixed against anything solid, the glutes need something to work against in order to create stability. This is the role of the abdominal muscles, such as the TvA. You should be able to feel your glutes working during lunges, squats, dead lifts, polymeric and almost any other large body movement you are performing. If you are not feeling those muscles working, there is a good chance that they are not activated properly. During any movement, it is necessary to enforce the neural connection between your brain and the hip stabilisers. The most effective technique for improvement of lateral stabilisation is unilateral training. i.e. performing each exercise on one side of the body instead of both sides at the same time e.g. one leg squat. During unilateral training, it is important that they body remain straight in the vertical direction and that the hips shoulder and knees all remain in the proper alignment, with TvA engaged and back straight. Hyperkyphosis Exercises Kyphosis is a common condition characterised by an excessive curvature of the upper portion of the spine. The long term effects of kyphosis on the body include impingement of the shoulder rotators and chronic tension in the back and shoulder muscles. 1) Prone extension Begin by lying face down on the floor with both arms down by your side and palms facing up. Place both feet together. Slowly lift your chest off the floor as high as you comfortably can without hyperextending your back. Contracting your scapulars together, raise both arms off the floor. Ensure that your head is in alignment with the rest of your body. Hold this position for 10 to 12 seconds.
2) Reverse fly To perform this exercise, you will need a set of lightweight dumbbells. Sit on the end of a bench with your back straight and your abdominal muscles tight. Lean forward, bringing your chest over your knees. Stretch your arms out and lift them up to your shoulder level, squeezing the shoulder blades together. Lower your arms down on either side of your body. When performing this exercise, make sure that your elbows are slightly bent and do not raise your arms higher than shoulder level. 3) Dumbbell shrug For this exercise, you will need a set of moderate dumbbells. Stand with both feet hip-width apart and your shoulders down and back. Slowly raise and lower your shoulders in a shrugging motion. Conclusion Although setting the body in motion can help to lessen back pain over time, many people choose to stay inactive during a period of lower back pain because of the discomfort. This is in contrast to some of the epidemiological evidence. It is recommended that bed rest should be avoided and patients should be as active as possible, including going to work. This is because inactivity allows the joints and muscles to stiffen, which can make normal activities difficult. Even if back pain hinders your ability to perform mild exercises, it is important to move as much as possible, even if it is just walking the dog or cleaning the house. Please note that the above is not an exhaustive list of stretches and exercises that will alleviate your back problems, you are therefore strongly advised to consult your personal trainer to devise the most appropriate stretches and exercises to suit your own personal circumstances. Prevention is better than cure. It is advisable that you strengthen your core and avoid sitting for a prolonged period of time. Standing up periodically will help. When you sit down, do so with an upright posture and neutral spine because sitting with an excessive lumbar extension can cause anterior pelvic tilt whereas sitting with an excessive lumbar flexion can cause posterior pelvic tilt. Both of these positions can create muscular imbalance predisposing to back pain.
Although the focus of this article is on educating the reader about the anatomy of the torso and the deeper muscles, many researchers of back pain recommend exercises that are a little wider in scope than core training. These include functional and flexibility training, aerobic exercises to strength your heart and lungs, as well as to control any weight gain, resistance training, as mentioned earlier, and squats and lunges etc. These activities improve general flexibility, thus ensuring there is a good range of movement around the joints.