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WARNING DISCLAIMER!" This report is for information purposes only.!" This report is not intended to diagnose the cause of back pain and you should consult with your doctor when you are suffering from any painful condition.!" If you are currently experiencing back pain, especially if the pain extends into your leg or buttock or if the pain is increasing, immediately see a Chiropractor or your Primary Care Physician.!" You should always be examined by a doctor to determine what is causing your pain.!" Before beginning any exercise program you should be examined by a doctor to ensure that it is safe for you to participate in an exercise program. 2
Those who have not the time for bodily exercise will sooner or later have to find the time for illness. -Edward Stanley Congratulations on taking the first step to beating back pain reading this report. The next step is the hardest for most people: following thru with the exercise recommendations, but I am confident that you can do it. Allow me to ask you a few questions:!" Do you suffer with back pain that goes away only to come back in a month or so?!" Have you had you back pain treated only to have it come back again?!" Are you tired of painkillers and muscle relaxants that make you feel like you are walking through a fog all day?!" Are you sick and tired of being sick and tired?!" Do you want to come home from work and enjoy your time at home without pain?!" Have you seen numerous doctors for your back pain with no lasting relief? If you answered YES to any of these questions then this report is for you. Back pain is the leading cause of missed work and disability in the U.S. Current estimates are that 4 out of 5 people will suffer from back pain during their lifetime and if you re reading this then you re probably either one of those four or else you re trying to avoid being one of them. 3
Now to what you all are reading this report to find out: The Top 10 Exercises for Beating Back Pain 1. Hamstrings Stretching 2. Psoas Stretching 3. Posterior Pelvic Tilt 4. Leg Raises 5. Bird Dog 6. Bridges 7. Back extensions 8. Squats 9. Gym Ball Marching 10. Single leg balance Now that you know what the exercises are I ll help you find out which ones you need and then how to do them. 4
A little background on the exercises and how they are organized. This is by no means an exhaustive list of exercises for beating back pain. These exercises and stretches address the most common problem areas that I see in my office. If you would like to pinpoint what is causing your back pain and target those causes please contact me. Research on back pain and exercise therapy continues to find newer and better approaches to treating back pain just 20 years ago bed rest was the most frequent recommendation and now we know that staying in bed for to long with a bad back only makes you feel worse and prolongs your recovery. The exercises in this report are broken down into 3 main areas: 1) Stretching -Flexibility, especially muscles of the low back and hip areas (exercises #1 & 2) Inflexible or tight muscles will limit your movement and other areas will have to make up for it putting that area under higher stress. Tight muscles will inhibit other muscles, when your hip flexors are overly tight then they can inhibit your hamstrings putting greater demand on your lower back muscles. 2) Strength and muscular endurance -Core muscle strength and endurance (exercises #3-8) For your low back to be stable your core (low back, abdominal and hip) muscles must be strong and conditioned. 3) Balance -Balance (exercises #9 &10) Balance is a key factor in preventing back pain as well as recovering from a bout of back pain. If you have poor balance then you are much more likely to injure your back in the future. Balance also represents the coordination necessary to use your core muscles to stabilize your back (yes you can have great abs and low back muscles and still have poor stability if can t coordinate these muscles). Most of the exercises begin with a test so you can determine if you need to do it, these tests also allow you to re-test yourself after you have been performing the exercises so you can see your progress. 5
Visual Guide to Muscles Psoas Transverse Abdominus Lower Abs Low back Spinal Erectors Glutes Hamstrings This is a general diagram to give you an idea of where the muscles that I refer to in this report are located. Of special note the Psoas muscle attaches to the inside of the thigh and runs deep in the abdomen (the reason I outlined it with a dotted line) to attach along the spine. Now on to the good stuff, the exercises. 6
Flexibility/Stretching Exercises (#1 & 2) 7
1. Stretching hamstrings a. Test Lie on your back with your legs out straight in front of you. Raise your right leg up keeping the knee straight, as high as you can (if you want you can have a partner help you). You should be able to get to where your leg forms a 90º angle to your body, if you can t reach that point then you have some work to do. b. Why - Hamstring tightness is a common problem due to the prolonged sitting many of us must do at work every day. When the hamstrings are tight they can pull your pelvis (your hips) out of alignment and place greater stress on the muscles and joints of your low back. c. How it s done - Hamstring Stretch Starting position: Lie on your back with both legs stretched out in front of you. Execution: Bend one knee up to your chest and wrap a towel over the bottom of your foot. Straighten your leg until you feel a stretch in the back of your leg. Hold for 10 secs. Repeat 3 times each side performing an extra set on the side that shows the greatest hamstring tightness. 8
2. Stretching psoas a. Test lie on your back with your legs stretched out in front of you. Pull your left knee up to your chest and while holding it there press the back of your right knee down to the floor. If your right psoas is very tight you will not be able to bring your right leg to the floor. If your right psoas is moderately tight you will feel a stretch in the front of your right thigh or groin area. b. Why - When the psoas muscle is short and tight it pulls the low back forward c. How it s done - Psoas Stretch Starting position: Lunge position stride one leg out and bring the knee of your rear leg down to the ground. Execution: Maintain a tall position, don t lean your upper body forward and keep your hips tucked in. Rock your hips forward until you feel a stretch in the front of your rear leg (the area in the oval in picture below). Hold for 10 secs. Repeat 3 times each side performing an extra set on the side that shows the greatest hamstring tightness. 9
Strength Exercises (#3, 4, 5, 6, 7 & 8) 10
3. Posterior Pelvic Tilt with Abdominal Hollowing a. Test N/A proper performance of this exercise is essential for the performance of most of the remainder of the exercises in this report. b. Why - The Posterior Pelvic Tilt is an essential movement for stabilizing your low back and many exercises for your low back require that you can hold a Posterior Pelvic Tilt to perform them. Abdominal hollowing, or pulling your gut in activates a very important muscle for stabilizing your back the Transverse Abdominus. The Transverse Abdominus muscle acts like a girdle around your midsection sort of like your own built support belt. c. How it s done. PPT exercise Starting position: Lying on your back with your hips and knees bent about 45º, with your knees and feet about shoulder width apart. Execution: Rock your hips back while pulling in your abdomen, your low back should press against the floor hold for a second then roll your hips forward lifting your back off the floor. This may sound easier than it is when you first try it. To help you learn this exercise I suggest placing your hand under your lower back so that you are able to feel your back press into the floor. To assist in learning to pull in your belly I use a weighted ball placed on the belly button to provide feedback as well as act a reminder (if you start to push out the ball can roll off). The goal of this exercise is to help you be more aware of the position of your low back and to find a neutral position for your spine. As you move your hips forward and back notice how far back your hips go as well as how far forward the spot between these two is your neutral position which is also the most comfortable. 11
4. Leg raises (lower abdominal strength) a. Test - Testing for strength of this muscle involves lying on your back with your legs extended above you as in the picture below. It is very important that you lower back is kept flat against the floor during this test you can monitor your lower back by placing one or both of your hands in the small of your back. Slowly lower your legs to the ground keeping your knees straight note how low you can go before your back starts to arch off the floor. Men with good lower abdominal control can lower their legs all the way to the ground, women to about 6 above the ground. If you are unable to do this then you need more work on your lower abdominal muscles. b. Why Frequently people with low back pain have either weak lower abdominals or poor coordination of the abdominals with the surrounding muscles both of which lead to poor stability in the low back. c. How it s done - Leg Raises Starting position: Begin by lying on your back in the same position as the Pelvic Tilt exercise above. Adjust your hips so that you are in your neutral position (I told you you d need the Pelvic Tilt exercise for other exercises), and pull your belly in (use a ball, like in the Pelvic Tilt exercise, if you want). Execution: Keeping the back in neutral and your belly pulled in bring your knees up to just past your hips and then lower your feet back to the ground. The straighter your knee the more difficult this exercise. 12
5. Bird Dog a. Test none needed, this is an exercise that should be done by everyone, at least as part of a warm-up. b. Why - This exercise focuses on working some of the smaller stabilizer muscles in your low back. Many studies have found weakness of these muscles in people suffering from chronic or recurring low back pain. c. How it s done. Bird Dog Starting position: Begin on your hands and knees with your belly pulled in toward your spine. Execution: Raise your left arm and right leg off the floor (your arm should end up alongside your ear). Repeat with your other arm and leg this is one repetition. 13
6. Bridges a. Test no home test (I test for activation of this muscle in the office but the procedure is to involved for this report). Almost everyone can benefit from doing this exercise especially those who have tight psoas muscles. b. The focus of bridges is to work the gluteal (butt) muscles, these muscles are frequently weak in people who have tight psoas muscles (see exercise #2). c. How its done Bridges Starting position: Begin by lying on your back in the same position as the Pelvic Tilt exercise above. Adjust your hips so that you are in your neutral position (I told you you d need the Pelvic Tilt exercise for other exercises), and pull your belly in. Execution: 3 Lift your hips off the floor so that your body makes a straight line from your knees to your shoulders. 14
7. Back extensions a. Test testing for strength and endurance of the back extensors is beyond the scope of this article and should be supervised by a professional to ensure safety. b. Why Low back strength and endurance have repeatedly been found in people with low back problems and people with chronic back pain. This exercise concentrates on the spinal erectors. c. How its done - Back Extensions Starting position: Kneel in front of a Gymball and drape your body over it, your back should be rounded. Execution: Using your low back muscles lift your chest off the ball. Your body should make a straight line from your butt to your shoulders. Hold the top position for a second or two then lower down and repeat. 15
8. Squats a. Test Place a piece of tape on the floor one-foot length (your foot) from a wall. Stand with your feet shoulder width apart with your toes touching the tape and your feet pointing forward. Now squat down as low as you can.!" Your head should not touch the wall!" Your heels should not rise from the floor!" Your feet should remain close to parallel.!" Most importantly you should have no pain performing the movement. If you experience pain with this movement it is wise to be checked by your doctor. If you are unable to perform this movement then we have found an area of weakness that you will need to work on. b. Why Squatting is a movement that we all perform many times each and every day, whether to sit down, to pick something up off the floor or to go to the bathroom. So if we do it so much why do we need to train it simple most of us do it wrong. Have you ever seen someone lean forward and then push themselves up out of a chair, if they need to do that to get out of a chair than they have some sort of weakness either in low back or legs. 16
c. How its done - Squats Starting position: Stand in front of a chair with your feet shoulder width apart. Your hands may be on your waist, your head or you may hold a pole in front of you for balance if you need it. Execution: Keeping your stomach tight and your belly pulled in, slowly squat down until your butt touches the chair and then raise your self back to the starting position. 17
Balance Exercises (#9 & 10) 18
9. Gym ball marching a. Test N/A b. Why This exercise works your balance and coordination in a sitting position, a position most of us spend way to much time in. To maintain your balance when you do this exercise your body is forced to use your hip, low back and abdominal muscles (your core) in a coordinated fashion c. How its done - Gym Ball Marching Starting position: Sit on a ball (use a ball that is big enough to sit with your hips and knees at about 90-100 - for most of us that means a 65cm ball). Adjust your hips to find a neutral position and pull your belly in (another exercise that you need Posterior Pelvic Tilt for). Execution: Lift your left foot off the floor, it doesn t have to be high (sounds simple I know but the first time you try it you ll be surprised). Place your left foot back on the floor and then left your right foot and keep marching. If this is too hard you can try just lifting your heel off the floor and keeping your toe down 19
10. Single leg balance a. Test This test is pretty much self-explanatory, stand on one leg looking straight ahead and time yourself. Stop timing if you put your other foot down or move your support leg (no hopping around). You should be able to comfortable stand on one leg for at least 30 seconds (ideally longer). For the sake of safety I always have people do this test near a wall so they can catch themselves if they start to fall. b. Why Every step we take requires us to balance on one foot (even if it s only or an instant. If we have poor balance any misstep can lead to an injury, sometimes just a sprained ankle or at the extreme you could even break a bone if you go so far as to fall. c. How its done - Single Leg Balance Starting position: Stand facing a wall or chair (so you can steady yourself if you need to). Your belly should be pulled in and your butt tight while performing the exercise (yes the Posterior Pelvic Tilt exercise again). Execution: Lift one foot a few inches from the ground and hold it there while maintaining your balance. 20
Testing Now that you know the exercises and the tests its time to test yourself to determine which exercises will benefit you the most in beating your back pain. Use the following summary sheet that you can use to grade yourself and place an x in the Work on section of the table for any tests that you are unable to pass. Self Test Summary Sheet Test Result Hamstrings Left Right 90 yes/no 90 yes/no Psoas Left Right Leg down Leg down yes/no yes/no Posterior Pelvic Tilt NA Leg Raise Men 180 Women 170 yes/no Bird Dog NA Bridges NA Back Extension NA Squat Head, heels, feet yes/no Gym Ball March NA Single Leg Balance Left Right 30sec yes/no 30sec yes/no Work On Congratulations now that you have read this report and graded yourself on the exercises you now know what you need to do and you re ready for the final step - following through and doing the exercises that will help you beat your back pain. If you wish a comprehensive evaluation of your back pain call (815-267-3707) or email me (meehantp@netzero.net). Your Workout Insert worksheet with weekly workout 21
Strength and balance exercises should be performed 3 times per week while flexibility exercises should be performed up to 3 times per day. Your stretching exercises should be performed before strength and balance exercises since tight muscles can inhibit the weak muscles that you are working on. Cautions!" You should never feel pain while performing any of these exercises if you experience pain while performing any of these exercises you should see your Chiropractor or Primary Care Physician.!" You should not have more than general muscle soreness the day or two following exercise if your pain increases the days following exercises you should see your Chiropractor or Primary Care Physician. Feel free to contact me if you have any questions regarding the information in this report or if you would want to have 22